Pleurisy: Causes, Symptoms & Treatment

Pleurisy is also known as pleurisy or pleurisy. In this condition, inflammation occurs within a thin layer of tissue between the lungs and the chest cavity. This layer is called the pleura or pleura. The cause of pleurisy is usually preceding lung or bronchial disease. Typical signs of pleurisy include pain on exhalation and inhalation and resulting shortness of breath or even shortness of breath.

What is pleurisy?

A so-called pleurisy – called pleurisy in medical terminology – is when the wafer-thin tissue (called pleura), which is located between the rib cage and the lungs, becomes inflamed. However, this tissue not only includes the lung itself, but is found extensively throughout the chest cavity and rib area. Therefore, those affected by pleurisy do not always experience severe pain only in the lung area, but in the entire chest area. In some cases, there is persistent shortness of breath or even shortness of breath.

Causes

Pleurisy most often occurs as a result of a previous illness that affected the inner chest area or lungs – for example, after severe pneumonia, severe bronchitis, or even tuberculosis, because it always takes a long time to heal completely. During the course of the disease, water usually accumulates in the irritated chest cavity due to the existing clinical picture and the occurring symptoms. In this very common case, it is medically called a wet pleurisy. However, physicians strictly separate this type of pleurisy from so-called dry pleurisy, in which the tissue is more likely to be affected due to respiratory effort and existing inflammation. Pleurisy almost never occurs as a completely independent disease, i.e. without a corresponding disease in advance. If a patient suffers from such a disease, pleurisy can be prevented by strengthening the immune system during the course of the disease.

Symptoms, complaints, and signs

Inflammation of the pleura is primarily manifested by typical signs of inflammation. Affected individuals first notice a mild fever and a general feeling of illness. A short time later, breathing difficulties appear: Dry cough, shortness of breath and occasionally hoarseness. Breathing sounds are creaky or rubbing, with this leathery rubbing becoming more pronounced as the disease progresses before slowly subsiding during the recovery period. As a result of the inflammation, the pleura becomes overly sensitive to pain, causing stabbing chest pain when breathing. Deep breaths are particularly painful, which is why many sufferers breathe mainly through the nose and limit themselves to shallow breaths. The characteristic breathing activity favors diseases of the respiratory tract. Thus, dry, painful coughing may occur as a result of pleurisy. The pain is usually unilateral and may radiate to the shoulder and chest regions. This is accompanied by the symptoms and complaints of the underlying disease in question. If the inflammation spreads to the diaphragm, hiccups may also occur. The signs of pleurisy appear over the course of two to five days after infection and quickly become more severe. With prompt treatment, symptoms resolve within a few days.

Course of disease

Patients suffering from pleurisy usually complain increasingly of pain when coughing and breathing. In this case, the pain begins rather inconspicuously and then slowly increases as the disease progresses. In the initial phase of pleurisy, many sufferers can still identify the precise source of pain, but later the pressure often spreads to the entire chest together with the pleurisy. In other words, patients complain of severe discomfort in the entire chest and no longer just in the lung area. As pleurisy progresses, the feeling of pain also increases. At a later stage of the disease, many people suffering from pleurisy also complain of persistent pressure in the rib area.

Complications

Provided that therapy for the underlying disease is given, there are usually no serious effects. However, if pleurisy is not treated in time, the risk of complications increases. One of the most common consequences of pleurisy is the so-called pleural rash. It is primarily seen in exudative pleurisy. If the inflamed pleural segments lie on top of each other for a long period of time without moving, the pleura and the lung pleura can fuse together. This in turn leads to the development of a pleural callus or pleural rind. This process results in a firm connection between the lungs and the chest. As a result, the patient can no longer breathe freely because less air is taken in with each breath. Even when the pleurisy has healed, limitations in lung elasticity continue to be present. Surgery is required to separate the pleura from the lung pleura again. A feared complication of pleurisy is pleural empyema, which is a purulent effusion. In this case, the pleural space is filled with fluid. If the extent is small, pleural empyema often goes unnoticed. However, if the volume increases, the lungs are unable to expand enough, making breathing difficult. The patient eventually suffers from shortness of breath. A pleural empyema is usually triggered by bronchiectasis, a bacterial pneumonia, a lung abscess or a surgical intervention within the chest cavity. It is noticeable by cough, high fever, night sweats as well as the loss of weight.

