pleurisy with nausea

Overview

Pleurisy (PLOO-ree-see) is swelling and irritation of the pleura, the thin layers of tissue that line your lungs and the inside of your chest. This inflammation causes sharp chest pain that gets worse when you breathe, cough, or sneeze. Sometimes pleurisy can also make you feel sick to your stomach (nausea).

Pleurisy is not extremely common, but it is a well-known condition. It often happens as a complication of another illness, such as a chest infection or pneumonia.

Pleurisy can affect people of any age, but it is more common in adults. People with lung infections, autoimmune diseases (like lupus), or a history of blood clots in the lungs are at higher risk.

Symptoms

Common symptoms

• Sharp, stabbing chest pain that worsens when you breathe deeply, cough, or sneeze
• Pain that may spread to your shoulder or back
• Shortness of breath or shallow breathing to avoid pain
• Dry cough
• Fever and chills (if there is an infection)
• Nausea or feeling sick to your stomach

Symptoms in children

• Children may have the same chest pain as adults, but they might describe it as a 'stitch' or 'hurt when I breathe'.
• They may breathe faster or shallower to avoid pain.
• Nausea and vomiting can happen, especially if there is a fever or infection.
• Children with pleurisy often seem irritable and may not want to eat.

Symptoms in older adults

• Older adults may have less obvious chest pain and might just feel generally unwell, breathless, or confused.
• Nausea can be more common, and they may lose their appetite.
• Fever might be lower or absent even with infection.
• They are at higher risk of complications like pneumonia or respiratory failure, so prompt medical attention is important.

Causes

Main causes

• Viral infections, such as the flu or a common cold
• Bacterial infections, especially pneumonia or tuberculosis
• Autoimmune diseases, like lupus, rheumatoid arthritis, or an inflammatory condition called sarcoidosis
• Blood clot in the lung (pulmonary embolism)
• Injury to the chest, such as a rib fracture or surgery
• Reaction to certain medications (rare)
• Cancer that spreads to the pleura (very rare)

Risk factors

• Having a lung infection like pneumonia or bronchitis
• A recent chest injury or surgery
• Autoimmune conditions like lupus or rheumatoid arthritis
• Being immobile for long periods (increases risk of blood clots)
• Smoking or exposure to secondhand smoke
• A history of blood clots or deep vein thrombosis (DVT)

When to see a doctor

See a doctor urgently if:

• If you have chest pain that makes it hard to breathe or that comes on suddenly
• If you have a high fever along with chest pain
• If you are vomiting and cannot keep fluids down

Book a routine appointment if:

• If you have a mild, persistent chest pain that gets worse with breathing, even without a fever
• If you have pleurisy symptoms that do not improve with home care after a few days
• If you have a chronic condition like lupus and develop new chest pain

Diagnosis

Your doctor will ask about your symptoms, listen to your chest with a stethoscope, and may order tests to find the cause. They will check for a grating or rubbing sound when you breathe, which is a classic sign of pleurisy.

Tests that may be done

• Chest X-ray – to check for pneumonia, air leaks, or fluid around the lungs
• Blood tests – to look for signs of infection or inflammation
• CT scan – a detailed scan that gives a clearer picture of the chest
• Pleural ultrasound – to see if there is fluid around the lungs
• If fluid is present, a sample may be taken (thoracentesis) to test for infection or cancer

What to expect at your appointment

The diagnosis process is usually quick. You may need to have a chest X-ray or other imaging. If fluid is found, a small needle may be used to remove some fluid for testing. This is done with local numbing and takes only a few minutes.

Treatment

Treatment for pleurisy focuses on relieving pain and treating the underlying cause. Most people recover at home with rest and medication, but some may need hospital care if the cause is serious.

Self-care at home

• Rest and avoid activities that make your breathing painful
• Take over-the-counter pain relievers such as paracetamol or ibuprofen (always read the label and check with your doctor if you have other health conditions)
• Apply a warm compress to your chest to ease discomfort
• Sleep in a semi-upright position to make breathing easier
• Avoid smoking and secondhand smoke

Medical treatments

Doctors may prescribe stronger pain relief or anti-inflammatory medications. If the cause is a bacterial infection, you will be given antibiotics. For autoimmune-related pleurisy, medications that reduce inflammation (like corticosteroids) may be used. If a blood clot is the cause, blood-thinning medication may be prescribed. Always follow your doctor's advice and do not stop medications without consulting them.

When is surgery considered?

Surgery is rarely needed for pleurisy itself. It may be necessary if there is a large collection of fluid that needs to be drained (e.g., via a chest tube) or if there is a complication such as a pleural effusion that becomes infected (empyema).

Living with this condition

During the acute phase, you may need to take it easy and avoid strenuous activity. Once the pain improves, you can slowly return to your normal routine. It is important to finish any prescribed treatments and attend follow-up appointments.

Lifestyle tips

• Get plenty of rest while you recover
• Avoid smoking and exposure to irritants like dust or chemicals
• Practice deep breathing exercises gently to keep your lungs expanded (as advised by your doctor)
• Stay up to date with vaccinations, especially the flu vaccine and pneumonia vaccine

Diet and exercise

Eat a balanced diet with plenty of fruits and vegetables to support your immune system. Stay hydrated. Once you feel better, gentle exercise like walking can help strengthen your lungs, but wait until the pain resolves completely. Check with your doctor before starting any new exercise.

Mental health and emotional wellbeing

Living with chest pain and nausea can be stressful. It is normal to feel anxious or worried. If you find it affecting your mood or sleep, talk to your healthcare provider. They can help you find support or refer you to a counsellor if needed.

Prevention

Pleurisy cannot always be prevented, but you can reduce your risk by promptly treating infections and managing underlying conditions. Avoiding smoking and getting vaccinated can also help.

Vaccines

Yes, getting the seasonal flu vaccine and the pneumonia vaccine can help prevent some infections that lead to pleurisy. Talk to your doctor about which vaccines are right for you.

Screening programmes

There is no routine screening for pleurisy. It is usually diagnosed when symptoms appear. However, if you have a condition that increases your risk (like lupus), your doctor will monitor you closely.

Complications

If left untreated

• Pleural effusion – fluid builds up around the lung, which can make breathing harder
• Empyema – a pocket of pus around the lung that needs drainage
• Lung scarring (rare)
• Breathing difficulties that may require hospital care
• Spread of infection to other parts of the body if the cause is bacterial

Long-term outlook

With proper treatment, most people with pleurisy recover fully within a few days to a couple of weeks. The outlook depends on the underlying cause, but even serious causes like bacterial infection are usually treatable. It is important to seek medical care early to avoid complications.

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