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FIGURE 99.3 Chest radiograph showing pneumothorax.

If pneumothoraces are recurrent or persistent, the patient should be evaluated
for pleurodesis. While this may prevent recurrence, such intervention may have
implications for lung transplant eligibility and should be discussed with
physicians having experience in either CF or lung transplantation.
Daily CF therapies, such as chest percussion and postural drainage, oscillatory
percussive vest therapy, other airway clearance techniques (e.g., positive
expiratory pressure [PEP] mask, flutter valve), inhalation of dornase alfa
(pulmozyme), and pulmonary function testing, should be suspended temporarily
to avoid exacerbating the pneumothorax. Inhalational therapy with
bronchodilators and/or ICSs may be continued with nebulization, but the usual
inhalational maneuvers with MDIs probably should be avoided until the