preventing pleurisy

Overview

Pleurisy is inflammation (swelling) of the pleura, the two thin layers of tissue that line the outside of the lungs and the inside of the chest cavity. When these layers rub together with each breath, it causes sharp chest pain, especially when you breathe in, cough, or move.

Pleurisy is fairly common, especially during cold and flu season when respiratory infections spread.

Anyone can develop pleurisy, but it is more common in people who smoke, have a lung infection, or have an autoimmune condition such as lupus or rheumatoid arthritis. It can also happen after chest surgery or an injury.

Symptoms

Common symptoms

• Sharp chest pain that gets worse when you breathe in deeply, cough, or sneeze
• A dry cough
• Shortness of breath, especially when lying flat
• A low-grade fever or chills
• A feeling of tightness in the chest

Symptoms in children

• Children may not describe the pain clearly; they may be irritable, cry, or breathe faster than usual.
• They may hold their side or complain that it hurts to take a deep breath.
• A fever and a recent cold or cough may also be present.

Symptoms in older adults

• Older adults may feel a dull or general chest discomfort rather than a sharp pain.
• Confusion, tiredness, or a rapid breathing rate can be early signs.
• A fall or change in usual activity level can sometimes be the only clue.

Causes

Main causes

• Viral infection, such as the flu or a cold
• Bacterial pneumonia
• Autoimmune conditions that cause inflammation, like lupus or rheumatoid arthritis
• Pulmonary embolism (a blood clot in the lung)
• Chest injury or recent chest surgery

Risk factors

• Smoking or exposure to secondhand smoke
• A weakened immune system from illness or certain medicines
• Having a chronic lung condition, such as asthma or COPD
• Recovery from a chest infection
• Being bedridden or having limited mobility, which can raise the risk of blood clots

When to see a doctor

See a doctor urgently if:

• Any lasting chest pain that worsens when you breathe
• Shortness of breath that develops or becomes worse over time
• Fever with chest pain or coughing
• Coughing up mucus that is brown, green, or tinged with blood

Book a routine appointment if:

• A mild chest ache that lasts more than a day or two
• A dry cough that lingers after a cold
• Unexplained tiredness or a feeling of pressure in the chest

Diagnosis

Your doctor will listen to your chest with a stethoscope. With pleurisy, the two layers of pleura make a characteristic scratchy sound called a friction rub. To confirm the cause, your doctor may order imaging tests or blood work.

Tests that may be done

• Chest X-ray
• Blood tests to check for infection or inflammation
• An ultrasound or CT scan of the chest
• Sometimes a pleural fluid sample if fluid has built up

What to expect at your appointment

You may be asked to breathe deeply or cough while the doctor listens. The tests are painless and usually take less than 30 minutes. You will likely get results the same day or within a few days.

Treatment

Treatment for pleurisy focuses on the underlying cause and on easing pain. If the cause is viral, rest and pain relief may be all that is needed. For bacterial infections, antibiotics are often prescribed. In all cases, your doctor will advise a plan tailored to your situation.

Self-care at home

• Rest until the sharp pain fades.
• Sleep propped up with pillows to make breathing easier.
• Hold a small pillow against your chest when you cough to reduce pain.
• Drink plenty of warm fluids to keep your throat moist and coughing productive.
• Take pain-relief medicine as recommended by your doctor or pharmacist.

Medical treatments

Your doctor may prescribe medicines to reduce inflammation or to treat a bacterial infection. Oxygen can be given if your blood oxygen levels drop. In some cases, a procedure is needed to drain fluid that has collected in the pleural space. Always follow your doctor’s instructions and complete any prescribed course of treatment.

When is surgery considered?

Surgery is rarely needed for pleurisy. If a large collection of fluid (pleural effusion) or pus builds up, a doctor may insert a small tube into the chest to drain it. Very rare cases of thickened pleura may require surgical removal of the scarred tissue.

Living with this condition

During recovery, listen to your body. Rest is important, but gentle movement as you feel better can help keep your lungs clear. Sleep with extra pillows to keep your chest elevated. Avoid lifting heavy objects and any activity that makes the pain worse.

Lifestyle tips

• Do not smoke and avoid secondhand smoke.
• Wash your hands often to prevent respiratory infections.
• Keep up to date with recommended vaccines, including flu and COVID-19 boosters.
• Manage any chronic conditions, such as asthma or diabetes, with the help of your healthcare team.

Diet and exercise

Eat a balanced diet with plenty of fruits, vegetables, and lean proteins to support your immune system. When you feel ready, short walks are good, but stop if you feel chest pain or shortness of breath. Always check with your doctor before returning to intense exercise.

Mental health and emotional wellbeing

Living with chest pain or breathing changes can be worrying and sometimes frightening. It is normal to feel anxious, frustrated, or low while recovering. Talk to your doctor if these feelings persist—they can connect you with a counsellor or respiratory support service.

Prevention

You cannot always prevent pleurisy, but you can reduce your risk significantly by protecting your lungs and lowering your chances of respiratory infections.

Vaccines

Staying up to date with recommended vaccinations, such as the flu vaccine, pneumonia vaccine, and COVID-19 vaccine, helps prevent infections that can lead to pleurisy. Talk to your doctor or local pharmacy about which vaccines you need.

Screening programmes

There is no routine screening test for pleurisy. If you have a chronic condition that raises your risk, such as an autoimmune disease, regular check-ups with your doctor can help manage inflammation early and prevent complications.

Complications

If left untreated

• Pleural effusion — fluid builds up between the layers of the pleura, which can press on the lungs and cause worse breathlessness.
• Scarring or thickening of the pleura (fibrothorax), which can make it harder for the lungs to expand.
• Spread of infection to the lung tissue itself, leading to pneumonia or a lung abscess.

Long-term outlook

With proper care, most people recover from pleurisy completely. The outcome depends on what caused the inflammation. For viral pleurisy, symptoms usually settle in a few days to weeks. For bacterial or autoimmune causes, treatment of the underlying condition can lead to full healing. Your doctor will guide you on the best path forward.

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