Pleurisy

Pleurisy is inflammation of the pleura, the two thin layers that cover the lungs. It causes sharp chest pain, called pleuritic pain, that gets worse when you breathe or cough.

Anyone can get pleurisy, at any age. But people aged 65 years and over are most at risk, because they're more likely to get a chest infection.

• You have severe difficulty breathing (for example, you struggle to speak without pausing, gasping or choking)
• Breathing in or coughing is painful, particularly if you also have other symptoms, such as coughing up blood or leg swelling
• You have severe chest pain in the middle of your chest that isn't going away (it may feel like pressure, tightness or squeezing)
• The pain spreads to your arms, back, neck and jaw
• You feel more drowsy than usual or find it more difficult to wake up
• Your lips or skin are turning pale, blue or grey (on brown or black skin this is easier to see on the palms of your hands)

Contact a doctor urgently if you:

• have difficulty breathing, or you feel more short of breath than usual
• feel confused, dizzy or lightheaded
• feel sick or are being sick, for example if you can't keep food or fluids down
• have heart palpitations (this may feel like your heart is racing, going too slowly or skipping a beat, or like a fluttering in your chest)
• have a sharp shoulder pain when breathing deeply
• have had a deep vein thrombosis (DVT) or a blood clot in the lungs (pulmonary embolism) before
• take blood thinning medicine
• are peeing less than usual, which can be a sign of dehydration
• have a very high or low temperature, for example you feel either hot or cold to touch, or you're shivering

If your doctor is closed, call the 16263 health line.

• you have breathlessness that is not getting better
• you have had a cough for more than 3 weeks
• your symptoms are not getting better, or they are affecting your daily life

Doctors can usually diagnose pleurisy just by asking about your symptoms. Your doctor can also listen to your chest for sounds that suggest you may have it.

You may need further tests to find the underlying cause and to see how severe the problem is. These can include:

• blood tests to find out whether you have an infection or an autoimmune condition
• chest X-rays
• an ultrasound scan
• a computerised tomography (CT) scan
• a biopsy, where a small sample of pleural or lung tissue is removed for further testing

How pleurisy is treated depends on what is causing it.

If a viral infection is behind your pleurisy, it will often clear up by itself without any treatment, usually within a few days. Pleurisy caused by a bacterial infection is different, and it is usually treated with antibiotics. People who are frail or already in poor health may be admitted to hospital, and they may take longer to recover.

Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are often used to relieve the chest pain.

Sometimes excess fluid builds up between the pleural layers. If that happens, the fluid may need to be drained to prevent breathing difficulties. This is known as pleural effusion.

Most cases of pleurisy start with a viral infection (such as the flu) or a bacterial infection (such as pneumonia). Methicillin-resistant Staphylococcus aureus (MRSA) can also cause it, especially in hospital patients. MRSA is a type of bacteria that resists a number of commonly used antibiotics.

In rarer cases, pleurisy comes from conditions such as a blood clot or lung cancer.