long lasting pleurisy

Overview

Pleurisy (also called pleuritis) is inflammation of the pleura – the thin, double-layered membrane that surrounds your lungs and lines the inside of your chest. When this membrane becomes swollen, the layers can rub against each other, causing sharp chest pain, especially when you breathe, cough, or move. 'Long-lasting' pleurisy means the inflammation doesn't go away quickly and may last for weeks or months.

Pleurisy is fairly common, but long-lasting (chronic) pleurisy is less common. Most people with pleurisy recover within a few weeks once the underlying cause is treated.

Anyone can get pleurisy, but it is more likely in people with lung infections (like pneumonia), autoimmune conditions (such as lupus or rheumatoid arthritis), or those who have had chest surgery or trauma. Long-lasting pleurisy is more often seen in people with ongoing inflammatory conditions or repeated infections.

Symptoms

Common symptoms

• Sharp chest pain that gets worse when you breathe in deeply, cough, sneeze, or laugh
• Pain that may spread to the shoulder or back
• Shortness of breath (because deep breathing hurts)
• Dry cough
• Fever and chills (if caused by infection)
• Feeling generally unwell or tired

Symptoms in children

• Children may not describe chest pain clearly; they might cry, hold their chest, or breathe quickly and shallowly
• Irritability, not wanting to play, or refusing to eat
• Fever and cough are common if an infection is the cause

Symptoms in older adults

• Chest pain may be less sharp and more of a dull ache, making it harder to recognize
• Shortness of breath and confusion can be early signs
• Older adults are more likely to have underlying conditions like pneumonia or heart failure that cause pleurisy

Causes

Main causes

• Lung infections like pneumonia, tuberculosis, or viral infections (such as the flu or COVID-19)
• Autoimmune diseases that cause inflammation throughout the body, such as lupus, rheumatoid arthritis, or sarcoidosis
• Chest injuries or trauma (like a rib fracture or after surgery)
• Blood clots in the lungs (pulmonary embolism)
• Cancer that spreads to the pleura (such as lung cancer or mesothelioma)

Risk factors

• Having a lung infection or recent pneumonia
• Having an autoimmune condition (like lupus, rheumatoid arthritis, or scleroderma)
• Recent chest surgery or trauma to the chest
• Smoking, which weakens the lungs and increases infection risk
• Exposure to asbestos (a material once used in construction) – this can cause a type of pleurisy called pleural plaques or mesothelioma years later

When to see a doctor

See a doctor urgently if:

• If you have chest pain that is severe, sudden, or accompanied by shortness of breath
• If you cough up blood or have a high fever that does not come down with over-the-counter medication
• If you feel faint, very dizzy, or your heart is racing

Book a routine appointment if:

• If you have mild chest pain that lasts more than a few days without getting better
• If you have a low-grade fever and cough that won't go away
• If you have known autoimmune disease and develop new chest pain

Diagnosis

Your doctor will start by asking about your symptoms and medical history, then listen to your chest with a stethoscope. A classic sign of pleurisy is a 'pleural friction rub' – a scratchy sound when you breathe. Further tests help confirm the diagnosis and find the underlying cause.

Tests that may be done

• Chest X-ray – to look for fluid, infection, or other problems in the lungs
• Blood tests – to check for signs of infection or autoimmune activity
• Ultrasound – to see if there is fluid around the lungs (pleural effusion) and guide a needle sample if needed
• CT scan – a more detailed imaging test to look at the lungs and pleura
• Pleural fluid analysis – if fluid is present, a sample is taken to test for infection, cancer, or inflammation

What to expect at your appointment

Most tests are done in a clinic or hospital. The process is usually quick and safe. If a sample of pleural fluid is needed, your doctor will numb the area first. You may feel some pressure but not sharp pain. Results may take a few days. Your doctor will explain what they find and discuss the next steps.

Treatment

Treatment for long-lasting pleurisy focuses on relieving pain and addressing the underlying cause. For infection-related pleurisy, antibiotics or antivirals may be prescribed. For autoimmune causes, treatments that reduce inflammation (like steroids or other immune-modulating medicines) are commonly used. Pain management is important – your doctor may suggest over-the-counter anti-inflammatory medications or prescription pain relievers. In some cases, a procedure to drain fluid from around the lungs can help breathing and reduce pain.

