RT Journal Article SR Electronic T1 A case report of a pneumothorax caused by aggressive use of an incentive spirometer in a patient with emphysema JF Respiratory Care FD American Association for Respiratory Care SP respcare.02130 DO 10.4187/respcare.02130 A1 Jon-Emile S. Kenny A1 Ware G. Kuschner YR 2012 UL http://rc.rcjournal.com/content/early/2012/12/04/respcare.02130.abstract AB A 68 year old man presented to the Emergency Department with a small pneumothorax following aggressive use of an incentive spirometer. The patient had a baseline chest radiograph consistent with emphysema. He was initially treated with oxygen in the Emergency Department with resolution of his symptoms. The pneumothorax resolved spontaneously over a period of three days. The development of the pneumothorax was likely due to the patient’s repeated forceful inspiratory maneuvers in the setting of emphysema and lung hyperinflation. Inspiratory resistive breathing can cause large negative swings in intrathoracic pressure which may result in mechanical stress of lung tissue. This is the first report of a secondary pneumothorax associated with use of an incentive spirometer. Patients with bullous emphysema should be counseled to avoid frequent high intensity maneuvers with an incentive spirometer if the potential benefits of the procedure are marginal.