pleurisy in older adults

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. When these layers become swollen and inflamed, they rub against each other when you breathe, causing sharp chest pain.

Pleurisy is not as common as it once was, but it still happens. It often develops as a complication of a viral or bacterial infection, such as pneumonia or the flu.

Pleurisy can affect anyone, but older adults are more likely to develop it because they are at higher risk for chest infections, pneumonia, blood clots, and conditions that affect the lungs, heart, or immune system.

Symptoms

Common symptoms

• Sharp, stabbing chest pain that gets worse when you breathe in deeply, cough, sneeze, or move
• Pain that may spread to the shoulder, neck, or back
• Shortness of breath or feeling like you cannot get enough air
• A dry cough
• Fever or chills in some cases

Symptoms in children

• In children, symptoms can be similar, but younger children may not be able to describe their pain. They might seem irritable, breathe quickly, or cry when taking deep breaths.
• A child with pleurisy may also refuse to eat or play and could have a temperature.

Symptoms in older adults

• In older adults, the classic sharp chest pain may be less obvious. Instead, they may feel a dull ache, general weakness, or confusion.
• Breathing may become rapid or more effortful, and fever might be absent or lower than expected.
• Sometimes the only clue is a sudden change in how someone feels or how active they are.

Causes

Main causes

• Viral infections, such as the flu or a cold
• Bacterial infections, such as pneumonia or tuberculosis
• A blood clot in the lung (pulmonary embolism)
• Injury to the chest, like a broken rib
• Lung cancer or a tumour affecting the pleura
• Autoimmune conditions, such as rheumatoid arthritis or lupus

Risk factors

• Being over the age of 65
• Having a chronic lung condition, such as COPD or asthma
• Smoking
• Recent chest surgery or trauma
• A weakened immune system
• Heart or kidney failure that causes fluid to build up

When to see a doctor

See a doctor urgently if:

• If you have unexplained chest pain that makes it hard to breathe, see a doctor the same day.
• If you have a high temperature, chills, or a cough with phlegm that is getting worse, consult a healthcare professional promptly.

Book a routine appointment if:

• If you have a mild, persistent chest discomfort that lasts for more than a few days.
• If you have a chronic condition like heart disease or arthritis and develop new chest symptoms.

Diagnosis

Your doctor will ask about your symptoms, listen to your chest, and may order tests to look for the underlying cause. Often, pleurisy produces a specific 'rubbing' sound when you breathe, called a pleural rub.

Tests that may be done

• Chest X-ray
• Blood tests
• A CT scan (a detailed cross-sectional picture of your chest)
• Ultrasound of the chest
• Sometimes a procedure called thoracentesis, where a small needle is used to remove a sample of fluid from the lining of the lung for testing

What to expect at your appointment

The doctor will gently press on your chest, ask you to breathe deeply, and may tap your back. You may be asked to have blood drawn. These tests are usually quick and painless, though you may feel a little discomfort. You should get an idea of what is causing your symptoms within a few days.

Treatment

Treatment for pleurisy depends on what is causing it. The main goals are to relieve your symptoms, especially the chest pain, and to treat the underlying illness. Most people with pleurisy can be managed at home, but some may need hospital care.

Self-care at home

• Rest until the sharp pain settles.
• Try gentle breathing exercises to keep your lungs clear.
• Hold a pillow against your chest when you cough or sneeze to reduce pain.
• Ask your pharmacist or doctor about safe pain relief options if you are uncomfortable.
• Stay hydrated and eat lightly if you feel unwell.

Medical treatments

Your doctor may prescribe medication to reduce inflammation and help with pain, or treat the underlying infection with antibiotics if it is bacterial. If a blood clot is found, you may receive medicines to thin the blood. If there is fluid around the lung, your doctor may drain it. Always follow your healthcare team's advice and finish the full course of any prescribed treatment.

When is surgery considered?

Surgery is not usually needed for pleurisy. However, if fluid keeps building up around the lung or if the lining becomes thickened and painful, a procedure may be used to drain the fluid or remove part of the inflamed lining. This is rare and only for serious cases.

Living with this condition

During the first few days, take it easy. Try to avoid heavy lifting or strenuous exercise until your symptoms improve. Listen to your body — if you feel tired, rest. Most people start to feel better within a week, though it may take a few weeks to fully recover.

Lifestyle tips

• If you smoke, ask your healthcare team about support to help you quit.
• Avoid exposure to cold air and dusty environments that can trigger coughing.
• Keep your chest warm and comfortable.
• Sleep propped up on extra pillows if lying flat makes your chest hurt.

Diet and exercise

Eat a balanced diet with plenty of fruits and vegetables to support your immune system. Gentle movement, like short walks as you recover, is good, but avoid anything that makes your chest pain worse. Always speak to your doctor before starting a new exercise routine.

Mental health and emotional wellbeing

Chest pain and breathlessness can be frightening and may cause anxiety or low mood, especially in older adults. It is normal to feel worried while recovering. Talk to your family or friends about how you are feeling, and mention any persistent worry to your doctor — you don't have to manage this alone.

Prevention

Pleurisy itself cannot always be prevented, but the infections and conditions that cause it often can be. Good hand hygiene, staying away from people who are sick, and looking after your general health can reduce your risk.

Vaccines

Vaccines for flu, pneumonia, and COVID-19 can help prevent some of the most common infections that lead to pleurisy. Ask your doctor about which vaccines are recommended for you.

Screening programmes

There is no routine screening for pleurisy. Regular check-ups for heart and lung health are important, especially if you have an ongoing condition like diabetes or high blood pressure.

Complications

If left untreated

• If the underlying cause is not treated, pleurisy can lead to a build-up of fluid around the lung (a pleural effusion), which can press on the lung and make breathing harder.
• The inflamed layers may form thick scar tissue, which can trap the lung and cause long-term breathlessness.
• In rare cases, the fluid can become infected and turn into an abscess (empyema), which requires more intensive treatment.
• Delaying treatment for a blood clot or pneumonia can make the condition much more serious.

Long-term outlook

With the right treatment, pleurisy usually improves completely, though it may take time. In older adults, recovery can be slower, but most people respond well to care. If a more serious condition like a blood clot or cancer is found, remember that many treatments are available, and your healthcare team will support you every step of the way. Early care makes a real difference.

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