pleurisy that comes and goes

Overview

Pleurisy (pronounced PLUR-uh-see) is inflammation (swelling) of the pleura, the thin tissue that lines your chest wall and covers your lungs. When the pleura is inflamed, the two layers rub together, causing sharp pain, especially when you breathe deeply, cough, or sneeze. 'Comes and goes' means the pain and other symptoms appear in episodes, with symptom-free periods in between.

Pleurisy that comes and goes is not as common as a single episode of pleurisy, but it happens. It is often seen in people who have an autoimmune condition or have had repeated chest infections.

Pleurisy can affect anyone at any age, but recurrent pleurisy is more common in adults, especially those with autoimmune diseases, a history of chest infections, or who smoke.

Symptoms

Common symptoms

• Sharp, stabbing chest pain that gets worse when you breathe in, cough, or move
• Pain that may spread to your shoulder or back
• Shortness of breath or shallow breathing to avoid the pain
• Dry cough or cough with mucus sometimes
• Fever or chills if an infection is present

Symptoms in children

• Children may have trouble describing the pain – look for crying, fussiness, or holding their chest.
• Rapid, shallow breathing or grunting sounds when breathing.
• Not wanting to play or eat as usual.
• Fever, especially if the cause is an infection.

Symptoms in older adults

• Pain may be less sharp and feel like a dull ache or tightness.
• Confusion, fatigue, or weakness may be the main signs.
• Shortness of breath that seems out of proportion to the pain.
• Older adults may not run a high fever even with infection, so watch for other changes.

Causes

Main causes

• Viral infections – like flu, common cold, or Coxsackievirus (which causes hand, foot, and mouth disease).
• Bacterial infections – for example, pneumonia or tuberculosis.
• Autoimmune diseases – such as lupus, rheumatoid arthritis, or sarcoidosis, where the immune system attacks healthy tissue.
• Pulmonary embolism – a blood clot in the lung, which can cause pleuritic pain.
• Chest injuries or surgery affecting the ribs or lungs.
• Cancer – lung cancer or mesothelioma can cause recurrent pleurisy, but this is less common.

Risk factors

• Recent respiratory infection, like a cold or the flu.
• Having an autoimmune disease or family history of one.
• Smoking or long-term exposure to second-hand smoke.
• Weakened immune system due to medications or health conditions.
• Blood clotting disorders or recent long-distance travel (increases risk of pulmonary embolism).

When to see a doctor

See a doctor urgently if:

• If you have chest pain that is severe, sudden, or accompanied by trouble breathing.
• If you cough up blood or notice blue lips or fingertips.
• If you have a fast heartbeat or feel dizzy.

Book a routine appointment if:

• If you have had pleurisy symptoms more than once and want to find out why.
• If you have a fever that lasts more than a week.
• If you have a known autoimmune condition and notice new chest pain.

Diagnosis

Your doctor will start by asking about your symptoms and medical history, then listen to your chest with a stethoscope. They may hear a grating sound called a 'pleural rub' when you breathe. From there, they will order tests to find the cause.

Tests that may be done

• Chest X-ray – to look for fluid, infection, or lung changes.
• Blood tests – to check for signs of infection or autoimmune conditions.
• CT scan – for a more detailed picture of the chest.
• Ultrasound – to see if there is fluid around the lungs (pleural effusion).
• Pleural fluid analysis – if fluid is present, a sample may be taken to test for infection, cancer, or other conditions.

What to expect at your appointment

Most tests are painless. If a pleural fluid sample is needed, a small needle is used to draw fluid from the chest area (thoracentesis). This is done with local anaesthetic so you stay awake but feel no sharp pain. Results can take a day or two, and your doctor will explain what they mean.

Treatment

Treatment for pleurisy that comes and goes focuses on managing pain and treating the underlying cause. Most cases resolve without long-term problems, especially if the cause is a viral infection.

Self-care at home

• Rest and avoid activities that make the pain worse, like heavy lifting or vigorous exercise.
• Take pain relief as recommended by your pharmacist or doctor – non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used, but always follow the instructions.
• Apply a warm compress to your chest to ease discomfort.
• Practice slow, deep breathing exercises when the pain settles to keep your lungs healthy.

Medical treatments

Doctors may prescribe anti-inflammatory medicines (such as NSAIDs) to reduce swelling and pain. If the cause is an infection, antibiotics or antiviral medicines may be given. For autoimmune conditions, treatments that calm the immune system, such as corticosteroids or disease-modifying antirheumatic drugs, can help prevent recurrences. Always take medicines exactly as prescribed.

When is surgery considered?

Surgery is rarely needed for pleurisy. It may be considered if there is a complication like empyema (a pocket of pus) that does not drain with a needle, or if a severe scar-like condition develops between the pleura layers (called decortication). Your doctor will discuss if surgery is an option for you.

Living with this condition

During a flare-up, take it easy and listen to your body. Pain can make you breathe shallowly, so consciously take gentle deep breaths when you can to prevent lung infections. Between episodes, try to stay as active as your health allows.

Lifestyle tips

• If you smoke, consider stopping – smoking irritates the lungs and can make pleurisy worse.
• Manage stress with relaxation techniques like meditation or gentle yoga.
• Keep up with regular medical check-ups, especially if you have an autoimmune condition.

Diet and exercise

Eat a balanced diet rich in fruits, vegetables, and whole grains to support your immune system. Gentle exercise like walking or stretching is good when you are pain-free. Avoid high-impact activities that jolt your chest until you have your doctor’s approval.

Mental health and emotional wellbeing

Chest pain that keeps coming back can be worrying and can cause anxiety or low mood. It is normal to feel frustrated or scared. Talking to your doctor or a mental health professional can help. Remember that most causes of pleurisy are treatable.

Prevention

Not always, but you can lower your risk. Getting vaccinated against the flu and pneumonia can prevent infections that sometimes lead to pleurisy. If you have an autoimmune condition, following your treatment plan can help keep flares under control.

Vaccines

Flu vaccine given every year and the pneumonia vaccine (ask your doctor if you need it) can help protect against infections that may trigger pleurisy.

Screening programmes

There is no routine screening for pleurisy itself. However, if you have risk factors like smoking or a family history of lung disease, your doctor may recommend periodic chest check-ups.

Complications

If left untreated

• Pleural effusion – fluid building up around the lung, which can cause more pain and shortness of breath.
• Empyema – the fluid becomes infected and turns into pus, requiring drainage.
• Pleural thickening or scarring – the pleura becomes stiff, which can limit how well your lungs expand.
• Respiratory failure – in very severe cases, if the lung cannot expand enough to get oxygen.

Long-term outlook

For the vast majority of people, pleurisy that comes and goes gets better with the right treatment. The outlook depends on the underlying cause, but most causes are manageable. With proper care, you can expect to return to your normal activities and keep symptoms under control.

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