Living with pleurisy

Overview

Pleurisy (also called pleuritis) is inflammation of the pleura, the two thin layers of tissue that line the outside of your lungs and the inside of your chest. Normally these layers glide over each other smoothly as you breathe. When they become inflamed, they rub together and cause sharp chest pain, especially when you take a deep breath, cough, or move.

Pleurisy is less common now than in the past, but it still affects many people every year. Viral infections are one of the most common triggers.

Pleurisy can occur at any age, but it is more common in adults. You are more likely to get it if you have recently had a lung infection, have an autoimmune condition such as lupus or rheumatoid arthritis, or have a history of blood clots.

Symptoms

Common symptoms

• Sharp chest pain that is worse with deep breathing, coughing, or sneezing
• Shortness of breath, especially when trying to take a big breath
• Cough, which may be dry or produce phlegm
• Low-grade fever or chills
• Pain that may travel to the shoulder or back

Symptoms in children

• Chest or tummy pain that gets worse with breathing
• Fast or shallow breathing
• Fever or flushed skin
• Irritability or crying more than usual
• Looking tired or not feeding well

Symptoms in older adults

• Breathlessness with little effort
• A dry cough that lingers
• Confusion, weakness, or a sudden change in function
• Less obvious chest pain than in younger adults
• A low temperature or no fever at all

Causes

Main causes

• A viral infection, like a cold, flu, or chest infection
• Bacterial pneumonia or a lung abscess
• Autoimmune conditions, such as lupus or rheumatoid arthritis
• A blood clot in the lung (pulmonary embolism)
• Injury to the chest, such as a broken rib or surgery
• Exposure to asbestos or certain medicines

Risk factors

• Recent respiratory infection
• Smoking or exposure to second-hand smoke
• A weakened immune system
• Being immobile or having a history of blood clots
• Living or working with asbestos

When to see a doctor

See a doctor urgently if:

• Sudden, severe chest pain or breathlessness
• Coughing up blood
• Fever with a rapid heartbeat or confusion

Book a routine appointment if:

• Chest pain that lasts more than a few days
• A persistent cough
• General fatigue or unexplained weight loss

Diagnosis

A doctor will ask about your symptoms and medical history, and will listen to your chest with a stethoscope. They may gently press on areas of your chest or ask you to breathe deeply. If the pleura is inflamed, the doctor may hear a 'rubbing' sound called a pleural rub. To find the cause, you will usually need some tests.

Tests that may be done

• Chest X-ray to look at your lungs and the space around them
• Blood tests to check for infection or inflammation
• CT scan, which gives a more detailed picture of the chest
• Ultrasound, if fluid is suspected around the lung
• Electrocardiogram (ECG) to check the heart's rhythm
• A small sample of pleural fluid (thoracentesis), if needed

What to expect at your appointment

Most tests are straightforward and done while you are awake. You may need to visit an outpatient clinic or a hospital. A sample of pleural fluid, if taken, is removed with a thin needle after numbing the skin. You will be told when to expect results and what they mean.

Treatment

Treatment focuses on relieving pain and treating whatever is causing the pleurisy. Many cases get better on their own, but you should always follow the plan agreed with your healthcare team.

Self-care at home

• Rest until the sharp pain begins to ease
• Take pain relief exactly as a pharmacist or doctor advises
• Use a warm compress on your chest for short periods
• Hold a pillow to your chest when coughing
• Breathe slowly and deeply to prevent shallow breathing and mucus build-up

Medical treatments

If a bacterial infection is causing pleurisy, your doctor may prescribe a course of antibiotics. If a blood clot is the cause, you may be given a blood-thinning medicine. If excess fluid has built up around the lung, a doctor may drain it to help you breathe more easily. Anti-inflammatory medicines may be recommended to reduce swelling and pain. The exact treatment depends on the cause and your individual situation.

When is surgery considered?

Surgery is rarely needed. In some cases, a procedure called pleurodesis may be done to prevent fluid from returning. This involves using a substance to make the two layers of pleura stick together. Ask your specialist for details if this is being considered.

Living with this condition

Expect to take life a little slower for a few weeks. The pain can be worse on some days than others, and tiredness is common. Try to set up a comfortable place to rest, sitting upright rather than lying flat, as this often makes breathing easier.

Lifestyle tips

• Avoid smoking and smoky environments
• Stay well hydrated
• Keep a routine with regular sleep
• Use relaxation techniques, such as slow breathing, to reduce tension
• Return to work or school gradually, as your symptoms allow

Diet and exercise

Eat a balanced diet with plenty of fruit, vegetables, and fluids. When you feel ready, start with gentle walking or light stretching. Stop if you feel a sharp pain or become very breathless, and build activity up slowly.

Mental health and emotional wellbeing

Living with pleurisy can be stressful, especially if breathing feels difficult. Anxiety and low mood are normal reactions. Talk to your doctor about how you are feeling. If you ever feel unable to keep yourself safe or have thoughts of self-harm, call your local emergency number immediately or go to your nearest emergency department.

Prevention

You cannot always prevent pleurisy, but you can reduce your chances by looking after your lungs and treating chest infections early. Avoiding smoking and staying active are important. If you have an autoimmune condition, keep up with your regular appointments.

Vaccines

Flu and pneumonia vaccines can protect you from some infections that may lead to pleurisy. Ask your pharmacist or local health service if you are eligible for these vaccines.

Screening programmes

There is no routine screening test for pleurisy. If you have ongoing lung or immune problems, your doctor may recommend regular check-ups to detect inflammation or fluid early.

Complications

If left untreated

• Pleural effusion, a collection of fluid around the lung that can make breathing difficult
• Thickening or scarring of the pleura, which can cause lasting chest discomfort
• A lung infection that spreads or becomes chronic
• Breathing failure if the underlying cause is severe and left untreated

Long-term outlook

With the right care, most people with pleurisy recover completely. The pain usually fades gradually over a few weeks, and long-term problems are uncommon. Even when a more serious cause is found, modern treatments are effective, and your healthcare team will work with you to manage symptoms and protect your lungs.

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