Pleurisy: Frequently Asked Questions
Pleurisy, also called pleuritis, is inflammation of a thin layer of moist tissue that lines the outside of the lungs and the inside of the chest wall. Many conditions can cause pleurisy, among them:
- Bacterial infections
- Viral infections including flu, bronchitis, and COVID-19
- Blood clots in the lungs
- Autoimmune disorders
- Bruised or broken ribs
Pleurisy makes it painful to breathe and, in severe cases, makes it hard to get enough oxygen, reduces blood flow, and can lead to shock. Get answers to questions about this frequently misunderstood condition.
Pleurisy is an inflammation of the pleura: two smooth, thin membranes of elastic tissue that have a small amount of fluid between them. The membranes cover the outside of the lungs and the inside of the chest wall and allow your lungs to glide easily as you breathe. When the pleural tissues swell and make it more difficult for you to move your lungs, it’s called pleurisy. If the amount of fluid in between the pleural layers accumulates to an abnormal volume, it’s called pleural effusion. Pleurisy is not a disease, but a sign of an underlying condition.
Pleurisy usually comes on quickly, causing a stabbing or sharp chest pain when you breathe. The pain can reach your back and up into your shoulder. The discomfort arises when the inflamed pleura rub against each other when you inhale or exhale. You may also feel short of breath because it hurts to take a normal sized breath. In some cases, you might have a dry cough or fever. One sign of pleurisy is that if you hold your breath, the pain will stop, because the pleura aren’t rubbing against each other.
Pleurisy can occur in people of any age, but it most commonly affects people over 65. People with certain underlying health conditions, such as autoimmune diseases, tuberculosis, or cancer are more likely to develop pleurisy, but it also occurs in people who have a bacterial, viral or even fungal infection. North African, Jewish, Arab, Armenian, Turkish, Greek or Italian people have a higher risk for pleurisy due to a hereditary condition called familial Mediterranean fever, a genetic mutation that causes inflammation in the chest as well as other parts of the body. People with sickle cell anemia are also more likely to develop 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. It 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.
Doctors diagnose pleurisy by observing symptoms, such as the sharp pain when you breathe. They can use a stethoscope to listen to your chest for a squeaking or rubbing sound, which is the noise of the pleura rubbing together. Blood tests can determine the nature of an underlying infection and an X-ray can identify a pleural effusion and show if your lungs are fully expanding when you breathe. There are other diagnostic tests available to confirm what’s causing your pleurisy.
Doctors treat the underlying cause of the inflammation, which in turn addresses pleurisy. If it’s due to an infection, your provider may give you a prescription for antibiotics, antivirals or antifungals. If pleurisy is the result of trauma, cancer, or an autoimmune disease, your treatment will focus on that condition. NSAIDs may ease pain and bronchodilators (medications to open your airways) can help make it easier to breathe. At home, get plenty of rest and avoid positions or movements that make the pain worse. Any excess fluid between the layers may need to be drained (by thoracentesis or a chest tube) if other treatments do not reduce it.
Pleurisy goes away as long as the underlying cause can be treated. People with pleurisy usually recover completely when they receive prompt diagnosis and treatment. If you take antibiotics for bacterial infections that led to pleurisy, you’ll usually feel better in about a week. 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, but death from pleurisy is very rare.