**Abstract**

Spontaneous pneumothorax (SP) is a type of collection of air in the pleural cavity that develops in the absence of trauma or iatrogenic cause. Its management has been a matter of debate for many decades. Nevertheless, clear guidelines from the American, British and European societies have been published. In this chapter, we will discuss the different society guidelines and the inter-guideline variations. We will also discuss the author's perspective for management of first-time pneumothorax which is an unsettled issue between respiratory physicians and thoracic surgeons. Finally, deviation from clinical guidelines is usually associated with deficient patient care, and in this chapter, the reflection on patient care from not following the pneumothorax guidelines will be discussed in detail.

**Keywords:** spontaneous pneumothorax, guidelines, first-time attack, indication for surgery, chest tube, primary pneumothorax, secondary pneumothorax
