pleurisy treatment options overview

Overview

Pleurisy is a condition where the thin layers of tissue lining your lungs and the inside of your chest (the pleura) become inflamed and swollen. This can cause sharp chest pain when you breathe, cough, or sneeze.

Pleurisy itself is not an everyday condition, but it is a recognised complication of several lung infections and other health problems. It leads to a small number of GP visits and emergency department attendances each year.

Pleurisy can affect anyone, but it is more likely in people with existing lung disease, after chest surgery, or with autoimmune conditions. It is most often seen in adults over 60, though it can happen at any age.

Symptoms

Common symptoms

• Sharp chest pain that worsens when you breathe in, cough, sneeze, or move
• A feeling like you cannot take a full breath
• A dry cough
• A low fever
• Pain that may spread to your shoulder or back

Symptoms in children

• Chest pain or holding the chest
• Breathing faster than usual
• Irritability or fussiness
• Difficulty feeding in babies

Symptoms in older adults

• Shortness of breath that may be more obvious than pain
• Vague chest discomfort rather than sharp pain
• Confusion or a change in activity level
• A faster heartbeat

Causes

Main causes

• Viral infections, such as a cold, flu, or COVID-19
• Bacterial infections, including pneumonia
• A pulmonary embolism (a blood clot in the lung)
• Autoimmune conditions, such as lupus or rheumatoid arthritis
• Injury to the chest, such as a broken rib
• Recent chest surgery or a procedure involving the lungs

Risk factors

• Recent surgery, especially heart or chest surgery
• Lung conditions, such as asthma, COPD, or cystic fibrosis
• A weakened immune system
• Sitting or lying still for long periods, which raises the risk of blood clots
• Smoking

When to see a doctor

See a doctor urgently if:

• If you have sharp chest pain that makes it hard to breathe
• If you have a high fever or a cough that brings up blood
• If your chest pain is sudden, severe, or feels like pressure

Book a routine appointment if:

• If you have chest pain that lasts more than a day or two
• If you recently had a chest infection and are not improving
• If you feel breathless doing normal activities

Diagnosis

A doctor will start by asking about your symptoms, listening to your chest with a stethoscope, and checking your temperature and breathing. They may also press gently on your chest to find where the pain is.

Tests that may be done

• Chest X-ray
• Blood tests to look for infection or signs of autoimmune disease
• CT scan of the chest for a more detailed view
• Ultrasound of the chest to check for fluid around the lungs
• An ECG (heart tracing) to rule out heart problems
• A pleural fluid sample, if fluid has built up around the lung

What to expect at your appointment

Most people are diagnosed fairly quickly with a clinical exam and a chest X-ray. If the cause is unclear, you may need extra tests. The doctor may ask you to take deep breaths while sitting or lying in certain positions to hear the tell-tale rubbing sound of inflamed pleura.

Treatment

Treatment for pleurisy mainly targets the underlying cause. For many people, this means resting, easing the pain, and letting the inflammation settle on its own. If a bacterial infection is the cause, antibiotics are likely to be prescribed. If a blood clot is the cause, treatment will focus on managing that clot.

Self-care at home

• Rest and avoid heavy activity until the sharp pain starts to ease
• Use a warm hot water bottle wrapped in a towel on your chest for comfort, but check with a doctor first
• Hold a small cushion against your chest when coughing or laughing
• Take simple pain relief as advised by your pharmacist or doctor
• Avoid smoke and other lung irritants

Medical treatments

Doctors tailor treatment to the trigger. For viral pleurisy, over-the-counter pain medicines and rest are usually enough. For bacterial infections, antibiotics are prescribed. If a blood clot is the cause, blood-thinning medicine may be used. Anti-inflammatory medicines are sometimes given for a short time to reduce swelling of the pleura. The doctor may also drain fluid from around the lung if a large amount has collected. Always follow your doctor's instructions and finish any prescribed course of medicine.

When is surgery considered?

Surgery is rarely needed for pleurisy itself. It might be considered if infected fluid around the lung (called an empyema) needs to be drained, or if the pleura becomes thick and scarred and needs surgical peeling. These situations are uncommon and are treated as complications rather than straightforward pleurisy.

Living with this condition

While you recover, it is normal to need more rest. Take things slowly and build up your activity day by day. Use pillows to make yourself comfortable when lying down, and keep a cushion handy to press against your chest when you need to cough or sneeze.

Lifestyle tips

• Stop smoking and avoid second-hand smoke
• Stay well hydrated
• Eat balanced meals to help your body repair
• Get plenty of sleep and rest

Diet and exercise

There is no special diet for pleurisy, but a balanced diet with plenty of fruit, vegetables, and protein supports recovery. Gentle movement like short walks is usually fine, but stop if you feel pain or become breathless. Always check with your doctor about what is safe for you.

Mental health and emotional wellbeing

Chest pain can be frightening and may make you feel anxious while you wait for tests or recovery. It is completely normal to feel low or worried after a scare with your chest. Talking to a trusted friend, family member, or mental health professional can help you process these feelings.

Prevention

Pleurisy cannot always be prevented, but you can reduce your risk of the lung infections and blood clots that often lead to it. Avoiding smoking, staying physically active, and managing long-term conditions like diabetes or heart disease all help.

Vaccines

Vaccines against flu, COVID-19, and pneumonia can protect you from some infections that could lead to pleurisy. Talk to your doctor about which vaccines are recommended for you.

Screening programmes

There is no routine screening for pleurisy. If you have a condition that increases your risk, such as an autoimmune disease, your doctor may monitor your lungs with regular check-ups.

Complications

If left untreated

• Fluid building up around the lung (pleural effusion), which can press on the lung and make breathing harder
• Infected fluid around the lung (empyema), which requires drainage and strong treatment
• Thickening or scarring of the pleura, which can restrict lung expansion
• In rare cases, sepsis if the infection spreads through the bloodstream

Long-term outlook

The outlook for pleurisy is very good for most people. If the cause is a viral infection, symptoms often settle within a few days to two weeks. Even when the cause is more serious, such as a blood clot or autoimmune condition, treatment can control it and many people recover fully. Your doctor will create a plan that is right for you and explain what to expect.

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