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For some, breathing can hurt. Every breath in and every breath out can be agonizing when the membranes surrounding our lungs swell up because of infection or some other cause. Called pleurisy, this condition, fortunately, fades in a few days for most people. However, pleurisy can occur secondary to a serious medical condition, so once breathing starts to hurt, it’s time to see a healthcare provider.
What is pleurisy?
Pleurisy is a condition in which there is swelling of the twin membranes—the pleura—that cover and separate the lungs from the chest wall. Normally, the pleural membranes are separated from each other by a small space filled with fluid (pleural fluid) which provides lubrication between the two membranes. As a person breathes in and out, these membranes glide past one another without friction. However, when these membranes swell, they rub and grate against each other as the lung rises or falls, a condition called pleural friction rub. Each breath brings a sharp stabbing pain in the chest and even shoulders or neck. Coughing or sneezing makes it worse.
Pleuritic chest pain makes breathing difficult, so people with pleuritis often take short, quick breaths. Besides chest pain and rapid breathing, other symptoms of pleurisy include shortness of breath, dry cough, and blue skin (cyanosis) due to not breathing enough to adequately oxygenate your blood.
Pleurisy, like swollen lymph nodes, is itself a condition arising fromany number of underlying disorders ranging from relatively harmless to life-threatening. Causes of pleurisy include:
- Lung infections
- Infection of the pleural space (empyema)
- A blood clot in the lungs (pulmonary embolism)
- Collapsed lung (pneumothorax)
- Cancer (lung cancer or mesothelioma)
- Autoimmune disorders such as lupus or rheumatoid arthritis
- Injury
- Swollen pancreas (pancreatitis)
- Inflammatory reactions to certain drugs, like hydralazine or isoniazid
Most instances of pleurisy are due to bacterial or viral infections and usually resolve without harm.
The sudden onset (within minutes or hours) of pleuritic pain, called hyperacute pleuritic pain, is a medical emergency requiring immediate treatment. The cause may be a pulmonary embolism, which is life-threatening, a collapsed lung, or other conditions, such as a heart attack or pericarditis, which have similar symptoms.
Depending on the underlying cause, pleurisy may be accompanied by other painful pleural disorders such as pleural effusion (excess fluid buildup in the pleural space, called “water on the lungs”), hemothorax (bleeding into the pleural space), and pneumothorax (air from the lung leaking into the pleural space and collapses the lung).
How is pleurisy diagnosed?
Because pleurisy is a condition arising from an underlying cause, the goal of diagnosis is to identify the underlying cause. Most patients will first typically visit a general practitioner or an emergency room doctor. That doctor will immediately begin to rule out the most common life-threatening conditions that cause pleuritic pain: pulmonary embolism, heart attack, pericarditis (inflammation of the membrane surrounding the heart), aortic dissection (a tear in the main artery, the aorta, coming off the heart), pneumonia, or a collapsed lung.
Diagnosis of the underlying condition will typically involve a medical history, physical examination, and, in most patients, a chest X-ray.
The most important information is how quickly the pleuritic pain started. Hyperacute onset often points to serious and life-threatening conditions, while more gradual onset may be due to less threatening conditions such as infection or rheumatoid arthritis. Be prepared to describe the onset of the condition along with other symptoms that started at the same time.
During the physical, the healthcare provider will listen to the lungs and heart through a stethoscope to differentiate pleurisy from other pleural disorders, pericarditis, or other heart disorders. Other symptoms examined during a physical such as shallow breathing, pulse abnormalities, or fever can help point a healthcare provider to the right diagnosis.
Depending on the results of the history and physical, one or more other tests may be necessary to definitively nail down the cause:
- Blood tests can identify substances unique to infections, inflammatory disorders, pulmonary embolism, pancreatitis, or heart problems
- A CT scan can help define the extent of the problem if an X-ray shows an infection, collapsed lung, aortic dissection, cancer, or pleural disorders
- An electrocardiogram (ECG) or echocardiogram can help identify heart problems
- Thoracentesis, drawing excess pleural fluid through a syringe and testing it, primarily helps identify the source and cause of the pleural fluid buildup
Pleurisy treatment options
Pleurisy is treated by fixing the underlying condition. Bacterial infection will be treated by antibiotics, viral infections by appropriate antiviral medications or supportive care, pulmonary embolism treated with blood thinners, and other conditions will be treated appropriately.
