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Pleurisy

 

Pleurisy is a condition in which the pleura, which is the double-layered covering of the lungs, becomes inflamed. The most common symptom of pleurisy is a sharp chest pain that feels worse with breathing.

Read more about the symptoms of pleurisy.

What causes pleurisy?

Pleurisy can have several causes, which can range from mild to life-threatening. They include:

Read more about the causes of pleurisy.

When to see your GP

You should visit your GP if you have chest pain that does not improve or gets worse after around five to seven days.

If your chest pain is accompanied by a high temperature, coughing up phlegm or blood, or breathing difficulties, you should seek immediate medical attention.

Treatment options

Treatment for pleurisy will depend on the underlying cause of the condition. For example, pleurisy that is caused by a viral infection will often resolve without needing treatment.

However, pleurisy caused by a bacterial infection will usually need to be treated with antibiotics, and people who are frail or already in poor health may be admitted to hospital.

Read more about treating pleurisy.

In some cases of pleurisy, the pleura can become filled with fluid. If this happens, it may be necessary to drain the fluid out of the pleura to prevent breathing difficulties.

Read more about the complications of pleurisy.

Who is affected?

In England, each year there is an average of 2,000 hospital admissions as a result of pleurisy. However, the total number of pleurisy cases is likely to be significantly higher as people with pleurisy often do not seek treatment.

Pleurisy can affect people of all ages, but older people who are 65 years of age or over are most at risk because they are more vulnerable to developing a chest infection.

Outlook

The outlook for pleurisy can vary significantly depending on the underlying cause of the condition. For example, the outlook for viral pleurisy is usually good and most people will make a full recovery.

However, the outlook for bacterial pleurisy can be mixed because people with this form of pleurisy are more likely to develop complications that could cause permanent lung damage. 

Acute
Acute means occurring suddenly or over a short period of time.
Lungs
Lungs are a pair of organs in the chest that control breathing. They remove carbon dioxide from the blood and replace it with oxygen.

 

Pleurisy happens when the linings between your lungs and ribcage are irritated by infection or disease.

The most common symptom of pleurisy is chest pain when breathing in and out. The pain is often described as sharp and stabbing and is worse when you:

  • breathe deeply
  • cough
  • sneeze
  • move around
  • apply pressure to your chest

The pain can often be relieved by taking shallow breaths.

As well as chest pain, other symptoms of pleurisy include:

  • shortness of breath
  • a dry cough

When to seek medical advice

Visit your GP if you have pain that does not improve or gets worse after around five to seven days.

When to seek immediate medical advice

Contact your GP immediately if your symptoms suggest that you have a serious underlying condition. For example, if you have symptoms such as:

  • a high temperature (fever) of 40°C (104°F)
  • coughing up thick yellow or green phlegm
  • serious breathing difficulties
  • intense chest pain that comes on suddenly
  • swelling in your arms or legs (this could indicate a blood clot)
  • persistent cough
  • coughing up blood
  • unexplained weight loss

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The pleura

The pleura is the double-layered membrane that is located between the lungs and ribcage. One layer is attached to the ribcage and the other is attached to the lungs.

The layers of the pleura are separated by a very thin layer of liquid. The liquid works like lubricating oil by reducing the friction between the layers of the pleura and allowing the lungs to expand and contract without any resistance.

If the pleura is irritated, the surfaces of the two layers can become uneven and the fluid in between them can become sticky. This can cause the layers to rub together, resulting in pain and discomfort.

Infection

An infection is the most common cause of pleurisy.

Any type of infection has the potential to spread to the pleura, but viral infections are usually to blame.

Viruses that are known to trigger pleurisy include:

  • the influenza virus - both seasonal flu  and swine flu
  • the Epstein-Barr virus - which is the virus that causes glandular fever
  • cytomegalovirus (CMV) - a common virus that is found in most people and does not usually cause any noticeable symptoms
  • parainfluenza - which is the virus that causes the childhood condition called croup

The most common causes of bacterial pleurisy are:

(Meticillin-resistant Staphylococcus aureus MRSA) is a common cause of bacterial pleurisy which can sometimes affect people who are staying in hospital. MRSA is a type of bacteria that has developed a resistance to a number of commonly used antibiotics.

