pleurisy when to seek care

Overview

Pleurisy is inflammation (swelling) of the pleura, the two thin layers of tissue that line your lungs and the inside of your chest. When these layers rub together during breathing, they can cause sharp chest pain.

Pleurisy is fairly common. It often happens as a complication of a respiratory infection, like a cold or flu.

Pleurisy can affect people of all ages, but it is more common in adults. People with lung infections, chest injuries, autoimmune conditions, or blood clotting problems may be at higher risk.

Symptoms

Common symptoms

• Sharp, stabbing chest pain that gets worse with deep breaths, coughing, sneezing, or laughing
• Shortness of breath, especially when you try to take a deep breath
• Pain that may spread to your shoulder, back, or abdomen
• A dry cough or a cough with mucus, depending on the cause
• Fever or chills if there is an infection

Symptoms in children

• Children may cry more than usual, be irritable, and have trouble breathing or fast breathing
• They may hold their chest or say it hurts when they breathe
• Fever and cough can also occur, similar to adults

Symptoms in older adults

• Older adults may have less obvious chest pain and more confusion, fatigue, or rapid breathing
• They may not complain of pain but may seem generally unwell
• Any new breathing difficulty in an older adult should be checked promptly

Causes

Main causes

• Viral infection, such as a cold, flu, or COVID-19 — the most common cause
• Bacterial infection or pneumonia
• Autoimmune disease, like lupus or rheumatoid arthritis
• Pulmonary embolism — a blood clot in the lung
• Injury to the chest, such as a rib fracture or trauma
• After heart surgery or other chest procedures
• Cancer affecting the lung or pleura, although less common

Risk factors

• Recent respiratory infection, like a cold, flu, or pneumonia
• Autoimmune conditions that cause inflammation
• Chest injury or recent surgery
• Conditions that increase blood clotting, such as a history of blood clots
• Smoking, which damages the lungs and makes infections more likely

When to see a doctor

See a doctor urgently if:

• See a doctor on the same day if you have new chest pain that gets worse when you breathe, especially with a fever or cough
• If you have a condition like heart disease or a blood clotting disorder and develop chest pain, seek care promptly
• If breathing becomes more difficult, do not wait — call your local emergency number

Book a routine appointment if:

• Make an appointment if you have a cold or flu and then develop chest pain that persists for more than a few days
• If the pain is not severe but keeps bothering you and you are not sure why, it is worth getting checked
• If you have an autoimmune disease and notice breathing symptoms, see your regular doctor

Diagnosis

Your doctor will ask about your symptoms and medical history, listen to your chest with a stethoscope, and check your oxygen level with a small sensor on your finger. A sound called a pleural rub may point to pleurisy.

Tests that may be done

• Chest X-ray — to look for signs of infection, fluid, or collapse
• CT scan — a more detailed scan of your chest if the X-ray isn't clear
• Ultrasound — to check for fluid around the lungs
• Blood tests — to check for infection, inflammation, or blood clotting problems
• Pleural fluid sample — if there is fluid, a small needle may be used to remove and test it

What to expect at your appointment

Most tests for pleurisy are not painful, but some may feel slightly uncomfortable. You may be asked to hold your breath or change position during scans. If a fluid sample is taken, you will be given local medicine to numb the area. The doctor or nurse will explain each step.

Treatment

Treatment for pleurisy depends on the underlying cause. If it's from a viral infection, it often gets better on its own with rest. If it's from a bacterial infection, your doctor may prescribe antibiotics. Pain relief is also important so you can breathe comfortably.

Self-care at home

• Get plenty of rest and take it easy until the pain improves
• Use a warm cloth or heating pad on your chest to help ease pain
• Try to breathe gently and cough if you need to — it helps keep your lungs clear
• Drink plenty of fluids to stay hydrated
• Avoid smoking and being around smoke

Medical treatments

Your doctor may recommend over-the-counter pain relievers or anti-inflammatory medicines — always ask your doctor or pharmacist which type is right for you. If a bacterial infection is present, antibiotics may be prescribed. If a blood clot is the cause, blood-thinning medicines may be given. When there is infected fluid around the lungs, it may need to be drained with a needle or a small tube. You will be given specific instructions by your healthcare team.

When is surgery considered?

Surgery is rarely needed for pleurisy itself. It may be considered if there is a collection of infected fluid that doesn't clear with drainage, or if another condition in the chest requires surgery. Your doctor will explain if surgery is an option for your situation.

Living with this condition

While recovering, it helps to rest and slowly return to normal activities. Pain can prevent you from taking deep breaths, but try to breathe normally as much as you can. If you have a cough, manage it as your doctor advises.

Lifestyle tips

• If you smoke, ask your healthcare provider for help to stop
• Avoid cold, dry air that may trigger coughing
• Use a humidifier to keep air moist, which can soothe your airways
• Avoid heavy lifting or intense exercise until your pain and symptoms improve

Diet and exercise

Eat a balanced diet with plenty of fruits, vegetables, and whole grains to help your body recover. Stay well hydrated. For exercise, start with gentle activities like short walks and slowly increase only as your symptoms allow. Check with your doctor before resuming strenuous exercise.

Mental health and emotional wellbeing

Chest pain can be very frightening and may cause anxiety. It is normal to worry, especially before the cause is known. Talk to your doctor about your concerns, and lean on family and friends for support during recovery.

Prevention

You cannot always prevent pleurisy, but you can lower your risk by treating respiratory infections early, avoiding smoking, and keeping chronic conditions like diabetes or autoimmune diseases well controlled.

Vaccines

Keeping up to date with recommended vaccines, such as the flu vaccine and pneumonia vaccine, may help prevent infections that can lead to pleurisy. Ask your local health service or pharmacist about which vaccines are recommended for you.

Screening programmes

There is no routine screening test for pleurisy. The best way to catch it early is to pay attention to new chest pain and see a doctor promptly.

Complications

If left untreated

• Pleural effusion — excess fluid builds up around the lung, which can make breathing harder
• Empyema — the fluid becomes infected and turns into a pocket of pus, which needs drainage and strong treatment
• Lung collapse — if air or fluid pushes on the lung, it may fail to expand properly
• Damage to the pleura or lung tissue if an underlying condition is left untreated

Long-term outlook

Most people with pleurisy recover fully, especially when the cause is a viral infection. With proper care and treatment, symptoms usually improve within a few days to a few weeks. Even when pleurisy is caused by a more serious condition, prompt diagnosis and treatment can make a significant difference. Your healthcare team will guide you through recovery.

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