Pleuritic pain and swelling will be treated conservatively with over-the-counter NSAIDs, although some cases may require corticosteroids.
Pleurisy medications
Treatment of pleurisy involves medications ranging from antibiotics to chemotherapy depending on the cause of pleurisy. The actual inflammation is usually treated with over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs). Depending on the cause or severity, the healthcare team may use corticosteroids to reduce pleural swelling and pain.
NSAIDs
Over-the-counter NSAIDs such as aspirin, ibuprofen, or naproxen are sufficient to relieve pleurisy swelling and pain while the underlying condition resolves. NSAIDs work by blocking the body’s production of prostaglandins, substances which cause swelling, fever, and pain. Because NSAIDs also impair the body’s ability to form blood clots, pleurisy patients on blood thinners or with bleeding problems will be put on over-the-counter acetaminophen or prescription celecoxib, an NSAID that does not interfere with blood clotting.
Corticosteroids
When pleuritis is particularly severe or caused by certain conditions, such as lupus or tuberculosis, a physician might use a short course of corticosteroids, such as prednisone, dexamethasone, or methylprednisolone, to reduce swelling and time to resolution of pleural effusion.
What is the best medication for pleurisy?
Pleurisy emerges due to an underlying condition, so medication will be prescribed that helps resolve that condition. The pain and swelling of pleurisy can be adequately relieved by over-the-counter NSAIDs, but different people will respond differently to these pain relievers. There is, then, no “best” medication for relieving pleurisy pain, just the medication that provides symptom relief with the fewest side effects.
| Best medications for pleurisy | ||||
|---|---|---|---|---|
| Drug Name | Drug Class | Administration Route | Standard Dosage | Common Side Effects |
| Aspirin | NSAID | Oral | 325 mg to 650 mg every four to six hours as needed for pain | Upset stomach, heartburn, bleeding |
| Motrin (ibuprofen) | NSAID | Oral | 400 mg tablets every four hours as needed for pain | Nausea, bleeding, stomach pain |
| Tylenol (acetaminophen) | Analgesic | Oral | 325 mg to 650 mg every six hour as needed for pain | Nausea, stomach pain, loss of appetite |
| Celebrex (celecoxib) | Prescription NSAID | Oral | 200 mg twice daily as needed for pain | Abdominal pain, diarrhea, stomach upset |
| Prednisone | Corticosteroid | Oral | Dose according to severity and patient response | Mood changes, fluid retention, increased blood pressure |
Many of the standard dosages above are from the U.S. Food and Drug Administration (FDA) and the National Institutes of Health (NIH). Dosage is determined by your doctor based on your medical condition, response to treatment, age, and weight. Other possible side effects exist. This is not a complete list.
What are the common side effects of pleurisy medication?
All medications may have side effects, and different classes of medications have different side effects. However, this is not a complete list, and you should consult with your healthcare professional for possible side effects and drug interactions based on your specific situation.
Over-the-counter NSAIDs are safe and have few side effects. However, NSAIDs block the body’s ability to form blood clots, so their most serious side effects are bleeding and bruising, especially in the digestive system. Celecoxib, an NSAID which does not interfere with blood clotting, and acetaminophen are often prescribed or advised for patients who have bleeding problems or who are on blood thinners.
Steroids are rapidly effective at reducing the pain and swelling of pleurisy, but they have some unpleasant and commonly-experienced side effects including mood and behavior changes, aggressiveness, elevated blood pressure, increased appetite, and weight gain. Because of their side effects, they are used in the smallest dose possible for the shortest possible duration for pleurisy.
What is the best home remedy for pleurisy?
For the most part, the best home remedy for pleurisy is to sit back and let the underlying condition heal. However, there are a few things people can do to get through this wait with less pain and discomfort.
Take prescribed medications
The only “cure” for pleurisy is to resolve the underlying condition. Your doctor will prescribe medications that will help fix that condition, so take these medications faithfully as directed.
Use over-the-counter medications to relieve symptoms
Do not hesitate to treat that pain with over-the-counter medications so that you can breathe adequately.
Breathe deeply
Pleurisy causes people to take short breaths to avoid pain. It’s important to periodically take deep breaths to prevent the lower lung from collapsing, a condition called atelectasis. A lower lung leaking air into the pleural space will only make the pain worse and poses a serious health threat. A good rule of thumb is to take two or three deep breaths every ten minutes to completely fill the lungs— even if it hurts a lot.
