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Background: The optimal management for spontaneous pneumothorax (SP) remains contentious, with various proposed approaches. This joint clinical practice guideline from the ERS, EACTS and ESTS societies provides evidence-based recommendations for the management of SP., Methods: This multidisciplinary Task Force addressed 12 key clinical questions on the management of pneumothorax, using ERS methodology for guideline development. Systematic searches were performed in MEDLINE and Embase. Evidence was synthesised by conducting meta-analyses, if possible, or narratively. Certainty of evidence was rated with GRADE (Grading of Recommendations, Assessment, Development and Evaluations). The Evidence to Decision framework was used to decide on the direction and strength of the recommendations., Results: The panel makes a conditional recommendation for conservative care of minimally symptomatic patients with primary spontaneous pneumothorax (PSP) who are clinically stable. We make a strong recommendation for needle aspiration over chest tube drain for initial PSP treatment. We make a conditional recommendation for ambulatory management for initial PSP treatment. We make a conditional recommendation for early surgical intervention for the initial treatment of PSP in patients who prioritise recurrence prevention. The panel makes a conditional recommendation for autologous blood patch in secondary SP patients with persistent air leak (PAL). The panel could not make recommendations for other interventions, including bronchial valves, suction, pleurodesis in addition to surgical resection or type of surgical pleurodesis., Conclusions: With this international guideline, the ERS, EACTS and ESTS societies provide clinical practice recommendations for SP management. We highlight evidence gaps for the management of PAL and recurrence prevention, with research recommendations made., Competing Interests: Conflict of interest: R. Hallifax has received consulting fees from Rocket Medical UK and Cook Medical, and honoraria for educational talks from AstraZeneca. M. Keijzers has received consulting fees from Philips. Y.C.G. Lee received drainage kits from Rocket Medical PLC for patients participating in clinical trials. P. Licht has received personal honoraria from Ethicon and Johnson & Johnson. N. Maskell has received consulting fees and device support for clinical trials from Rocket Medical UK and BD. B. Nagavci acted as ERS methodologist. E. Roessner has received consultancy fees from Rivolution, lecture fees from Siemens Healthineers and AstraZeneca, and was Thoracic Domain chair, Council member and Task Force member of the Solitary Pulmonary Nodules Task Force for EACTS. N. Rahman has received consulting fees Rocket Medical UK and Cook Medical, and has received device support for clinical trials from Rocket Medical UK. P. Van Schil has received personal payments from BMS and Roche, institutional payment from Janssen, MSD and AstraZeneca, and is the treasurer of BACTS (Belgian Association for Cardiothoracic Surgery) and president-elect for IASLC (International Association for the Study of Lung Cancer). D. Waller has received lecture fees from Pulmonx and Medtronic. T. Walles has received a grant (WA 1649/5-2) for clinical study on surgical therapy for treatment of primary pneumothorax from the German Research Foundation, and is an assessor (unpaid) for the German Society of Thoracic Surgery. The remaining authors have no potential conflicts of interest to disclose., (This article has been co-published with permission in the European Journal of Cardio-Thoracic Surgery and in the European Respiratory Journal. Copyright ©The Author(s) 2024. Published by European Respiratory Society. All rights reserved. The articles are identical except for minor stylistic and spelling differences in keeping with each journal's style. Either citation can be used when citing this article. For reproduction rights and permissions contact permissions@ersnet.org.)