Pleurisy worse lying down. Pleurisy: Symptoms, Diagnosis, and Treatment in General Practice

17.05.202121.07.2023 by alexxlab

What are the main symptoms of pleurisy. How is pleurisy diagnosed in general practice. What are the most effective treatments for pleurisy. When should someone with pleurisy seek urgent medical care. What complications can arise from untreated pleurisy.

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Understanding Pleurisy: An Overview of the Condition

Pleurisy, also known as pleuritis, is an inflammatory condition affecting the pleura – the thin membrane that lines the chest cavity and covers the lungs. This condition can cause significant discomfort and pain, particularly when breathing deeply or coughing. But what exactly happens in the body when pleurisy develops?

In a healthy respiratory system, the pleural layers provide a smooth surface allowing the lungs to glide effortlessly within the chest cavity during breathing. However, when inflammation occurs, these layers become irritated and swollen, leading to friction between the lungs and chest wall. This friction is the primary cause of the characteristic sharp chest pain associated with pleurisy.

Is pleurisy always accompanied by fluid buildup? Not necessarily. While some cases involve fluid accumulation between the pleural layers (known as pleural effusion), others present as “dry pleurisy” without fluid. Understanding these distinctions is crucial for accurate diagnosis and appropriate treatment.

Recognizing the Signs: Key Symptoms of Pleurisy

Identifying pleurisy early can lead to prompt treatment and improved outcomes. What are the telltale signs that someone might be suffering from this condition?

Sharp chest pain, especially when breathing deeply or coughing
Pain that may worsen with movement or extend to the shoulders and back
Shortness of breath or rapid, shallow breathing
Dry cough
Fever (in some cases)

One distinctive feature of pleurisy is how the pain changes with body position. Many patients report that lying down exacerbates their discomfort, while sitting up or leaning forward may provide some relief. This phenomenon is due to the increased pressure on the inflamed pleura when in a recumbent position.

Pleurisy Causes: From Infections to Autoimmune Disorders

Pleurisy can arise from various underlying conditions. What are the most common culprits behind this inflammatory process?

Viral infections (e.g., influenza, COVID-19)
Bacterial infections (e.g., pneumonia, tuberculosis)
Autoimmune diseases (e.g., lupus, rheumatoid arthritis)
Pulmonary embolism
Chest injuries or trauma
Certain medications
Exposure to toxins (e.g., asbestos)
Cancers affecting the lungs or pleura

Understanding the underlying cause is crucial for effective treatment. In some cases, pleurisy may be a symptom of a more serious condition that requires immediate medical attention.

Diagnosing Pleurisy: Tools and Techniques in General Practice

How do healthcare providers diagnose pleurisy in a general practice setting? The process typically involves a combination of clinical assessment and diagnostic tests:

Physical examination: The doctor will listen to the patient’s lungs with a stethoscope, often detecting a characteristic “friction rub” sound.
Medical history: Understanding the patient’s symptoms, their duration, and any potential risk factors is crucial.
Chest X-ray: This imaging test can reveal signs of inflammation, fluid accumulation, or underlying lung conditions.
Blood tests: These can help identify infections or inflammatory markers.
CT scan: For more detailed imaging, especially if a pulmonary embolism is suspected.
Ultrasound: Useful for detecting and measuring pleural effusions.
Thoracentesis: In cases of pleural effusion, a sample of the fluid may be extracted for analysis.

Are these diagnostic procedures always necessary? Not always. In many cases, a thorough physical exam and patient history may be sufficient for diagnosis, especially in mild cases or when the cause is apparent (such as a recent viral infection).

The Role of Differential Diagnosis

Given that chest pain can be a symptom of various conditions, including some life-threatening ones, healthcare providers must consider a range of possible diagnoses. This process, known as differential diagnosis, helps ensure that serious conditions like heart attacks or pulmonary embolisms are not overlooked.