Stop smoking
Smoking is a bad idea in the best of times. Anytime you have lung problems and trouble breathing, it’s time to give tobacco a rest. Smokers in the household should take it outside until you’re feeling better.
Get rest
Your job is to find the most comfortable position for breathing and commit to it. However, don’t overdo it. Remember that moving around does help clear fluid from the pleural cavity.
Frequently asked questions about pleurisy
How do you treat pleurisy at home?
Pleurisy interferes with breathing by making it painful to breathe in and out, but breathing is perhaps the most important job every person needs to do. The best home treatments, then, maximize a person’s ability to breathe. Take pain medications to reduce the pain. Breathe deeply every ten minutes or so to completely fill the lungs. Find a resting position that allows you to breathe. Stop smoking.
How serious is pleurisy?
Pleurisy emerges due toan underlying condition that could be benign or a serious threat. Pleurisy and its accompanying pleuritic pain does make it hard to breathe, so not getting enough oxygen is a constant risk. It is very important to manage the pain and breathe deeply to maintain lung health while pleurisy resolves.
How long does pleurisy last?
Pleurisy usually resolves in a few days to two weeks depending on the underlying condition.
How long does it take to recover from pleurisy?
Pleurisy is a symptom of an underlying condition, such as infection, cancer, or a blood clot. Like other symptoms, it typically fades in a few days or a couple of weeks. However, recovering from the underlying condition may take longer.
How do you feel when you have pleurisy?
Pleurisy hurts. Breathing in and breathing out causes sharp pain in the chest. People describe the pain as dull aching, burning, stabbing, or a “catching” feeling when they breathe. Some of the nerves connecting to the outer layer of the pleura also connect to the shoulder and neck, so this sharp pain can radiate to the shoulder and neck, too. Coughing, sneezing, deep breathing, and moving the chest area can cause even worse pain.
Is pleurisy contagious?
Pleurisy is a condition, so it is not contagious. However, if it occurs because of an infection, that infection could be contagious.
Should you go to the ER for pleurisy?
Pleurisy can develop rapidly in a few minutes (hyperacute pleurisy), hours (acute pleurisy), days, or weeks. Any rapid onset of chest pain or difficulty breathing requires immediate emergency medical treatment. What you think might be pleurisy may be pain due to heart problems or may appear due to a severe problem, such as a collapsed lung. If you experience a slow onset of chest pain or problems breathing, you need to see a healthcare professional, but the situation is not as urgent.
What herbs are good for pleurisy?
Traditional and alternative medical practitioners advise herbs such as pleurisy root, capsicum, and garlic to relieve the pain and swelling of pleuritis. Some, such as pleurisy root, have been used for centuries for pleuritis. None, however, have been definitively shown to relieve pleurisy symptoms.
What antibiotics treat pleurisy?
Pleurisy itself is not treated with antibiotics. If there is an underlying lung or pleural infection causing pleurisy, then that infection will be treated with the appropriate antibiotics.
What causes pleurisy to flare up?
The most common causes of pleurisy are viral or bacterial infections, but pleurisy can also occur due to a blood clot in the lungs (pulmonary embolism), cancer, pancreatic swelling, autoimmune diseases, or a collapsed lung (pneumothorax). Certain drugs, such as hydralazine, can cause inflammatory reactions that include pleurisy.
Can you die from pleurisy?
Pleurisy does not kill people. Pleurisy is caused by conditions, such as infections, that range from benign to life-threatening. Most cases of pleurisy resolve without any threat to a person’s health.
Can pleurisy go away on its own?
Pleurisy, or inflammation of the pleural membranes, occurs as a result of an underlying condition, usually a bacterial or viral infection. Pleurisy will resolve with the underlying condition.
Where is the pain located when you have pleurisy?
Pleurisy produces sharp pain in the chest and, sometimes, in the shoulders or neck whenever a person breathes in, breathes out, talks, coughs, sneezes, or rotates their chest area. There are serious heart conditions, such as pericarditis (swelling of the tissues surrounding the heart), that cause very similar pain in the same locations. However, pleuritic pain goes away if a person holds their breath. Chest pain due to heart problems does not.