Self-care at home

• Rest and take it easy to let the inflammation settle
• Use heat packs on your chest (not too hot) to help relax muscles and ease pain
• Take over-the-counter pain relievers like ibuprofen or paracetamol – always follow the package instructions and check with your pharmacist if you have other health conditions
• Sleep with extra pillows to keep your upper body raised – this can make breathing easier
• Practice slow, gentle breathing exercises to avoid taking shallow breaths that can lead to lung problems

Medical treatments

Medical treatment depends on the cause. If an infection is to blame, your doctor will prescribe antibiotics or antiviral medicines (only take as directed). For inflammation from autoimmune disease, anti-inflammatory drugs (like non-steroidal anti-inflammatory drugs, or NSAIDs) or steroid tablets are often used to reduce swelling. If fluid builds up, a doctor may drain it using a needle or thin tube (thoracentesis). In persistent cases, medications that calm the immune system (disease-modifying antirheumatic drugs, or DMARDs) may be considered for long-term control. Always follow your doctor's advice and never adjust medications on your own.

When is surgery considered?

Surgery is rarely needed for pleurisy alone. It may be considered if there is a build-up of infected fluid (empyema) that cannot be drained with a needle, or if scarring (pleural thickening) restricts breathing badly. In those cases, a surgeon might remove part of the pleura (pleurectomy) or place a chest tube for drainage. Your doctor will explain if surgery is an option for you.

Living with this condition

Living with long-lasting pleurisy can be challenging due to ongoing pain and tiredness. It's important to pace yourself – do what you can, and rest when you need to. Keep a diary of your symptoms to share with your doctor. Avoid activities that make your chest pain worse, like heavy lifting or strenuous exercise, until you feel better. Slowly increase your activity level as the pain improves.

Lifestyle tips

• If you smoke, seek help to quit – smoking worsens lung problems and delays healing
• Avoid exposure to lung irritants like dust, smoke, and chemical fumes
• Get plenty of rest and good sleep – elevate your head with pillows if lying flat hurts
• Stay on top of your medical appointments and follow your treatment plan

Diet and exercise

Eat a balanced diet rich in fruits, vegetables, and lean proteins to support your immune system. Drink plenty of water to stay hydrated. For exercise, start with gentle activities like short walks or stretching, as long as they don't cause pain. Ask your doctor or a physiotherapist which exercises are safe. Avoid vigorous exercise until the pleurisy has resolved.

Mental health and emotional wellbeing

Living with persistent pain can be stressful and may lead to anxiety or depression. It is normal to feel frustrated or worried. If you are struggling with your emotions, talk to your doctor – they can recommend support. You can also contact a mental health helpline for confidential advice. Remember, you are not alone, and help is available.

Prevention

It is not always possible to prevent pleurisy, especially when it is caused by an autoimmune condition. However, you can lower your risk by treating lung infections early, avoiding smoking, and managing chronic health conditions like lupus or rheumatoid arthritis with your doctor's help.

Vaccines

Getting recommended vaccines – such as the flu shot, pneumonia vaccine, and COVID-19 vaccine – can help prevent some infections that cause pleurisy. Ask your doctor which vaccines are right for you.

Screening programmes

There is no routine screening test for pleurisy. If you have ongoing symptoms like chest pain or cough, see your doctor for evaluation. If you have a condition that increases your risk (like an autoimmune disease), your doctor will monitor you during regular check-ups.

Complications

If left untreated

• Pleural effusion (fluid buildup around the lungs) that can make breathing very difficult
• Empyema (a pocket of infection in the pleural space) requiring drainage or surgery
• Pleural thickening or scarring that can restrict lung expansion and cause long-term breathing problems
• Worsening of the underlying condition (like pneumonia or autoimmune disease)

Long-term outlook

With proper diagnosis and treatment, most people with pleurisy improve. Long-lasting pleurisy can take longer to resolve, but the outlook is generally good when the underlying cause is managed. Working closely with your healthcare team and following your treatment plan can help you feel better and prevent complications. Even in cases where pleurisy is part of a chronic condition, there are many ways to control symptoms and maintain a good quality of life.

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