Introduction

Pleurisy is a condition caused by inflammation of the pleurae (the membrane that surrounds the lungs in the chest).¹

The condition is treatable and usually improves within a few days,² It can happen to anyone, but is more common in people over the age of 65.³ Other factors that make you more likely to develop pleurisy are: scarring or tumours in and around the lungs, having an autoimmune disease, or if you take medications that cause inflammation.¹⁰

Understanding the symptoms and what to do about them can help you get diagnosed and treated quicker.

Symptoms

Chest pain

The most common symptom of pleurisy is a sharp or stabbing pain in the chest (at the place where your lung has become inflamed).¹ This pain usually becomes worse on:

• Moving
• Taking a deep breath
• Sneezing
• Talking
• Coughing

You may find that positioning your body in a certain way improves the pain.^1,2 Taking shallow breaths may also help.³

Cough

Pleurisy can cause a dry cough in some people.³ The sharp chest pain may be worse when coughing.²

Shortness of breath

Dyspnoea, or shortness of breath, can also be a symptom of pleurisy.¹ This can mean that you feel like you are not able to get enough air and can be very frightening. 

Pain elsewhere

The pain may not just be in your chest; it can also spread to your shoulders and back.² This pain can also be worse on:

• Moving
• Taking a deep breath
• Sneezing
• Talking
• Coughing

Fever

Pleurisy may also cause a fever.¹⁰

If you have a temperature of above 38°C, this is considered a fever and the NHS recommends rest and drinking plenty of fluids to help treat this.¹¹ If your fever doesn’t improve after rest and fluids, or if it begins to get worse, it is best to speak to your GP.

Fatigue

If you have pleurisy, you may feel extremely tired (fatigued).^10.Rest is the best treatment for this.

When to seek help?

Most cases of pleurisy will go away by themselves within a few days if you rest. However, it is important that you have an appointment with your GP if:²

• Your pain is present when breathing or coughing, or if it is intermittent (comes and goes)
• You have shortness of breath often
• Your chest pain has not improved within a few days
• You have coughed up blood in streaks, spots or flecks.

You should go to A&E if:²

• You have a very fast heartbeat
• You’re coughing up blood in amounts larger than streaks, spots or flecks
• You’re finding it hard to breathe
• You have chest pain that comes on all of a sudden that lasts longer than 15 minutes
• You have pain which has come on suddenly and spreads to your jaw, arms, back or neck

Causes

Many things can cause pleurisy, most of which are benign though some can be very serious.^1,2 Possible causes include:^{1,2,3,4,5,6,10}

• Viral infection (e.g. the flu)
• Bacterial infection (e.g. pneumonia, tuberculosis)
• Some medications (eg. Ergotamine)
• Pneumothorax (collapsed lung)
• Pericarditis (inflammation of the lining around your heart)
• Myocardial infarction (heart attack)
• Autoimmune disease
• Aftereffects of surgery
• Lung cancer
• Sickle Cell disease
• Blood clot in the lung

Diagnosis

Pleurisy is often diagnosed from your symptoms,³ though your GP will usually perform some tests to rule out other causes for the problems you are having too.

Chest exam

Your doctor will listen to your chest with a stethoscope as pleurisy usually causes a crunchy/dry sound that can be heard on examination.³ 

Chest imaging

Your GP may request that you have a computerised tomography (CT) scan, an X-ray  or an ultrasound to gather images of the inside of your chest.³ 

These tests let your GP rule out or diagnose any serious causes behind the pleurisy.

Blood tests

You may have small amounts of blood taken so that they can be sent away and analysed in a laboratory. 

This analysis will help to find out if there is an infection causing your symptoms.^2,3

Electrocardiogram

This test (known as ECG or EKG) is used to make sure that your chest pain is not being caused by a heart problem. Electrodes are placed on your chest by a trained healthcare professional to monitor how your heart is working.^10,13

This test is usually over very quickly and does not hurt.¹³

Biopsy

A biopsy is when a small part of tissue - in this case, from the lung - is removed and tested for problems. This can be done in the case of pleurisy to make sure there are no unusual causes behind the problem.³

Pleural fluid analysis

There is a small amount of fluid that fills the layers between the membranes that surround your lungs. Sometimes, your medical team will take some of this fluid and have it checked to try and find the cause of problems you may be having.⁷

Thoracoscopy

Thoracoscopy is a method of checking the inside of your chest.

Your doctor will make a very small hole in your skin and use a camera that’s inside a thin, flexible tube to look inside your chest.¹⁴ This can take up to an hour and most patients can go home on the same day.¹⁴

Treatment

There are several treatments for pleurisy. Which one you and your doctor decide to use will depend on the cause of the problem.

Treating the underlying cause

If the cause of your symptoms is a bacterial infection, you may be put on antibiotics to help you recover.³ If it is caused by something else, such as an autoimmune disease, your doctor may treat this problem to help improve the pleurisy symptoms.¹⁰

If you are very ill, or already have other underlying health conditions, you may be admitted into hospital so that your medical team can monitor you closely.

Pain management

Non-steroidal anti-inflammatory drugs (NSAIDs) are the most common way of controlling pain caused by pleurisy.³

If NSAIDs do not do enough to keep the pain manageable, narcotic analgesics (eg. morphine, codeine) may be prescribed. However, these can dampen the cough reflex and can be addictive and so are prescribed less often.¹

Rest

Pleurisy usually improves very quickly - within a few days - without any treatment.² If the problem is caused by a viral infection, resting while your body takes care of the infection itself is usually enough.³

Often people find there is a resting position which is more comfortable than others. Rest in this position, and try to take it easy even when you start to feel better.⁸

If you have a fever, it is recommended that you rest and drink lots of water so that you do not become dehydrated.¹¹

Thoracentesis

If it’s needed, your doctor may drain fluid from your lungs to help improve the pain.¹⁰

In this procedure, after your skin has been cleaned and you have been given painkillers, a needle is put in through your back and used to remove the fluid from between your lungs and your ribcage. This usually takes between 10-30 minutes.¹² 

Stop Smoking 

Smoking causes irritation to your lungs which can make you feel worse if you develop symptoms of pleurisy.⁸

Stopping smoking can be extremely difficult. Fortunately, there are services that can help you to stop - in fact, using these services improves your chances of stopping for good.⁹

You can ask your GP, pharmacist or other health professionals to guide you towards stop smoking help.

Preventing Pleurisy

There are certain steps you can take to reduce the chances that you will develop pleurisy. These include:¹⁰

• Washing your hands regularly to avoid catching infections
• Not smoking
• Treating underlying health issues (lung problems or autoimmune diseases)

Summary

The most common symptoms of pleurisy are:

• Stabbing pain in the chest which is worse on deep breathing or movement
• Dry cough
• Feeling short of breath

Other symptoms include:

• Fever
• Fatigue

Most pleurisy will go away by itself within a few days if you rest. However, it is important that you have an appointment with your GP if:

• Your pain is present when breathing or coughing, or if it is intermittent (comes and goes)
• You have shortness of breath often
• Your chest pain has not improved within a few days
• You have coughed up blood in streaks, spots or flecks.

You should go to A&E if:

• You have a very fast heartbeat
• You’re coughing up blood in amounts larger than streaks, spots or flecks
• You’re finding it hard to breathe
• You have chest pain that comes on all of a sudden that lasts longer than 15 minutes
• You have pain which has come on suddenly and spreads to your jaw, arms, back or neck

Pleurisy can be very painful, but fortunately it can be treated and usually does not last long. However, it can be a sign of more serious conditions and therefore it’s important to allow your GP to check you over to rule out underlying problems.