pleurisy after diagnosis

Overview

Pleurisy (PLUR-uh-see) is inflammation of the pleura, the two thin layers of tissue that surround your lungs and line the inside of your chest. When these layers become swollen, they rub together each time you breathe, causing sharp chest pain.

Pleurisy is less common than it used to be, but it still affects many people each year. It can happen at any age.

Anyone can get pleurisy, but it is more likely if you have a chest infection, lung disease, an autoimmune condition, or a recent chest injury or surgery.

Symptoms

Common symptoms

• Sharp chest pain that worsens with deep breathing, coughing, or sneezing
• Shortness of breath or feeling like you cannot get enough air
• Dry cough
• Fever or chills, especially if the cause is an infection
• Pain that eases when you hold your breath or lean forward

Symptoms in children

• Chest pain or fussiness
• Rapid breathing or grunting
• Tummy pain (children often feel chest pain in the belly)
• Fever

Symptoms in older adults

• Less obvious pain, sometimes only a dull ache
• Confusion or unusual sleepiness
• Faster breathing or feeling breathless
• Fever

Causes

Main causes

• Viral infections, like flu or a cold (the most common cause)
• Bacterial infections, such as pneumonia or tuberculosis
• Autoimmune diseases like lupus or rheumatoid arthritis
• A blood clot in the lung (pulmonary embolism)
• Injury to the chest, such as a rib fracture
• Cancer that spreads to the chest or lungs
• Being a side effect of certain medical procedures or medicines

Risk factors

• Recent lung or chest infection
• Weakened immune system
• Lung disease such as asthma, COPD, or pneumonia
• Autoimmune condition
• Long periods of inactivity, such as after surgery or a long flight
• Smoking
• Exposure to asbestos or other lung irritants

When to see a doctor

See a doctor urgently if:

• If you have new or worsening chest pain
• If you have trouble breathing that is getting worse
• If you develop a high fever, chills, or rapid heartbeat
• If you cough up blood or bloody mucus
• If your symptoms do not improve after a few days of treatment

Book a routine appointment if:

• Keep all follow-up appointments with your healthcare provider
• Talk to your doctor if you have questions about your recovery or when you can return to work or exercise
• Contact your doctor if you need a sick note or advice on managing a chronic health condition

Diagnosis

Your doctor will ask about your symptoms, examine you, and listen to your chest. They may hear a grating or rubbing sound called a pleural rub. To confirm pleurisy and find its cause, they will usually order one or more tests.

Tests that may be done

• Chest X-ray
• Blood tests
• CT scan (a detailed X-ray of your chest)
• Ultrasound (uses sound waves to see fluid around the lungs)
• Thoracentesis (removing a small sample of fluid from the chest with a needle to test)

What to expect at your appointment

The tests are usually done in a clinic or hospital. An X-ray and blood tests are quick. A CT scan or ultrasound takes a little longer. If you have fluid around your lungs, the doctor may numb an area of your back and insert a thin needle to drain some fluid — this sounds uncomfortable but is usually well tolerated. You will be looked after the whole time, and results often come back within days.

Treatment

Treatment for pleurisy depends on the underlying cause. The goals are to reduce pain and inflammation, and to treat the condition that triggered it. Many people are treated at home, but some need a short hospital stay if they have a serious infection or fluid build-up.

Self-care at home

• Rest and take time off work or school until you feel better
• Use a warm heating pad on your chest for 10 to 15 minutes at a time, wrapped in a towel, to ease pain
• Hold a pillow over your chest when you cough to reduce pain
• Breathe slowly and deeply when awake to help keep your lungs clear
• Avoid smoking and secondhand smoke
• Stay hydrated by drinking plenty of water unless your doctor says otherwise

Medical treatments

Your doctor may prescribe medicines to reduce inflammation and relieve pain. Do not take any medicine without your doctor's advice, especially if you have kidney problems or stomach ulcers. If a bacterial infection is the cause, you will likely be given antibiotics. For a blood clot, you may receive blood-thinning medicines. If fluid is causing pressure, it may be drained with a needle or a small tube. For autoimmune causes, your specialist may suggest medicines that calm the immune system. Always take all medicines exactly as prescribed and finish the full course of antibiotics.

When is surgery considered?

Surgery is rarely needed for pleurisy itself. It may be used to drain pus that does not clear with a needle (called an empyema) or to remove thickened scar tissue around the lung. Your specialist will explain if this applies to you and what it involves.

Living with this condition

Recovery from pleurisy takes time — usually one to two weeks for a viral cause, but longer if the underlying infection is severe. Listen to your body and do not rush back to heavy lifting or intensive exercise. Keep a symptom diary so you can tell your doctor about any changes.

Lifestyle tips

• Quit smoking and avoid lung irritants like strong fumes or dust
• Get plenty of sleep to support your immune system
• Manage stress with activities like deep breathing, meditation, or gentle yoga
• Before you resume exercise, ask your doctor what is safe for you
• Keep your hands clean and stay away from people with colds or flu

Diet and exercise

Eat a balanced diet with plenty of fruit, vegetables, and lean protein to help your body heal. Drink enough fluids (unless your doctor says not to). Once you feel able, start with short, gentle walks and build up gradually. A physiotherapist or respiratory nurse can give you exercises to help clear your lungs.

Mental health and emotional wellbeing

Living with chest pain and breathlessness can be frightening, and it is common to feel anxious or down. It may help to talk about how you feel with a trusted friend or family member. You can also ask your healthcare team about counseling or a local support group. Remember that your feelings are valid and you do not have to face this alone.

Prevention

You cannot always prevent pleurisy because it often follows a common viral infection. But you can reduce your chances of developing a cause by not smoking, keeping well hydrated, washing your hands, and managing underlying health conditions with your healthcare team.

Vaccines

Vaccines that protect against flu, COVID-19, and pneumonia can help prevent some infections that might lead to pleurisy. Ask your healthcare provider which vaccines are recommended for you. This is especially important if you have a long-term lung condition.

Screening programmes

There is no routine screening test for pleurisy. If you have a condition that raises your risk, such as lung cancer or an autoimmune disease, your specialist will follow you up regularly to spot problems early.

Complications

If left untreated

• Difficulty breathing if fluid builds up around the lung (pleural effusion)
• Pockets of pus (empyema) that may need draining
• Scarring or thickening of the pleura that can trap the lung and cause long-term breathlessness
• Spread of infection to the bloodstream (sepsis)
• Pleurisy returning if the underlying cause is not treated

Long-term outlook

Most people with pleurisy get better fully with the right treatment. For example, viral pleurisy usually clears up in a couple of weeks. The outlook depends on the cause — treatable infections have an excellent outcome, while causes like lung cancer need ongoing support. With modern medicine, even serious causes can be managed to give you the best quality of life. Your healthcare team will be with you every step of the way.

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