Other causes

Other possible causes of pleurisy include:

Autoimmune conditions, such as rheumatoid arthritis and lupus, are another possible cause of pleurisy. In these conditions, something goes wrong with the immune system and it begins to attack healthy tissue. The immune system is the body's natural defence against infection and illness.

Tissue

Body tissue is made up of groups of cells that perform a specific job, such as protecting the body against infection, producing movement or storing fat.  

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Before diagnosing pleurisy, your GP will ask you about your symptoms and recent medical history. They will use a stethoscope to listen to your chest. If you have pleurisy, your lungs will make a distinctive dry, crunching sound that is known as a friction rub.

Further tests may be needed to identify the underlying cause of your pleurisy. These tests can include:

  • blood tests to determine whether you have an infection or an autoimmune condition
  • chest X-rays
  • an ultrasound scan, where sound waves are used to build up a picture of the inside of your lungs
  • computerised tomography (CT) scan, a where a series of X-rays is taken and a computer is used to create a more detailed three-dimensional image of your lungs

If lung cancer or tuberculosis is suspected, it may be necessary to remove a small sample of lung tissue for further testing. This is done in hospita. The tissue can be removed using a fine needle which is inserted through your skin and into your lungs. Before the procedure, a local anaesthetic is used to numb your skin so that you do not feel any pain.

Alternatively, a small tube called a bronchoscope can be passed down into your throat and used to remove a tissue sample. The procedure can be uncomfortable but you will be given a mild sedative to help you relax, and local anaesthetic to numb your throat. The procedure is very quick and only takes a few minutes.

Tissue
Body tissue is made up of groups of cells that perform a specific job, such as protecting the body against infection, producing movement or storing fat.
X-ray

An X-ray is a painless way of producing pictures of inside the body using radiation.

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Non-steroidal anti-inflammatory drugs

The chest pain that is associated with pleurisy can be treated using the type of painkillers that are known as non-steroidal anti-inflammatory drugs(NSAIDs). Ibuprofen is often used to treat pleurisy. It is available over the counter from pharmacies.

If NSAIDs are not effective at treating your chest pain, or you are unable to take them because of a pre-existing health condition, such as liver disease, your GP may prescribe a short course of steroid tablets (oral corticosteroids) to reduce inflammation and relieve pain.

It may seem strange, but lying down on the side of your chest that hurts may help to reduce the pain.

Treating the underlying cause

It may also be necessary to treat the underlying cause of your pleurisy. If it is caused by a viral infection, further treatment may not be required because the infection will usually resolve on its own after a few days.

You will need a course of antibiotics if you have pleurisy that is caused by a bacterial infection. Depending on the severity of your symptoms, this may be either in the form of tablets or injections. Combinations of different antibiotics are usually used.

If your symptoms are particularly severe or you are already in poor health, you may need to be admitted to hospital so that your body's functions can be supported until your condition stabilises.

Antibiotics
Antibiotics are medicines used to treat infections caused by micro-organisms, usually bacteria or fungi. Examples of antibiotics include amoxicillin, streptomycin and erythromycin.
Immune system
This is the body's defence system which helps protect it from disease, bacteria and viruses.
Inflammation
Inflammation is the body's response to infection, irritation or injury. It causes redness, swelling, pain and sometimes a feeling of heat in the affected area.
Pain

Pain is an unpleasant physical or emotional feeling and your body's way of warning you that it has been damaged.

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Pleural effusion

In some cases of pleurisy, excess fluid can build up between the layers of the pleura. This is known as pleural effusion.

Pleural effusion is more likely to occur in cases of pleurisy that have been caused by a pulmonary embolism or a bacterial infection. Symptoms of pleural effusion include:

  • shortness of breath that gets progressively worse
  • cough
  • chest pain

Pleural effusion usually clears up after the condition that caused the pleurisy has been successfully treated. If it does not clear up naturally, a surgical procedure can be used to drain the fluid.

Surgery may also be recommended if your shortness of breath is so severe that it poses a serious threat to your health.

Pain

Pain is an unpleasant physical or emotional feeling and your body's way of warning you that it has been damaged.

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Content provided by NHS Choices www.nhs.uk and adapted for Ireland by the Health A-Z.