Objective(s): To address the question whether neutrophil to lymphocyte ratio may be an indicator of recurrence in primary spontaneous pneumothorax Design: Retrospective study Setting: Bursa Yüksek Ihtisas Hospital for Education and Research, Bursa, Turkey Subjects: A total number of 124 primary spontaneous pneumothorax patients treated in our hospital between 5th July, 2002 and 30th April, 2015. Patients with only initial episode were enrolled in Group 1 and patients presented with recurrence were enrolled in Group 2. Intervention(s): Age, gender, cigarette smoking history, bullae presence, pneumothorax side, length of hospital stay and presence of recurrence were noted. Initial complete blood count results were used for neutrophil to lymphocyte ratio calculation. Main Outcome Measure(s): All data are analyzed statistically for any significant relationships between the variables and recurrence. Result(s): Statistical analysis using chi-square test revealed a significant relationship between recurrence and neutrophil to lymphocyte ratio (X2 =62.752, P=.000) and cigarette smoking (X2 =8.116, P=.004). We did not find any significant relationship between recurrence and presence of bullae or gender. Conclusion(s): We believe that neutrophil to lymphocyte ratio value higher than 2.48 may be an indicator of recurrence in primary spontaneous pneumothorax patients. Further multicenter studies with larger number of patients, however, are needed to verify this conclusion.