Pleurisy is inflammation of the pleura, the membranes surrounding the lungs and lining the chest cavity. This inflammation typically causes sharp chest pain. While pleurisy often resolves within days or weeks, its duration varies considerably depending on the underlying cause.
Understanding Pleurisy
The pleura consists of two layers: one that covers the lungs and another that lines the inside of the chest wall. Between these layers is a small space containing a lubricating fluid, which allows the lungs to expand and contract smoothly during breathing. When the pleura becomes inflamed, these layers can rub against each other, leading to discomfort.
The characteristic symptom of pleurisy is a sharp, stabbing chest pain that often worsens with deep breaths, coughing, sneezing, or movement. This pain might sometimes spread to the shoulder or back. While pain is the primary symptom, pleurisy can also present with other signs like shortness of breath, a cough, or fever, depending on its cause. Pleurisy itself is a symptom of an underlying condition rather than a standalone disease.
Why Pleurisy May Persist
Pleurisy can last for an extended period, sometimes months, when the underlying cause is slow to resolve or when complications arise. Persistent infections are a common reason for prolonged pleurisy. Bacterial infections, such as pneumonia or tuberculosis, can cause ongoing inflammation of the pleura if not effectively treated with antibiotics. Viral infections, including influenza or other respiratory viruses, can lead to persistent pleurisy, especially if the body’s immune response is slow to clear the pathogen.
Certain chronic health conditions can also contribute to pleurisy’s persistence. Autoimmune diseases, like systemic lupus erythematosus (lupus) or rheumatoid arthritis, involve the immune system mistakenly attacking healthy tissues, including the pleura, leading to sustained inflammation. In these cases, pleurisy can be a recurring or chronic symptom. Malignancies affecting the pleura, such as lung cancer or mesothelioma, can cause chronic pleuritic pain that continues as long as the cancer is present.
A blood clot in the lung, known as a pulmonary embolism, can induce pleurisy that lasts until the clot is resolved or treated. Some medications can also cause drug-induced pleurisy, with symptoms persisting as long as the drug is taken. A significant buildup of fluid in the pleural space, called a pleural effusion, is a common complication that can prolong symptoms and may require drainage. More severe inflammation of the pleura takes longer to heal, and if the underlying cause is not identified and managed promptly, pleurisy can linger.
Treatment and Management
Effective treatment for pleurisy focuses on addressing its underlying cause to promote resolution and alleviate symptoms. For pain relief, over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen are commonly used to reduce inflammation and discomfort. In cases of severe pain, a healthcare provider might prescribe stronger pain relievers or corticosteroids. Rest also aids recovery, allowing the body to heal.
Treating the specific cause is key for resolving pleurisy. Bacterial infections are managed with antibiotics, while viral infections often receive supportive care, though antivirals may be used in some instances. For autoimmune conditions, treatment involves medications like corticosteroids or immunosuppressants to control systemic inflammation. A pulmonary embolism requires anticoagulant medications to dissolve the clot.
If a significant pleural effusion develops, a procedure called thoracentesis may be performed to drain the excess fluid from the pleural space. This drainage can relieve pressure on the lungs and ease breathing difficulties. In some situations, especially if coughing exacerbates the pain, cough suppressants might be recommended.
When to Seek Medical Attention
While many cases of pleurisy improve with rest and pain management, certain symptoms warrant prompt medical evaluation. Consult a healthcare professional if pleuritic pain does not improve or intensifies over several days or weeks, as this could indicate a persistent underlying issue. Difficulty breathing, shortness of breath, or rapid breathing can signal a more serious condition or a significant pleural effusion requiring medical attention.
Other concerning signs include a high fever and chills, which may suggest a severe infection. Coughing up blood is a serious symptom requiring immediate medical assessment. Unexplained weight loss or night sweats could point to chronic infections or malignancies. Swelling or pain in the legs might indicate deep vein thrombosis, a risk factor for pulmonary embolism. Any persistent feeling of general illness or fatigue also warrants medical investigation.