What is pleurisy?
Pleurisy is a respiratory disease characterized by inflammation of the moist, dual-layered outer lining of the lungs. This inflammation, along with fluid buildup (pleural effusion), creates friction (commonly referred to as a pleural rub, when heard using a stethoscope) during breathing, resulting in sharp chest pain, usually when inhaling.
Certain lung disorders, such as pneumonia, asbestosis and tuberculosis, are common causes of pleurisy. Chest trauma and different types of lung cancers can also cause pleurisy. Systemic lupus erythematosus (a disorder in which the body attacks its own healthy cells and tissues) is a potential cause of pleurisy. Sometimes the cause may not be identified.
While the main symptom of pleurisy is severe pain when taking even a shallow breath, some people with pleurisy have mild symptoms or just a cough. Treatment for pleurisy includes pain and cough control; treating the underlying cause, possibly with antibiotic therapy or by removing fluid from the pleural space; and prevention of complications such as lung collapse.
Healthy lifestyle practices can reduce the risk of lung infection for people with pleurisy, including good hand washing, drinking plenty of fluids, eating a well-balanced diet, getting plenty of rest, and refraining from smoking.
In some cases, pleurisy can be associated with serious or life-threatening symptoms. Seek immediate medical care (call 911) for serious symptoms, such as severe difficulty breathing, severe sharp chest pain, bluish lips or fingernails, fast heart rate, and anxiety.
Seek prompt medical care if you are being treated for pleurisy but mild symptoms recur or are persistent.
What are the symptoms of pleurisy?
Pleurisy is an inflammation of the lining surrounding the lungs and may result in a number of symptoms. The symptoms can vary in intensity among individuals.
Common symptoms of pleurisy
Pleurisy may include any number of common symptoms, which may become severe at any time. Examples include:
Bluish coloration of the lips or fingernails
Chest pain or pressure
Fever and chills
Painful breathing (inhaling or exhaling)
Rapid breathing (tachypnea) or shortness of breath
- Unexplained weight loss
Serious symptoms that might indicate a life-threatening condition
In some cases, pleurisy can be life-threatening. Seek immediate medical care (call 911) if you or someone you are with has any of these life-threatening symptoms including:
Bluish coloration of the lips or fingernails
Change in level of consciousness or alertness, such as passing out or unresponsiveness
Rapid heart rate (tachycardia)
- Respiratory or breathing problems, such as shortness of breath, difficulty breathing, labored breathing, wheezing, not breathing, or choking
What causes pleurisy?
Pleurisy develops as the result of irritation and inflammation of the lining surrounding the lungs, causing friction and pain during breathing. Sometimes doctors can’t determine the cause of pleurisy. Infections of the lung, including viral infections (such as the flu) and bacterial infections (such as pneumonia) are causes of pleurisy. Other lung diseases or conditions, such as asbestosis, tuberculosis, and some types of lung cancer can cause pleurisy, as well as chest trauma and injuries.
Conditions that can cause pleurisy
A number of conditions may cause pleurisy including:
Bacterial infections, commonly pneumonia
Pancreatitis (inflammation of the pancreas)
Rheumatic disease, such as rheumatoid arthritis
Systemic lupus erythematosus (disorder in which the body attacks its own healthy cells and tissues)
Trauma or injury to the chest, such as a rib fracture
- Viral infection, such as the flu
Contagious infections that can cause pleurisy
Certain contagious infections cause pleurisy, like COVID-19, bacterial pneumonia, or Streptococcus infection; but pleurisy itself is not spread from one person to another.
Pleurisy is not caused by face masks, but if you wear a face mask infected with bacteria or a virus, it can make you sick with a disease that might lead to pleurisy. Keep your face masks clean and do not share them with others, which will protect both you and your community from infectious diseases like COVID-19.
What are the risk factors for pleurisy?
Several factors increase the risk of developing pleurisy. Not all people with risk factors will get pleurisy.
Risk factors for pleurisy include:
Inflammatory bowel disease, including Crohn’s disease and ulcerative colitis
Lymphangioleiomyomatosis (disease of the lung)
Medications, such as isoniazid (Laniazid, Nydrazid), hydralazine (Apresoline), or procainamide (Pronestyl, Procanbid)
- Autoimmune disorders, including rheumatoid arthritis or lupus
How do you prevent pleurisy?
