**2. Percutaneous needle aspiration or chest tube drainage?**

The evidence for needle aspiration NA as the initial treatment for spontaneous pneumothorax has been growing over the years. It is a simple, safe procedure and the learning curve for performing it is shorter than the classic chest tube drainage (CTD). It can also be performed in an out-patient setting, and if patients do require hospitalization, it usually requires a shorter hospital stay. Despite this, the guideline for using NA as an initial intervention is more evident in the European guidelines in comparison to the American guidelines for management of spontaneous pneumothorax.

The British Thoracic Society (BTS) guideline [5] and European Respiratory Society (ERS) task force statement [6] recommend aspiration as the first intervention, when needed, for all PSP without tension or haemodynamic instability. The BTS guideline is considered more modest for SSP: Needle aspiration can be considered for symptomatic patients with small spontaneous pneumothorax in an attempt to avoid CTD. On the other hand, the American College of Chest Physicians (ACCP) guideline [7] does not include needle aspiration for any patients with spontaneous pneumothorax. The classification of a small pneumothorax in the BTS guidelines is <2 cm on a chest X-ray.

