Pleurisy & Other Disorders Of the Pleura

What Is Pleurisy?

Pleurisy is a condition which occurs when the pleura becomes inflamed. The pleura is the double-layer membrane that covers the lungs, of which one membrane is attached to the ribcage and the other to the lung. Usually, the membranes glide over each other when you take a breath, however, if the pleura become inflamed the movement is no longer smooth and the membranes grind against each other.

It is estimated that around 2,000 people are admitted to hospital due to pleurisy each year in England and Wales. However, the number of people with pleurisy is likely to be significantly higher, as many people do not seek treatment for their symptoms. Pleurisy can affect people of all ages but it is most common among those over the age of 65.

What causes pleurisy?

There are various possible causes of pleurisy, of which the most common include:

• Viral infection: this is the most common cause of pleurisy. It does not usually make you feel very ill but the chest pain can be quite severe. Examples of viral infections known to cause pleurisy include influenza (flu), Epstein-Barr virus, Parainfluenza (this causes croup in children) and CMV (cytomegalovirus).
• Bacterial infection: infections caused by streptococcal and staphylococcal strains of bacteria are known to cause pleurisy. MRSA is one of the most common bacteria causes of pleurisy.

Less common causes include:

• Pulmonary embolism (a blood clot that blocks the supply of blood to the lungs).
• Lung cancer.
• Pneumonia.
• Chest injuries.
• Collapsed lung (pneumothorax).
• Some forms of arthritis.
• HIV and AIDS.
• Cancer treatment: chemotherapy and radiotherapy can increase the risk of pleurisy.
• Sickle cell anaemia.

Symptoms of pleurisy

The most common symptom of pleurisy is chest pain, which is known as pleuritic pain and the pain occurs when you breathe in and out. Many people describe the pain as a sharp, stabling pain, which gets worse when you breathe deeply, move around or cough or sneeze. Other symptoms of pleurisy include:

• Dry cough.
• Difficulties with breathing.

When should I see my GP?

You should see your GP if you experience chest pain and it does not improve or the pain gets worse. If you have any of the following symptoms you should seek immediate medical help, as they are often indicative of an underlying health condition:

• High temperature of 40 degrees or higher.
• Coughing up phlegm.
• Severe chest pain that develops very quickly.
• Unexplained weight loss.
• Coughing up blood.
• Inflammation in the arms or legs (this suggests a blood clot).

How is pleurisy diagnosed?

When you go and see your GP they will ask you about your symptoms and ask questions about your medical history. They will also listen to your chest using a stethoscope. This is because pleurisy causes the lungs to make a crunching sound, which doctors are usually able to hear. Further tests will often be carried out to identify the underlying cause of pleurisy, including:

• CT scan.
• Chest X-ray.
• Blood tests.
• Ultrasound scan.

If a doctor suspects a patient may have lung cancer or tuberculosis they will order a biopsy test, which involves removing a small sample of tissue to be analysed. The biopsy can be removed using a very fine needle or a bronchoscope, which is a fine tube that is passed down through the throat.

Treatment for pleurisy

Treatment for pleurisy depends on the cause of the condition. If pleurisy is caused by an underlying condition, this will be treated as a priority and symptoms of pleurisy usually improve as a result. Chest pain caused by pleurisy can usually be treated very effectively with non-steroidal anti-inflammatory drugs, such as over-the-counter ibuprofen. If these drugs do not work or you cannot take them due to a health condition (such as liver disease), your doctor may prescribe a course of steroids to reduce inflammation and ease chest pain. Some people also find that lying on their side helps to reduce pain.