When should you go to the doctor?

A doctor should always be consulted in case of pleurisy. There is no self-healing in this disease and in most cases there is also a significant worsening of symptoms if treatment is not initiated. Early diagnosis and treatment of pleurisy always has a positive effect on the further course of the disease and can prevent complications. A doctor should be consulted if the patient suffers from severe chest pain. There is also fever and general symptoms of flu. The pain itself can also spread to the shoulders and therefore has a very negative effect on the patient’s quality of life. In most cases, there is also coughing or severe shortness of breath. If these complaints occur, a doctor must be consulted in any case. In the first place, a general practitioner can be visited in case of pleurisy. In emergencies or in case of very strong and acute complaints, an emergency doctor can also be called or the hospital can be visited directly. Pleurisy can be treated relatively well, so that the life expectancy of the patient is also usually not limited by this disease.

Treatment and therapy

For pleurisy to be truly successfully treated, it must be diagnosed as soon as possible. If the necessary therapy is started promptly, pleurisy usually heals without problems and without major late effects. However, the therapy for pleurisy is not so much aimed at treating the pleurisy itself, but the underlying disease that causes it. The situation is different, however, when it comes to the symptoms themselves: The pain that occurs can be relieved, for example, with gentle heat, after consultation with the attending physician. In addition, patients must be kept on strict bed rest and take it easy, as they are usually very short of breath during pleurisy. Medications are only ever used during pleurisy if it is compatible with the underlying disease. In addition, breathing therapies are often initiated to support deep breathing – even during painful pleurisy. This is because the patient must be prevented from taking only short breaths for fear of pain. This could cause the pleura to fuse with the rib cage. If this is the case, surgery is usually unavoidable after pleurisy.

Aftercare

Pleurisy is associated with marked pain in the upper body. The affected person finds the symptoms very distressing in everyday life. The inflammation may indicate another organic cause. Follow-up therapy depends on the particular trigger. Moreover, it aims to relieve the symptoms. In the end, pleurisy should heal without consequences.Follow-up care continues until complete cure. If not sufficiently cured, the disease can become life-threatening. For this reason, both treatment and aftercare must be taken seriously by the patient. Computer tomography scans, blood draws or a chest x-ray will reveal the cause. It must be treated first. The lung specialist prescribes pain-relieving and fever-reducing medication to combat the inflammation. If the cause is bacterial, the patient also receives antibiotics. Follow-up care ends when the medication is discontinued. The exact timing is determined by the physician. Aspiration of pleural effusion is performed by means of puncture in the chest cavity. The progress of healing can be recorded with regular monitoring. Late complications must be avoided. Even after the therapy is finished, the patient should attend follow-up appointments. In the event of an unexpected recurrence of pleurisy, treatment and follow-up will begin again. The specialist will schedule further examinations for clarification.

What you can do yourself

The focus of self-applicable measures for pleurisy is to maintain adequate lung ventilation and prevent inflammation of the lungs (pneumonia), as well as to relieve breath-dependent pain. For this purpose, various exercises can be performed to ensure ventilation of all lung areas. Of course, any painkillers that may be prescribed should be taken beforehand, with some time between them, to make it easier to perform. Children in particular enjoy being asked to produce soap bubbles. All that is needed is a straw and a cup of soap solution. Slowly blowing in air expands the lung tissue and allows the body’s own secretions to drain more easily. Adult patients should remember to take regular deep breaths to achieve the same effect. Regular walking or rubbing with rubbing alcohol or similar can also be beneficial. Under no circumstances should the affected person resort to limiting his or her own personal mobility because of the unpleasant sensation. An accompanying fever can be alleviated by drinking sufficient amounts of mineral water, resting and taking antipyretic medication. However, high fever or a bacterial origin should be treated by a physician.