Treatment Approaches: Managing Pleurisy in General Practice

Once pleurisy is diagnosed, what treatment options are available? The approach to managing pleurisy often depends on its underlying cause and severity:

Pain management: Over-the-counter pain relievers like ibuprofen or naproxen can help alleviate discomfort and reduce inflammation.
Rest: Allowing the body time to heal is crucial, especially in cases caused by viral infections.
Antibiotics: If a bacterial infection is the cause, appropriate antibiotic therapy will be prescribed.
Corticosteroids: In some cases, particularly those related to autoimmune conditions, corticosteroids may be used to reduce inflammation.
Treating underlying conditions: Addressing the root cause, whether it’s an autoimmune disorder or another chronic condition, is essential for long-term management.
Drainage: In cases of significant pleural effusion, draining the excess fluid may be necessary to relieve symptoms and prevent complications.

How long does it typically take for pleurisy to resolve? In many cases, particularly those caused by viral infections, symptoms may improve within a few days to two weeks with appropriate treatment and rest. However, recovery time can vary depending on the underlying cause and the individual’s overall health.

When to Seek Urgent Care: Recognizing Serious Symptoms

While many cases of pleurisy can be managed effectively in general practice, certain symptoms warrant immediate medical attention. When should a patient with suspected pleurisy seek urgent care?

Severe chest pain that doesn’t improve with over-the-counter pain relievers
Difficulty breathing or shortness of breath that worsens
High fever (above 39°C or 102.2°F)
Coughing up blood
Signs of infection, such as increased mucus production or change in mucus color
Unexplained weight loss or night sweats

These symptoms could indicate a more serious underlying condition or complications from pleurisy that require immediate evaluation and treatment.

Complications and Long-Term Outlook: What Patients Should Know

While many cases of pleurisy resolve without significant complications, it’s important for patients to understand potential risks and long-term considerations. What complications can arise from pleurisy, and how might they impact a patient’s prognosis?

Pleural adhesions: Scar tissue can form between the pleural layers, potentially causing chronic pain or breathing difficulties.
Empyema: A serious complication where pus accumulates in the pleural space, often requiring drainage and intensive antibiotic treatment.
Atelectasis: Partial collapse of a lung due to fluid accumulation or restricted lung expansion.
Fibrothorax: Severe scarring of the pleura that can permanently reduce lung function.

Can pleurisy recur? Yes, particularly if the underlying cause is not adequately addressed or if the patient has a chronic condition predisposing them to inflammation. This underscores the importance of comprehensive treatment and follow-up care.

Long-Term Management and Prevention

For patients who have experienced pleurisy, particularly those with underlying chronic conditions, ongoing management may be necessary. This might include:

Regular check-ups to monitor lung function
Adhering to treatment plans for underlying conditions
Lifestyle modifications, such as quitting smoking or avoiding environmental irritants
Vaccination against pneumococcal disease and influenza to prevent infections that could lead to pleurisy

Pleurisy in Special Populations: Considerations for High-Risk Groups

Certain populations may be at higher risk for developing pleurisy or experiencing more severe complications. How does the approach to diagnosis and treatment differ for these groups?

Elderly Patients

Older adults may present with atypical symptoms, making diagnosis more challenging. They are also more likely to have underlying health conditions that complicate treatment. Special considerations for this group include:

Careful medication management to avoid interactions with existing prescriptions
Close monitoring for complications, as older adults may have reduced physiological reserves
Emphasis on early mobilization to prevent deconditioning and secondary complications

Immunocompromised Individuals

Patients with weakened immune systems, such as those undergoing chemotherapy or living with HIV/AIDS, are at increased risk for infections that can lead to pleurisy. For these patients:

Aggressive diagnostic workup may be necessary to identify the underlying cause
Prophylactic antibiotic therapy might be considered in certain cases
Close collaboration with specialists (e.g., infectious disease experts) is often required

Pregnant Women

Diagnosing and treating pleurisy in pregnant women requires careful consideration of both maternal and fetal health. Key points include:

Limited use of imaging studies to minimize radiation exposure to the fetus
Careful selection of medications that are safe during pregnancy
Monitoring for potential impacts on fetal development and pregnancy outcomes

By understanding these special considerations, healthcare providers can tailor their approach to ensure optimal outcomes for all patients, regardless of their unique circumstances or risk factors.

