When pneumomediastinum occurs in a patient with an identifiable underlying cause — such as pre-existing asthma or chronic obstructive pulmonary disease (COPD) — it is classified as secondary pneumomediastinum. Respiratory diseases such as asthma are recognised triggers, particularly during periods of exacerbation with excessive coughing.
An identifiable causative factor is present — pre-existing asthma or COPD — establishing this as secondary pneumomediastinum. The presence of air in the mediastinum is considered secondary when such a causative factor is identified.
Initial treatment addresses the underlying pathology — ensuring asthma or COPD is adequately managed — alongside conservative measures: hospitalisation for observation, bed rest, restriction of physical activity, analgesics for pain, anti-anxiety agents, and antitussives to suppress coughing.
This protocol applies when those measures have not achieved the required goals: control of pain, stability of the pneumomediastinum, and elimination of complications such as pneumothorax. When these targets are not met, escalation is indicated.
DOI: 10.3978/j.issn.2072-1439.2015.01.11