Pleurisy (Pleuritis)

Pleurisy, also known as pleuritis, is a condition characterized by inflammation of the pleura, the double-layered membrane surrounding the lungs. Each individual has two pleurae, with one for each lung. This inflammation can cause sharp chest pain and discomfort, making breathing difficult.

The pleura consists of two thin, sheet-like layers of tissue. The inner layer envelops the lung, while the outer layer lines the interior of the chest wall. These layers snugly fit within the chest cavity, with a small amount of fluid present in the space between them, known as the pleural space. This fluid facilitates smooth gliding of the pleurae during breathing movements.

The primary function of these layers is to prevent the lungs from directly rubbing against the chest cavity wall with each breath.

When the pleurae become swollen and inflamed, they rub against each other in a painful manner whenever the lungs expand during breathing. Deep inhalation, coughing, sneezing, or laughing may elicit sharp, stabbing pains in the affected area.

In most cases, pleurisy arises due to an underlying infection. Treating the infection under the guidance of a doctor typically resolves the pleurisy and alleviates associated pain.

Is Pleurisy Contagious?

• Pleurisy itself is not contagious, but the bacteria and viruses responsible for causing pleurisy can be contagious.

Causes of Pleurisy (Pleuritis)

Pleurisy can stem from various underlying factors, including:

1. Lung Infections:
   • Bacterial infections such as pneumonia are common culprits of pleurisy. Additionally, viral infections like the flu or fungal infections can also lead to pleurisy.
2. Pulmonary Embolism (PE):
   • A blood clot in the lung, known as a pulmonary embolism, obstructs blood flow to the lungs and poses a life-threatening risk. Typically, these clots originate in deep veins, break loose, and travel to the lungs.
3. Collapsed Lung (Pneumothorax):
   • The presence of air in the pleural space can exert pressure, causing partial or complete collapse of the lung. Sudden chest pain and shortness of breath are key symptoms of pneumothorax.
4. Autoimmune Diseases:
   • Autoimmune disorders, where the immune system mistakenly attacks healthy tissues, can trigger pleuritic chest discomfort. Conditions like rheumatoid arthritis and lupus are examples of autoimmune diseases associated with pleurisy.
5. COVID-19:
   • Emerging evidence suggests that pleuritic pain can manifest as a symptom of COVID-19, the respiratory illness caused by the coronavirus. However, further research is needed to elucidate this association.
6. Other Causes:
   • Pleuritic chest pain may result from diverse factors, including chest injuries, lung cancer, other types of cancer affecting the lungs or pleura, sickle cell anemia, mesothelioma (a rare cancer linked to asbestos exposure), chemotherapy, HIV, or AIDS.

Prevalence of Pleurisy (Pleuritis)

Pleurisy is relatively common and can affect individuals of any age, though it is more prevalent in adults. The exact prevalence varies depending on factors such as geographical location, population demographics, and underlying health conditions.

Relationship between Pleurisy and Other Conditions:

• Pleurisy and Pneumonia:
  • Pneumonia, an infection inflaming the air sacs in the lungs, is a common precursor to pleurisy.
• Pleurisy and Lupus:
  • Pleurisy is a prevalent lung complication in individuals with lupus, an autoimmune disease characterized by inflammation and pain in various body parts. Lupus can induce pleurisy either through lung infections or by triggering blood clot formation leading to lung complications.

Symptoms of Pleurisy (pleuritis)

Pleurisy presents with various symptoms, including:

1. Chest Pain:
   • Pleurisy typically manifests as chest pain that worsens with breathing, particularly during deep inhalation. This pain is often described as sharp, stabbing, or burning, a sensation termed “pleuritic chest pain.”
2. Pain in Other Body Parts:
   • In certain cases, pleurisy can cause pain to radiate to other areas of the body, such as the neck, shoulder, back, or abdomen.
3. Cough:
   • Some individuals with pleurisy may experience a cough as a symptom.
4. Fever and Chills:
   • Fever and chills may accompany pleurisy in some cases, indicating an underlying infection.

Pleurisy Back Pain:

• While pleurisy primarily affects the chest, movement of the upper body can cause the pain to extend to the back, often presenting as a constant dull ache.

Risk Factors for Pleurisy (Pleuritis)

Several factors may increase the risk of developing pleurisy, including:

1. Having respiratory infections.
2. Smoking.
3. Underlying lung or autoimmune diseases.
4. Recent chest trauma or surgery.
5. Certain medications that suppress the immune system.

Diagnosis of Pleurisy (Pleuritis)

To diagnose pleurisy, your doctor will conduct a comprehensive evaluation, which may include:

1. Symptom Assessment:
   • Your doctor will inquire about the nature of your chest pain, its exacerbating or alleviating factors, and any associated symptoms.
2. Physical Examination:
   • Using a stethoscope, your doctor will listen to your lungs for abnormal sounds, such as the characteristic rubbing of the pleurae against each other.
3. Diagnostic Tests:
   • Imaging studies like X-rays, CT scans, or ultrasounds may be ordered to visualize the chest and rule out other potential causes of your symptoms.
   • Blood tests can help identify infections or autoimmune diseases like lupus.
   • An electrocardiogram (EKG) may be performed to assess heart function and rule out cardiac-related chest pain.
   • Thoracentesis involves analyzing a sample of pleural fluid under a microscope to detect infections or cancer.
   • Thoracoscopy allows direct visualization of the chest cavity using a thin, flexible tube called a thoracoscope.

