SERPINA1 and hyperinsulinemic hypoglycemia, familial, 4: Known risk factors for the development of primary spontaneous pneumothorax include male gender, tall stature, thin body habitus, and age-group 10–30 years.18 Secondary causes include infections, smoking, chronic obstructive pulmonary disease, alpha-1 antitrypsin deficiency, and trauma.19 Severe alveolar and airway inflammatory damage from the release of cytokines in COVID-19 can lead to weakening of the bronchial walls.