Few trials to guide clinical management of primary spontaneous pneumothorax (PSP) exist. This study aims to reveal current practice in the management of PSP in Switzerland, to define the level of consensus and to provide evidence in guiding clinical practice. Questionnaires were sent to 355 departments of internal medicine and surgery in Switzerland and 114 (32.1%) were available for analysis. Recommendations based on the highest consensus are extracted. Good to very good consensus is reached in 63% of all management options. There is very good consensus for the management of clinically stable or unstable patients with small or large PSP, for the treatment of patients without chest tubes and the operative management of persistent air leaks and recurrence prevention. There is good consensus concerning the role of suction, the size of chest tubes, and the use of CT-scans. However, there is little consensus concerning chest tube removal and chemical pleurodesis. Good and very good consensus exists for most management options in the treatment of PSP in Switzerland. The given recommendations can be used as evidence in guiding clinical practice in circumstances where no evidence of higher levels exists.