Emerging Research and Future Directions in Pleurisy Management

As medical science advances, new insights into the pathophysiology of pleurisy and innovative treatment approaches continue to emerge. What are some of the promising areas of research that could shape future management strategies?

Biomarkers for Rapid Diagnosis

Researchers are exploring the potential of biomarkers that could allow for quicker and more accurate diagnosis of pleurisy and its underlying causes. This could lead to:

Point-of-care testing for faster diagnosis in general practice settings
Improved ability to differentiate between infectious and non-infectious causes
Earlier initiation of targeted treatments

Novel Anti-Inflammatory Agents

The development of new anti-inflammatory medications with fewer side effects could revolutionize pleurisy treatment. Areas of focus include:

Targeted therapies that reduce pleural inflammation without systemic effects
Biologics that modulate specific inflammatory pathways
Nanoparticle-based drug delivery systems for enhanced efficacy

Advanced Imaging Techniques

Innovations in medical imaging may provide more detailed insights into pleural pathology, potentially leading to:

Earlier detection of subtle pleural changes
Improved ability to monitor treatment response
Enhanced guidance for interventional procedures

As these research areas progress, general practitioners may find themselves equipped with new tools and strategies to manage pleurisy more effectively, potentially improving patient outcomes and quality of life.

In conclusion, while pleurisy remains a challenging condition to diagnose and treat in general practice, ongoing advancements in medical science offer hope for improved management strategies. By staying informed about the latest developments and maintaining a comprehensive approach to patient care, healthcare providers can continue to enhance their ability to address this painful and potentially serious condition.

Pleurisy – NHS

Pleurisy is inflammation around the lungs, which causes sharp chest pain. It’s easy to treat and usually gets better in a few days, but can sometimes be a sign of something more serious, like pneumonia.

Check if it’s pleurisy

The main symptom of pleurisy is sharp chest pain when you breathe in.

The pain may be worse when you cough, sneeze or move around.

It may also spread to your shoulders and back.

Urgent advice: Ask for an urgent GP appointment or get help from NHS 111 if:

you have sharp chest pain that comes and goes, or only happens when breathing or coughing
you have sharp chest pain that has not got better after a few days
you’ve coughed up a few small spots, flecks or streaks of blood, or noticed blood in your phlegm or on a handkerchief
you’re feeling short of breath regularly

You can call 111 or get help from 111 online.

Immediate action required: Call 999 or go to A&E if:

you have sudden chest pain that lasts for 15 minutes or more
you have sudden chest pain that spreads to your arms, back, neck or jaw
you have difficulty breathing
you’re coughing up more than just a few spots or streaks of blood
you’re coughing up blood and finding it hard to breathe, have a very fast heartbeat, or have pain in your chest or upper back

These symptoms could be a sign of a more serious problem, such as a heart attack or a blood clot in the lungs (pulmonary embolism).

What happens at your appointment

If you have symptoms of pleurisy, a GP will examine you and listen to your chest.

The GP may refer you to a specialist if they’re not sure what’s causing your symptoms.

You may need to have tests, such as:

blood tests
a chest X-ray
an ultrasound scan
a CT scan

Treatment for pleurisy

Pleurisy will usually get better on its own in a few days without treatment from a GP.

If your symptoms are being caused by a bacterial infection, such as pneumonia, you may need antibiotics.

You can ease the chest pain by:

taking painkillers such as paracetamol or ibuprofen
resting in different positions until you find a comfortable one – lying on the painful side can help

You may need to have treatment in hospital if your symptoms are severe or being caused by something more serious, such as a pulmonary embolism or tuberculosis.

Page last reviewed: 18 May 2023
Next review due: 18 May 2026

Pleurisy | Cedars-Sinai

ABOUT

DIAGNOSIS

TREATMENT

Overview

Pleurisy, also known as pleuritis, is swelling of the thin lining around the chest cavity and lungs, also known as the pleura. This lining creates a smooth surface so the lungs glide easily in the chest while breathing. When the lining swells, the lungs rub painfully against the chest, causing swelling and chest pain.

In some cases, fluid can collect between the pleura. This is called pleural effusion. When there is no fluid, the condition is called dry pleurisy.