You can’t prevent pleurisy, but you can lower your risk of pleurisy by seeking regular medical care and treating any underlying conditions or autoimmune disease that can cause or put you at risk for pleurisy.
Conditions that can cause pleurisy include:
- Infections, bacterial or viral
- Chest trauma or injury
- Pulmonary embolism
Conditions that increase your risk for pleurisy include:
- Inflammatory bowel disease
- Lung diseases including lymphoma, lung cancer, and lymphangioleiomyomatosis (LAM)
Healthy lifestyle practices can also reduce the risk of lung infection for people with pleurisy, including good hand washing, drinking plenty of fluids, eating a well-balanced diet, getting plenty of rest, and refraining from smoking.
Smoking is not likely to cause pleurisy; however, coughing from smoking (including vaping) can worsen symptoms of pleurisy.
What are some conditions related to pleurisy?
Besides the conditions that can cause pleurisy, three other conditions involving fluid in the pleural space may occur with pleurisy:
- Atelectasis, partial or complete collapse of one lobe of the lung. With pleurisy excessive fluid accumulates in the small space between the lungs and the chest (the pleural space). This creates pressure on the lungs making breathing difficult. Atelectasis can eventually lead to a partially or completely collapsed lung.
- Empyema, extra fluid in the pleural space that has become infected potentially forming pus, and causing fever.
- Pleural effusion, a different type of abnormal fluid accumulation in the pleural space. Pleurisy symptoms may resolve because the two layers of pleura no longer rub together. Pleural effusion is potentially dangerous and may be caused by an underlying serious condition, such as congestive heart failure, cancer, pneumonia, and pulmonary embolism.
How do doctors diagnose pleurisy?
Contact your healthcare provider any time you have unexplained severe chest pain, trouble breathing, or other symptoms of pleurisy.
To diagnose pleurisy, a healthcare provider will observe symptoms, such as shortness of breath or sharp pain when you breathe. Using a stethoscope, a provider will listen to your chest for a squeaking or rubbing sound—the noise of the pleura rubbing together.
Doctors use other diagnostic tests to determine what is causing pleurisy. These include:
Blood tests to determine if there is an underlying infection
- An X-ray to check for related conditions, such as pleural effusion, and to see how well your lungs are expanding when you breathe
What are the treatments for pleurisy?
Treatment for pleurisy begins with seeking medical care from your healthcare provider. The goal of treatment for pleurisy is to decrease shortness of breath, remove fluid from the pleural space, and resolve infection if present.
Treatment depends on the severity of the pleurisy and the cause. Pain medications can help ease discomfort and improve deep breathing. Antibiotics are an effective treatment for pleurisy that is caused by bacterial infection.
Common pleurisy treatment options
Multiple treatment options are available for pleurisy including:
Antibiotic treatment, if the pleurisy is due to a bacterial infection
Cough syrup, usually codeine, to ease cough
Incentive spirometer, a device to encourage and measure deep breathing
Insertion of a chest tube with suction to drain large amounts of fluid
Pain medications, such as acetaminophen (Tylenol), ibuprofen (Advil, Motrin), or naproxen (Aleve)
Surgical removal of fluid, if other options are unsuccessful
- Thoracentesis, a needle aspiration of small amounts of pleural fluid
What are the potential complications of pleurisy?
Complications of untreated pleurisy can be serious, even life-threatening in some cases. You can help minimize your risk of serious complications by following the treatment plan you and your healthcare professional design specifically for you.
Complications of pleurisy include:
Does pleurisy shorten life expectancy?
People with pleurisy usually recover completely when they receive prompt diagnosis and treatment. In cases when pleurisy is caused by a bacterial infection, patients usually feel better within a week of taking antibiotics.
Left untreated, pleurisy can lead to serious complications including spread of infection and breathing difficulties due to fluid buildup (pleural effusion) between the pleura. The outlook also depends on the underlying condition that caused the pleurisy; death from pleurisy is very rare.