Pleurisy

Overview

Pleurisy is an inflammation (swelling) of the pleura, the thin, double layer of tissue that surrounds the lungs and lines the inside of the chest. When these layers rub together, each breath can feel sharp and painful.

Pleurisy is a relatively common condition, especially as a complication of a chest infection.

It can affect anyone, but it is more often diagnosed in people with lung infections, autoimmune conditions, or a recent chest injury.

Symptoms

Common symptoms

• Sharp, stabbing chest pain when you take a deep breath
• Pain that spreads to the shoulder or back
• Shortness of breath, often because taking a deep breath hurts
• A dry cough
• Fever and chills in some cases

Symptoms in children

• Similar chest pain, though younger children may say their tummy or shoulder hurts
• Fussiness or irritability, especially when lying down
• Fast or noisy breathing

Symptoms in older adults

• Pain may be less sharp but more like a general chest ache
• Breathlessness with everyday activities
• Confusion or unusual tiredness can be a sign of infection

Causes

Main causes

• Viral infection, such as influenza or a common cold virus
• Bacterial pneumonia or other chest infections
• Autoimmune diseases, where the immune system attacks healthy tissue, such as lupus or rheumatoid arthritis
• Pulmonary embolism (a blood clot in the lung)
• Chest injury or surgery

Risk factors

• Having a recent chest infection
• Weakened immune system
• History of autoimmune disease
• Smoking or exposure to second-hand smoke
• Prolonged immobility, which increases blood clot risk

When to see a doctor

See a doctor urgently if:

• Chest pain that makes it hard to breathe
• Fever above 39°C (102°F) or any fever lasting more than a few days
• Coughing up discoloured mucus or blood

Book a routine appointment if:

• Chest pain that lasts more than a few days without improving
• A persistent cough or breathlessness
• You have an underlying condition like heart failure or an autoimmune disease

Diagnosis

Your doctor will listen to your chest with a stethoscope to check for the tell-tale friction rub (a scratchy sound when you breathe). They will also ask about your symptoms and medical history.

Tests that may be done

• Chest X-ray to look at the lungs and pleura
• Blood tests to check for infection or inflammation
• Ultrasound or CT scan to see if fluid has collected around the lungs
• In some cases, a small fluid sample may be taken (pleural tap) for testing

What to expect at your appointment

You may be asked to 'breathe in deeply' and 'cough' during the exam. If fluid is present, a specialist may drain it with a needle. This is usually done with a local anaesthetic in an outpatient clinic.

Treatment

Treatment focuses on the underlying cause, because pleurisy itself is an inflammation that usually settles when its cause is treated. Pain relief and rest help you stay comfortable while you recover.

Self-care at home

• Rest until the pain starts to ease.
• Hold a cushion or pillow against your chest when coughing to reduce discomfort.
• Apply a warm compress to the outside of your chest for short periods, if it feels soothing.
• Sleep propped up with pillows to make breathing easier.

Medical treatments

Your healthcare provider may recommend anti-inflammatory medicines or pain relievers to ease discomfort. If a bacterial infection is the cause, antibiotics may be prescribed. If fluid has collected around the lungs, a procedure called thoracentesis (draining the fluid) can help you breathe more easily. Always discuss your options with your doctor, and do not start any medication without professional advice.

When is surgery considered?

Surgery is rarely needed. In rare cases where a fluid collection cannot be drained by needle, or if the pleura is severely scarred, a surgical procedure might be considered. Your doctor will explain if this applies to you.

Living with this condition

Recovery time varies. Viral pleurisy may take a few weeks to fully settle. During this time, listen to your body and rest when you need to. Slowly build up your activities as your symptoms improve.

Lifestyle tips

• Avoid smoking and exposure to smoke, as this can irritate the lungs.
• Stay hydrated.
• Learn a gentle coughing technique – take a deep breath, then cough from the 'belly' while bracing your chest.

Diet and exercise

Eat a balanced diet to support your immune system. When you feel ready, start with gentle walking and stretching. Avoid strenuous exercise until your doctor agrees it is safe.

Mental health and emotional wellbeing

Living with chest pain can feel worrying and may affect your mood. It is normal to feel anxious, especially if the cause is unclear. Talking to a mental health professional or a support group can help.

Prevention

It is not always possible to prevent pleurisy, but reducing your risk of chest infections and blood clots helps. This includes practising good hand hygiene, staying active, and seeking early treatment for respiratory symptoms.

Vaccines

Your doctor may advise staying up to date with flu and pneumonia vaccines, as these can reduce your chance of developing serious chest infections that may lead to pleurisy.

Screening programmes

There is no routine screening test for pleurisy, but regular check-ups can help manage conditions that increase your risk, such as autoimmune disease or heart problems.

Complications

If left untreated

• Pleural effusion (a build-up of fluid around the lungs)
• Infections spreading deeper into the lungs (pneumonia or empyema)
• Thickening or scarring of the pleura, which can restrict breathing

Long-term outlook

With the right treatment, most people with pleurisy recover completely. Even when a more serious cause is found, early diagnosis and modern treatments offer good chance of recovery. Remember, your healthcare team is there to help you step by step.

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