What is pleurisy?

Pleurisy (PLOOR-ih-see) or pleuritis is the inflammation of the pleura. The pleura are the two thin layers of tissue surrounding the lungs and lining the chest cavity. Pleurisy can be caused by viral infections, bacterial infections, lung diseases, chest injuries, or autoimmune conditions. One of the most frequent causes of pleurisy is viral infection.¹

Influenza, responsible for the common flu and respiratory syncytial virus are among the viruses connected as causal agents. These viruses primarily infect the respiratory tract but can extend to the pleura, leading to pleurisy. The hallmark of this condition is a strong chest ache (pleuritic pain) that gets worse when you breathe, cough, or sneeze. Pain caused by pleurisy might worsen with movement of your upper body and can spread to your shoulders or back.

Treatment of viral pleurisy focuses on symptomatic management and addressing the underlying viral infection. Preventing viral pleurisy involves vaccination, infection control measures, and public health initiatives. Annual influenza vaccines significantly reduce the risk of flu-related pleurisy, and ongoing research aims to develop effective respiratory syncytial virus (RSV) vaccines.²

Risk factors for pleurisy

Numerous illnesses and lifestyle decisions are risk factors for pleurisy.

• Respiratory infections: Viral diseases such as influenza and RSV, as well as bacterial infections like TB and pneumonia
• Chronic lung diseases: COPD and poorly managed asthma 
• Autoimmune diseases: Lupus and rheumatoid arthritis
• Trauma and injuries to the chest: Thoracic surgery and blunt trauma to the chest
• Smoking: Use of tobacco harms the respiratory system
• Occupational and environmental exposures: Asbestos exposure and extended exposure to poisons and pollutants
• Conditions: Malignancy and pulmonary embolism
• Age and immunocompromised status: Older people and those with compromised immune systems
• Family history: Genetic susceptibility to lung disorders or autoimmune diseases

Understanding these risk factors facilitates the early detection and treatment of pleurisy.

Pathophysiology of pleurisy

When viruses like the respiratory syncytial virus (RSV) or influenza are inhaled and infect the upper respiratory tract, they travel to the lower respiratory tract and the pleura, causing pleurisy. As the virus undergoes replication, the immune system is activated and pleural tissues sustain direct injury. Inflammatory mediators are released by this immune response, which causes inflammation and heightened vascular permeability.

Pleural effusion is the result of fluid, proteins, and immune cells seeping into the pleural space.^3,4 Breathing, coughing, or sneezing exacerbates the intense, stabbing chest discomfort caused by the inflammation rubbing against the pleura. Other signs and symptoms include tiredness, fever, and muscle soreness. 

Diagnosis and treatment 

A comprehensive clinical evaluation, including a history and physical examination, is necessary to diagnose viral pleurisy. Key symptoms include fever, coughing, and acute chest pain. Diagnostic procedures that help confirm the diagnosis and pinpoint the precise virus causing it include pleural fluid analysis, viral cultures, blood tests, CT scans, and chest X-rays.

The goal of treating viral pleurisy is to treat the underlying viral illness and manage the symptoms. Common methods include admission of NSAIDs or paracetamol for pain relief and antipyretics to lower fever.⁶ When certain antiviral medications are available, antiviral therapy is employed, such as oseltamivir for influenza. Since there are no particular antiviral medications for RSV, supportive care is the cornerstone of treatment for this virus. Adequate rest, hydration, and respiratory support, such as oxygen, are further supporting interventions.⁵

How can I reduce my risk of pleurisy?

Preventing pleurisy involves several key strategies:

• Vaccination: Pneumococcal vaccinations, annual flu injections, and RSV prophylaxis for high-risk individuals
• Good hygiene habits: leaning your hands frequently, using hand sanitizers, and covering your mouth and nose when you cough or sneeze
• Preventing infections: Avoiding sick people and according to public health advisories when there is an outbreak
• A healthy lifestyle: Eating a balanced diet, getting regular exercise, and getting enough sleep to boost the immune system
• Handling chronic conditions: Controlling COPD and asthma well, as well as giving up smoking to enhance lung function
• Prompt infection treatment: To avoid complications like pleurisy, get medical assistance for respiratory infections as soon as possible and follow prescribed treatment plans

FAQs

Does pleurisy resolve itself?

Pleurisy may sometimes go away on its own, particularly if a minor viral illness is the underlying reason. To guarantee appropriate management and avoid problems, medical examination and therapy are crucial.

Is lying down worse for pleurisy?

Yes, lying down can make pleurisy worse. The position may put more strain on the pleura, which exacerbates the pain. Getting into a comfortable posture, such as sitting up straight, could help ease the pain.

Does pleurisy spread easily?

Although the actual form of pleurisy is not communicable, its causative illnesses, like the flu or RSV, can be. To stop the spread of these infections, maintain proper hygiene and stay away from people who are infected.

Is COVID-19 associated with pleurisy?

Pleurisy is one of the respiratory problems that COVID-19 can induce. Pleuritic discomfort and other symptoms resembling those of common respiratory illnesses can be brought on by the virus's inflamed pleura.

Summary

The inflammation of the pleura, the tissue that surrounds the lungs and chest cavity, is known as pleurisy or pleuritis. Viral infections including the respiratory syncytial virus (RSV) and influenza are common causes of pleurisy. These viruses mostly affect the respiratory system, but they can also move to the pleura and cause acute chest pain that gets worse when you breathe, cough, or sneeze. A family history of lung illnesses, ageing, smoking, respiratory infections, autoimmune diseases, chest injuries, and environmental exposures are risk factors.

Diagnostic procedures include imaging and pleural fluid investigation in addition to clinical examination. The goals of treatment are to manage the underlying illness and relieve symptoms. Painkillers and, where available, antiviral medication are used in this regard. Vaccinations, proper cleanliness, avoiding infections, leading a healthy lifestyle, and managing chronic illnesses are examples of preventive actions.