pleurisy that worsens lying down

Overview

Pleurisy (pronounced PLUR-uh-see) is swelling and irritation of the lining around your lungs. This lining is called the pleura. When it becomes inflamed, it can cause sharp chest pain, especially when you breathe deeply, cough, or lie down. Many people notice the pain gets worse when they lie flat on their back or on the side with the sore area.

Pleurisy is not extremely common, but it affects many people each year. It can happen at any age and is often a complication of another illness, like a chest infection.

Pleurisy can affect anyone, but it is more common in people who have lung infections, autoimmune diseases (like lupus or rheumatoid arthritis), or blood clots in the lungs. It can occur in children, adults, and older adults.

Symptoms

Common symptoms

• Sharp chest pain that gets worse when you breathe in deeply, cough, sneeze, or lie down
• Pain that may spread to your shoulder or back
• Feeling short of breath (breathlessness)
• Dry cough
• Fever or chills if there is an infection

Symptoms in children

• Chest pain that may be harder for a child to describe, often shown as fussiness or holding the chest
• Rapid breathing or working hard to breathe
• Fever
• Not wanting to eat or drink

Symptoms in older adults

• Similar sharp chest pain, but may be less intense due to age-related changes
• Increased shortness of breath
• Confusion or dizziness if oxygen levels are low
• Fatigue or weakness

Causes

Main causes

• Viral infections, like the flu or a cold (most common cause)
• Bacterial infections, such as pneumonia or tuberculosis
• A blood clot in the lung (pulmonary embolism)
• Autoimmune diseases, like lupus or rheumatoid arthritis
• Injury to the chest, like a rib fracture
• Certain medicines or reactions to drugs

Risk factors

• Having a lung infection or recent chest cold
• A history of autoimmune disease
• Surgery or injury to the chest area
• Being bedridden or not moving for long periods (risk for blood clots)
• Cancer that has spread to the lungs or pleura

When to see a doctor

See a doctor urgently if:

• If you have chest pain that is severe, getting worse, or feels like a heart attack
• If you have trouble breathing or feel short of breath at rest
• If you have a high fever with chest pain

Book a routine appointment if:

• If you have mild chest pain when breathing that lasts more than a few days
• If you had pleurisy before and it is coming back
• If you have a dry cough that won't go away

Diagnosis

Your doctor will ask about your symptoms and do a physical exam. They will listen to your lungs with a stethoscope. A classic sign of pleurisy is a scratching sound called a pleural rub, which is made when the inflamed pleura rub together.

Tests that may be done

• Chest X-ray – to look for fluid, infection, or other problems
• Blood tests – to check for infection or autoimmune markers
• Ultrasound of the chest – to see fluid around the lungs
• CT scan – a more detailed picture of your lungs and pleura
• Electrocardiogram (ECG) – to rule out heart problems

What to expect at your appointment

Most tests are quick and painless. You may need to undress from the waist up and wear a gown. A chest X-ray takes only a few minutes. Your doctor will explain each test and what they are looking for. If you have a lot of fluid around the lung, you may need a procedure to drain it.

Treatment

Treatment for pleurisy focuses on the cause and on relieving the pain. Pleurisy itself often heals once the underlying problem is treated. Your doctor will recommend the right approach based on your specific situation.

Self-care at home

• Rest and avoid activities that make the pain worse, like heavy lifting or strenuous exercise
• Sleep propped up with pillows to make breathing easier and reduce pain when lying down
• Apply a warm compress or heating pad to your chest for 15–20 minutes at a time (wrapped in a cloth to prevent burns)
• Take over-the-counter pain relievers like ibuprofen or acetaminophen, but only as directed and after checking with your doctor
• Practice deep breathing exercises as tolerated to prevent pneumonia

Medical treatments

Depending on the cause, doctors may prescribe anti-inflammatory medicines (like NSAIDs) to reduce swelling and pain. If an infection is present, you may need antibiotics or antiviral medicines. For autoimmune causes, steroids or other immune-modulating drugs may be used. If there is a blood clot, blood-thinning medicine is given. If fluid collects around the lung (pleural effusion), the fluid may be drained using a needle or a chest tube.

When is surgery considered?

Surgery is rarely needed for pleurisy. In very rare cases, if the pleura becomes thick and scarred (called a fibrothorax) or if infection cannot be cleared, a procedure called decortication may be done to remove the inflamed lining.

Living with this condition

While you recover, take it easy. Listen to your body and rest when you need to. Sleeping with extra pillows can help reduce pain when lying down. Keep a diary of your symptoms to show your doctor.

Lifestyle tips

• Avoid smoking and secondhand smoke, as these irritate your lungs
• Stay up to date with flu and pneumonia vaccines to prevent infections
• Avoid close contact with people who have colds or the flu

Diet and exercise

Eat a balanced diet with plenty of fruits and vegetables to support your immune system. Stay hydrated with water. Gentle movement, like short walks, may help your breathing, but avoid any activity that causes chest pain. Ask your doctor when it is safe to return to exercise.

Mental health and emotional wellbeing

Having chest pain can be worrying. It is normal to feel anxious or stressed. Talk to your doctor about your concerns. If you feel overwhelmed, ask for support from a counselor or mental health professional.

Prevention

Pleurisy itself cannot always be prevented, but you can reduce your risk by taking care of your lungs and treating infections early.

Vaccines

Vaccines for the flu and pneumococcal pneumonia can help prevent some infections that lead to pleurisy. Ask your doctor if these are right for you.

Screening programmes

There is no routine screening for pleurisy. If you have an autoimmune condition, regular checkups with your specialist can help catch pleurisy early.

Complications

If left untreated

• Pleural effusion – a buildup of fluid around the lung that can make breathing harder
• Empyema – a pocket of pus in the pleural space that needs drainage
• Pneumothorax – a collapsed lung from air leakage
• Chronic pleurisy – long-term inflammation and scarring of the pleura

Long-term outlook

Most people with pleurisy recover fully with treatment. The chest pain usually improves within a few days to weeks once the cause is addressed. Even if fluid is present, it often goes away on its own or with drainage. With proper care, you can return to your normal activities. Your doctor will help you manage any underlying conditions to prevent it from coming back.

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