Symptoms

Usually the first sign of pleurisy is a sudden chest pain. The pain may be very mild or very severe. Sometimes the pain is only felt while breathing deeply or coughing. Other times, the pain may be felt all the time and get worse with deep breathing or coughing. Usually the pain is felt in the chest wall over the area that’s inflamed. You might also feel pain in the upper abdominal area, neck, back, and shoulders.

Because inhaling deeply hurts, a person with pleurisy tends to breathe quickly and shallowly. On the side where the pain is, the muscles of the chest move less than those on the other side. If fluid builds up between the layers of the pleura, the chest pain may go away. Large quantities of fluid can make expanding one or both lungs difficult.

Other symptoms may include:

Fever
Cough
Shortness of breath
Rapid breathing

Causes and Risk Factors

Irritation of the pleura can be caused by:

Viruses
Bacterial infections
Cancer
Inhaling asbestos or other toxic substances
The use of certain medications
Some types of autoimmune diseases, such as lupus or rheumatoid arthritis

Diagnosis

Diagnosis of pleurisy usually starts with a physical exam. Because the pain tied to pleurisy is distinct, it is often easy for the physician to diagnose. Using a stethoscope, the doctor may hear a squeaky, rubbing sound.

Chest X-rays and CT scans are often used to see an image of what is going on inside the lungs and chest. These tests help show if fluid is building up in the lungs. They will also show if the lungs are filling up with air as much as possible.

Other imaging tests may be used, such as an ultrasound or electrocardiogram, to rule out heart disease.

If fluid has begun to build up in the chest or lungs, the doctor may take a test sample of it. This will help determine the cause of the pleurisy and rule out the possibility of cancer.

A biopsy of a small sample of tissue may also be done to rule out the possibility of cancer. To do this, a needle will be used to remove a small tissue sample to be examined under a microscope.

A blood test to detect lupus or rheumatoid arthritis may also be performed.

Treatment

Treatment for pleurisy depends on what caused the condition. The experts at Cedars-Sinai’s Advanced Lung Disease Program can help you find the best treatment plan.

Antibiotics may be prescribed for infections caused by bacteria. If a virus causes the pleurisy, no treatment will be given. If the cause is lupus or an autoimmune disease, corticosteroids often quickly cure the pleurisy. These drugs suppress the immune system, which stops the swelling in the lining.

Nonsteroidal anti-inflammatory drugs, such as aspirin or ibuprofen, help relieve the chest pain. Codeine and other stronger pain relievers should not be used. These medicines can stop you from coughing. Coughing is important because it stops the lungs from collapsing and helps prevent pneumonia.

Holding a pillow against the part of the chest that hurts while coughing or breathing deeply can be helpful. Wrapping the chest in wide, elastic bandages can help relieve severe pain. Wrapping the chest also makes it harder to breathe and increases the risk of a collapsed lung or pneumonia.

Pleurisy – health articles

Human lungs are located in the chest cavity. Outside they are covered with pleura. The pleura is a serous membrane that lines the inner layer of the chest cavity and envelops both lungs. The pleura is made up of mesothelial cells.

Pleurisy – an inflammatory disease of the pleura, which is characterized by the deposition of fibrin on their surface (fibrinous or dry pleurisy), or the accumulation of fluid in the pleural cavity (exudative pleurisy).

This disease is very common. This is the most commonly diagnosed pathology of the lungs. In the general structure of the incidence of the population, pleurisy accounts for 5-15%.

Causes

Pleurisy is a disease that in most cases develops on the basis of some existing pathology. The most common cause of the development of an inflammatory reaction in the pleural cavity are various infections. Often pleurisy occurs against the background of systemic diseases, tumors, injuries.

Some authors refer to pleurisy and cases of pleural effusion without a clear presence of an inflammatory response. This situation is not entirely correct, since pleurisy is an ailment that involves an obligatory inflammatory component.

The following causes of pleurisy are distinguished:

infection of the pleura;
tuberculosis;
allergic inflammatory reaction;
autoimmune and systemic diseases;
exposure to chemicals;
chest injury;
exposure to ionizing radiation;
exposure to pancreatic enzymes;
primary and metastatic tumors of the pleura.