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

18.05.202121.07.2023 by alexxlab

What are the main symptoms of pleurisy. How is pleurisy diagnosed in general practice. What treatment options are available for pleurisy. When should you seek urgent medical care for pleurisy symptoms.

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Understanding Pleurisy: An Overview of the Condition

Pleurisy, also known as pleuritis, is a condition characterized by inflammation of the pleura – the thin membrane that surrounds the lungs and lines the chest cavity. This inflammation can cause sharp chest pain, particularly when breathing deeply or coughing. While pleurisy often resolves on its own within a few days, it can sometimes indicate a more serious underlying condition that requires medical attention.

What Causes Pleurisy?

Pleurisy can be triggered by various factors, including:

Viral infections (most common cause)
Bacterial infections, such as pneumonia
Autoimmune disorders like lupus or rheumatoid arthritis
Pulmonary embolism (blood clot in the lungs)
Lung cancer or other chest cancers
Exposure to certain medications or toxins
Trauma to the chest wall

Can pleurisy be a sign of a more serious condition? In some cases, yes. While pleurisy itself is not typically life-threatening, it can be a symptom of potentially serious underlying conditions such as pneumonia, tuberculosis, or pulmonary embolism. This is why proper diagnosis and timely medical attention are crucial.

Recognizing the Symptoms of Pleurisy

The hallmark symptom of pleurisy is a sharp, stabbing pain in the chest that worsens with breathing, coughing, or sneezing. This pain occurs because the inflamed pleural layers rub against each other during respiratory movements. However, pleurisy can manifest with various other symptoms as well.

Key Symptoms to Watch For

Sharp chest pain that worsens with breathing or coughing
Shortness of breath or rapid, shallow breathing
Dry cough
Fever and chills (if caused by an infection)
Pain that may extend to the shoulder or back
Discomfort that may worsen when lying down

Is pleurisy pain constant or intermittent? The pain associated with pleurisy can vary. Some individuals experience constant discomfort, while others may only feel pain during certain activities or positions. Typically, the pain is most noticeable during deep breaths, coughing, or sudden movements.

Diagnosing Pleurisy in General Practice

When a patient presents with symptoms suggestive of pleurisy, general practitioners employ a combination of clinical examination and diagnostic tests to confirm the diagnosis and identify any underlying causes.

The Diagnostic Process

Physical Examination: The doctor will listen to the patient’s lungs with a stethoscope. A characteristic friction rub sound may be heard, indicating the rubbing of inflamed pleural surfaces.
Medical History: A thorough review of the patient’s medical history and current symptoms helps identify potential causes and risk factors.
Chest X-ray: This imaging test can reveal signs of inflammation, fluid accumulation (pleural effusion), or underlying lung conditions.
Blood Tests: These can help detect infections, inflammatory markers, or other systemic conditions that might be causing pleurisy.
CT Scan: In some cases, a more detailed image of the chest may be necessary to identify subtle abnormalities or complications.
Ultrasound: This can be particularly useful for detecting and assessing pleural effusions.

How accurate is a chest X-ray in diagnosing pleurisy? While a chest X-ray is a valuable tool in the diagnostic process, it may not always definitively diagnose pleurisy. It’s most useful for identifying complications like pleural effusion or underlying lung conditions. In some cases, pleurisy may not be visible on an X-ray, especially in its early stages or if it’s a case of dry pleurisy.

Treatment Approaches for Pleurisy in Primary Care

The treatment of pleurisy in general practice focuses on addressing the underlying cause, managing symptoms, and preventing complications. The approach may vary depending on the severity of symptoms and the identified cause.

Common Treatment Strategies

Pain Management: Over-the-counter pain relievers such as ibuprofen or naproxen can help alleviate pain and reduce inflammation.
Rest: Adequate rest allows the body to heal and can help minimize pain during recovery.
Antibiotics: If a bacterial infection is the cause, appropriate antibiotic therapy will be prescribed.
Antiviral Medications: In cases of viral pleurisy, antiviral drugs may be recommended, especially for high-risk patients.
Corticosteroids: These may be used to reduce inflammation in certain cases, particularly if an autoimmune condition is involved.
Drainage: If significant pleural effusion is present, drainage may be necessary to relieve symptoms and prevent complications.

How long does it typically take for pleurisy to resolve with treatment? The duration of pleurisy can vary depending on its cause and the individual’s overall health. In many cases, with appropriate treatment, symptoms begin to improve within a few days to a week. However, complete resolution may take several weeks, especially if there’s an underlying condition that needs addressing.

Managing Pleurisy at Home: Self-Care Strategies

While medical treatment is often necessary for pleurisy, there are several self-care measures that patients can employ to manage symptoms and support recovery at home.

