Objective: To explore the clinical features of pneumoconiosis complicated with spontaneous pneumothorax to improve the diagnosis and treatment of this disease. Methods: Analyze the clinical characteristics and treatment of 350 cases of pneumoconiosis complicated with spontaneous pneumothorax in Hunan Prevention and Treatment Institute for Occupational Diseases from May 2016 to May 2018. Results: In 350 patients, 22 cases are pneumoconiosis stage I, accounting for 6.3%, 26 cases are pneumoconiosis stage Ⅱ, accounting for 7.4%, 302 cases were pneumoconiosis stage Ⅲ, accounting for 86.3%.168 cases were recurrent pneumothorax, the recurrence rate was as high as 48%.There were 232 cases occurred in winter and spring, accounting for 66.3%. Chronic obstructive pulmonary disease and pulmonary infection were 54.9% and 47.4%, respectively. 233 patients were treated with basic therapy such as high flow oxygen therapy, with an effective rate of 93.1%. 114 cases were treated with thoracic closed drainage, with an effective rate of 86%. Conclusion: Spontaneous pneumothorax is a common complication of pneumoconiosis with high recurrence rate. According to the different conditions to give different treatments in a timely manner can achieve better results.