Pleurisy is inflammation of the sheet-like layers that cover the lungs (the pleura).
The most common symptom of pleurisy is a sharp chest pain when breathing deeply. Sometimes the pain is also felt in the shoulder.
The pain may be worse when you cough, sneeze or move around, and it may be relieved by taking shallow breaths.
Other symptoms can include shortness of breath and a dry cough.
Visit your GP if you experience the above symptoms. Seek immediate medical help if your chest pain is severe, particularly if you also have other symptoms, such as coughing up blood, nausea or sweating.
Seeing your GP
Pleurisy can usually be diagnosed by studying your symptoms. Your GP can listen to your chest to check for the distinctive dry, crunching sound that suggests you may have pleurisy.
Further tests may be needed to identify the underlying cause of your pleurisy and to assess how severe it is. These can include:
blood tests to determine whether you have an infection or an autoimmune condition
an ultrasound scan
a computerised tomography (CT) scan
a biopsy – a small sample of pleural or lung tissue is removed for further testing
What causes pleurisy?
Most cases are the result of a viral infection (such as the flu) or a bacterial infection (such as pneumonia).
In rarer cases, pleurisy can be caused by conditions such as a blood clot blocking the flow of blood into the lungs (pulmonary embolism) orlung cancer.
Pleurisy can affect people of all ages, but people of 65 years and over are most at risk, because they're more likely to develop a chest infection.
How is pleurisy treated?
Treatment for pleurisy depends on the underlying cause.
For example, pleurisy caused by a viral infection will often resolve itself without treatment. However, pleurisy caused by a bacterial infection is usually treated with antibiotics, and people who are frail or already in poor health may be admitted to hospital.
Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are often used to relieve the chest pain associated with pleurisy.
If excess fluid builds up between the pleural layers, it may be necessary to drain the fluid to prevent breathing difficulties.
Causes of pleurisy
Pleurisy is inflammation of the pleura. It's usually caused by another condition, such as an infection, but sometimes no cause can be identified.
The pleura are two thin sheets of tissue that separate the lungs and ribcage. One is attached to the ribcage and the other is attached to the lungs.
Between the pleural sheets is a thin layer of liquid that lubricates the pleura, helping to reduce friction when you breathe in and out.
When there's inflammation, the surfaces of the two layers can become rough and the fluid can become sticky. This can cause the layers to rub together, resulting in pain and discomfort.
An infection is the most common cause of pleurisy. Any type of infection has the potential to spread to the pleura, but viral infections are usually responsible.
Viruses known to cause pleurisy include:
the influenza (flu) virus
the Epstein-Barr virus – which causes glandular fever
cytomegalovirus (CMV) – a common virus found in most people, which doesn't usually cause any noticeable symptoms
parainfluenza – the virus that causes the childhood condition croup
In some cases, pleurisy is caused by bacteria, such as:
streptococcal bacteria – often associated with pneumonia, throat infections and some types of skin infections, such as impetigoand cellulitis
staphylococcal bacteria – often associated with skin infections, food poisoning and, more seriously, blood poisoning (sepsis)
Meticillin-resistant Staphylococcus aureus (MRSA) can cause pleurisy, especially in hospital patients. MRSA is a type of bacteria with a resistance to a number of commonly used antibiotics.
Other possible causes of pleurisy include:
injury – if the ribs are bruised or fractured, the pleura can become inflamed
pulmonary embolism – a blood clot developing inside the lungs
sickle cell anaemia – a blood disorder that usually affects people of African or Caribbean descent
chemotherapy and radiotherapy
HIV or AIDS
mesothelioma – a type of cancer caused by inhaling asbestos
Autoimmune conditions, such as rheumatoid arthritis and lupus, are other possible causes of pleurisy. In these conditions, something goes wrong with the immune system (the body’s natural defence against infection and illness) and it begins to attack healthy tissue.
Treatment for pleurisy usually involves relieving pain and treating the underlying cause of the condition.
If treated promptly, pleurisy often resolves without any lasting damage to the lungs.
The chest pain associated with pleurisy can be treated using a type of painkiller known as non-steroidal anti-inflammatory drugs (NSAIDs). Most often, ibuprofen is used.
If NSAIDs are ineffective or unsuitable, you may be prescribed another painkiller, such as paracetamol or codeine.
It may seem strange, but lying down on the side of your chest that hurts may also help to reduce the pain.
Treating the underlying cause
It may also be necessary to treat the underlying cause of your pleurisy.
If you have pleurisy caused by a bacterial infection, you'll need a course of antibiotics. Depending on the severity of your symptoms, this may be either tablets or injections. Combinations of different antibiotics are sometimes used.
However, if your pleurisy is caused by a viral infection, further treatment may not be required, as the infection usually resolves itself after a few days.
In cases where your symptoms are particularly severe or you're already in poor health, you may need to be admitted to hospital so your body’s functions can be supported until your condition stabilises.
In some cases, pleurisy causes a build-up of excess fluid around the lungs called pleural effusion.
Pleural effusion can result in shortness of breath that gets progressively worse. This is more likely in cases of pleurisy caused bypulmonary embolism or a bacterial infection.
If pleural effusion doesn't clear up as your pleurisy is treated, or if you're very short of breath, a tube will need to be inserted so the fluid can be drained away.
The tube may be inserted using either general anaesthetic (where you're asleep) or local anaesthetic (the area where the tube is inserted is numbed).
If a lot of fluid has to be drained away, you may need to stay in hospital for a few days.