Effective Home Management Techniques

Pain Relief: Use over-the-counter pain medications as recommended by your healthcare provider.
Positional Relief: Find a comfortable position that minimizes pain, often lying on the affected side.
Breathing Exercises: Gentle deep breathing and coughing exercises can help prevent lung complications.
Avoid Smoking: Smoking can irritate the lungs and exacerbate symptoms.
Stay Hydrated: Adequate fluid intake can help thin mucus and support overall recovery.
Use a Humidifier: Moist air can soothe irritated airways and ease breathing.

Are there any specific breathing techniques that can help manage pleurisy pain? While deep breathing may be painful, controlled breathing exercises can be beneficial. One technique is to take slow, shallow breaths, gradually increasing depth as tolerated. Another approach is to use pursed-lip breathing, which involves inhaling slowly through the nose and exhaling through pursed lips. These techniques can help manage pain and prevent complications like atelectasis (collapsed air sacs in the lungs).

When to Seek Urgent Medical Care for Pleurisy

While many cases of pleurisy can be managed in primary care settings, certain symptoms warrant immediate medical attention. It’s crucial for patients to recognize these red flags and seek urgent care when necessary.

Warning Signs Requiring Immediate Attention

Severe, persistent chest pain that doesn’t improve with medication
Difficulty breathing or severe shortness of breath
High fever (over 39°C or 102°F) that doesn’t respond to antipyretics
Coughing up blood or blood-tinged sputum
Signs of shock, such as pale, clammy skin or confusion
Sudden onset of symptoms, especially if accompanied by leg pain or swelling (which could indicate a pulmonary embolism)

How can you differentiate between pleurisy pain and a heart attack? While both conditions can cause chest pain, there are some key differences. Pleurisy pain typically worsens with breathing or coughing and may be localized to a specific area of the chest. Heart attack pain often feels like pressure or squeezing, may radiate to the arm or jaw, and is usually not affected by breathing. However, if there’s any doubt, it’s crucial to seek immediate medical attention, as a heart attack is a life-threatening emergency.

Preventing Recurrence and Complications of Pleurisy

After recovering from an episode of pleurisy, patients and healthcare providers should focus on preventing recurrence and potential complications. This involves addressing underlying causes and adopting lifestyle changes to support overall lung health.

Strategies for Long-Term Management

Follow-up Care: Regular check-ups with your healthcare provider to monitor recovery and address any ongoing issues.
Vaccination: Stay up-to-date with vaccinations, especially against pneumonia and influenza, which can trigger pleurisy.
Smoking Cessation: If you smoke, quitting is crucial for lung health and preventing recurrence.
Manage Chronic Conditions: Properly control underlying conditions like asthma or autoimmune disorders that may increase the risk of pleurisy.
Occupational Safety: If exposure to irritants or toxins is a concern, use appropriate protective equipment in the workplace.
Healthy Lifestyle: Maintain a balanced diet, regular exercise, and adequate sleep to support overall immune function.

Can pleurisy lead to long-term lung damage? In most cases, pleurisy itself does not cause permanent lung damage. However, if left untreated or if there are recurrent episodes, it can potentially lead to complications such as pleural thickening or adhesions. These can affect lung function over time. Additionally, some underlying causes of pleurisy, such as tuberculosis or asbestos exposure, may cause long-term lung damage if not properly managed.

Special Considerations: Pleurisy in High-Risk Populations

Certain groups of individuals may be at higher risk for developing pleurisy or experiencing more severe complications. These populations require special attention and potentially modified management approaches in general practice.

High-Risk Groups and Considerations

Elderly Patients: May have atypical presentations and are at higher risk for complications.
Immunocompromised Individuals: More susceptible to infections and may require aggressive treatment.
Patients with Chronic Lung Diseases: May experience more severe symptoms and slower recovery.
Pregnant Women: Require careful consideration of treatment options to ensure fetal safety.
Children: May present with different symptoms and require age-appropriate management.

How does the management of pleurisy differ in pregnant women? Managing pleurisy in pregnant women requires a delicate balance between treating the condition and ensuring the safety of the developing fetus. Non-steroidal anti-inflammatory drugs (NSAIDs) are typically avoided, especially in the third trimester. Acetaminophen is often the preferred pain reliever. Antibiotics, if needed, must be carefully selected for their safety profile during pregnancy. Close monitoring and collaboration between the patient’s obstetrician and pulmonologist are essential to ensure optimal care for both mother and baby.

In conclusion, pleurisy is a condition that, while often manageable, requires careful assessment and tailored treatment in general practice. By understanding its causes, recognizing its symptoms, and implementing appropriate management strategies, healthcare providers can effectively care for patients with pleurisy and minimize the risk of complications. Patients, too, play a crucial role in their recovery by adhering to treatment plans, practicing self-care measures, and promptly reporting any concerning symptoms. With proper care and attention, most individuals with pleurisy can expect a full recovery and return to their normal activities.

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.