Treatment of Pleurisy (Pleuritis)

Effective treatment of pleurisy hinges upon identifying its underlying cause:

1. Viral Infections:
   • If pleurisy stems from a viral infection, such as the flu virus, it typically resolves on its own within a few days to weeks without specific medical intervention.
2. Bacterial Infections:
   • Antibiotics are prescribed to combat bacterial infections, such as streptococcal bacteria, causing pleurisy.
3. Fungal Infections:
   • Antifungal medications are administered to address pleurisy resulting from fungal infections.
4. Fluid Accumulation:
   • In cases where excess fluid accumulates between the pleura layers, a procedure known as thoracentesis may be performed. This involves inserting a thin needle into the pleural space to drain the fluid.
5. Symptomatic Relief:
   • Painkillers and steroid medications can alleviate discomfort associated with pleurisy.
   • Cough suppressants like codeine may be prescribed to alleviate severe coughing that exacerbates pain.

Home Care Tips for Pleurisy

While recovering from pleurisy, it’s essential to:

1. Follow Prescribed Medication:
   • Take any medications prescribed by your doctor, such as antibiotics or anti-inflammatory pain relievers. Ensure you complete the full course of antibiotics, even if you start feeling better.
2. Over-the-Counter Pain Relief:
   • Use over-the-counter anti-inflammatory pain relievers like ibuprofen to alleviate pain and inflammation associated with pleurisy.
3. Rest:
   • Get plenty of rest to aid in the body’s healing process.
4. Avoid Smoking:
   • Refrain from smoking, as it can exacerbate lung irritation and prolong recovery.

Sleeping Tips for Pleurisy:

1. Positioning:
   • Lie on the side that’s causing pain, and elevate your head with pillows rather than lying flat. Placing a pillow between your legs may also provide additional comfort.
2. Deep Breathing and Coughing:
   • As pain subsides, try to breathe deeply and cough to clear any phlegm from your lungs.

Can Pleurisy Resolve on Its Own?

Yes, if caused by a viral infection, pleurisy may resolve on its own within a few days. Bacterial causes may require antibiotics, while fungal causes may necessitate antifungal medication.

Duration of Pleurisy

The duration of pleurisy varies depending on its underlying cause:

• Pleurisy caused by a bacterial infection typically resolves within a few days with antibiotic treatment.
• If pleurisy stems from conditions like lung cancer or lupus, chest pain may persist for several weeks.

Prevention of Pleurisy

Although pleurisy may not always be preventable, some measures can reduce the risk:

1. Quit smoking and avoid exposure to secondhand smoke.
2. Practice good hygiene to prevent respiratory infections.
3. Seek prompt treatment for respiratory symptoms to prevent complications.
4. Follow a healthy lifestyle with regular exercise and a balanced diet.

Not-to-Do List with Pleurisy:

1. Avoid Rapid Breathing and Excessive Coughing:
   • Refrain from activities that induce rapid breathing or excessive coughing, as they can exacerbate symptoms.
   • While it’s important to cough to expel phlegm, excessive coughing can be managed with cough syrup.
2. Take it Easy:
   • Don’t rush to resume daily activities or exercise. Rest and allow your body time to recover fully before engaging in strenuous activities.

Is Pleurisy Worse When Lying Down?

Surprisingly, lying down on the side of the chest affected by pleurisy may provide relief. Conversely, coughing, sneezing, and movement can exacerbate pain.

Complications of Pleurisy

Pleurisy can lead to serious complications, including:

• Atelectasis: Blocked or impaired lung expansion.
• Empyema: Accumulation of pus in the pleural cavity.
• Shock: A sudden drop in blood flow.
• Sepsis: A severe reaction to infection.
• Pleural Effusion: Fluid buildup in the pleural cavity, which can impede breathing. Treatment may involve medications like diuretics or drainage procedures.

When to See a Doctor

Seek medical attention if you experience:

1. Severe chest pain or difficulty breathing.
2. Persistent coughing or fever.
3. Symptoms that worsen or fail to improve with home care.
4. Chest trauma or injury.

Outlook/Prognosis for Pleurisy

The outlook for pleurisy depends on its underlying cause and how promptly it is diagnosed and treated. In many cases, pleurisy resolves with appropriate treatment, and most individuals recover fully without complications. However, complications such as pleural effusion (fluid buildup) or respiratory failure may occur in severe cases.

Sources:

1. Mayo Clinic. (2022). Pleurisy.
2. National Heart, Lung, and Blood Institute
3. Johns Hopkins Medicine
4. Cedars-Sinai
5. American Cancer Society
6. Cleveland Clinic
7. Centre for Disease Control (CDC)
8. American Family Physician
9. National Organization for Rare Disorders
10. UpToDate: “Pericarditis.”
11. Lupus Foundation of America
12. Harvard Health Newsletter
13. American Academy of Family Physicians
14. National Health Service (U.K.):  Pleurisy.
15. American Lung Association. (2022). Pleurisy.