What is Pleurisy?
Pleura are a double-layered, moist membrane, which cover the lungs and line the rib cage. Inflammation of the pleura is known as pleurisy (also known as pleuritis). Any person suffering from Pleurisy finds it extremely painful to breathe. Pleurisy can also occur in conjunction with pleural effusion, which is a condition where there is excess accumulation of fluid between the layers of the membrane. Pleura is a double-layered membrane, which helps in protecting and lubricating the lung's surface as they inflate and deflate in the rib cage.
The pleural space, which is a thin, fluid-filled gap between the two 2 membranes, help in gentle sliding of the two layers of the pleural membrane past each other. However, in pleurisy, there is inflammation of these membranes where with every breath, cough, sneeze, these inflamed and roughened surfaces of the pleura rub painfully against each other.
In some of the cases of pleurisy, there is seeping of the excess fluid into the pleural space, which leads to pleural effusion. This accumulated fluid often has a lubricating effect, which helps in alleviating the pain related with pleurisy, as this fluid will decrease the friction between the membrane's layers. However, this excessive fluid also puts pressure on the lungs thereby decreasing their ability to move freely. If there is large amount of fluid present then it can also cause shortness of breath. There are some patients where the excessive fluid in pleural effusion may also get infected.
Treatment for Pleurisy consists of treating the underlying cause of the Pleurisy.
Causes of Pleurisy
The most common cause of pleurisy is mostly viral infection. Some of the causes of pleurisy include:
- Lung infections, like tuberculosis and pneumonia.
- Injuries to the chest.
- Other medical conditions, such as systemic lupus erythematosus (SLE), cancer, rheumatoid arthritis, pulmonary embolism and liver diseases.
- Reactions to certain medicines.
- Pleurisy commonly occurs due to some other underlying medical condition, which should be treated first.
- A person can have pleural effusion even without pleurisy. Medical conditions, such as heart failure, kidney disease and liver disease can also cause pleural effusion without the additional pain and inflammation of pleurisy.
Signs & Symptoms of Pleurisy
- Patient suffering from Pleurisy has chest pain, which worsens upon breathing, coughing or sneezing.
- Pain from the pleurisy can also radiate towards the shoulder and back.
- Shortness of breath is one of the symptoms of Pleurisy, as the patient tries to reduce the amount of inhaling and exhaling he/she does.
- Fever can be present in some cases.
- Sometimes, the patient suffering from Pleurisy can also have a cough.
- Patient can have pleural effusion sometimes in pleurisy, which is a condition where there is buildup of fluid in the pleural space (space between the two layers of tissue). If moderate amount of fluid is present, then patient will feel less pain or even no pain at all, as the two pleural membranes no longer touch each other. If the accumulated fluid in the pleural space is large in quantity, then it can cause compression on the lungs where they can collapse, partially or completely. This can cause the patient difficulty in breathing and also cough. Infection can also develop in the excess fluid. This condition is known as empyema which is usually accompanied by fever.
- Patient suffering from Pleurisy should consult a doctor immediately if he/she experiences unexplained, acute chest pain upon breathing, as there could be a problem with the lungs, pleura or the heart, which is causing chest pain and needs immediate medical attention.
Investigations to Diagnose Pleurisy
Medical history and physical exam are done to diagnose Pleurisy. Some tests which are carried out include:
- Blood tests are done to help detect an infection. Blood tests are also done to find out if the patient has some autoimmune disorder like lupus or rheumatoid arthritis where pleurisy is the initial sign.
- Chest x-ray can show if the lungs are completely inflating or if there is any fluid or air present between the ribs and the lungs. Decubitus chest x-ray can also be done where a chest x-ray is taken when the patient is lying on his/her side.
- Ultrasound is an imaging test which uses high-frequency sound waves to generate accurate images of the structures present within the body. It also helps in showing whether the patient has pleural effusion or not.
- CT (Computerized Tomography) scan is a test where a computer generates the x-rays into detailed images of the chest, which will help in detecting any blood clot in the lung or any other causes of the pleuritic pain.
- Electrocardiogram is a test which monitors the heart and helps in excluding certain heart problems as a cause for the chest pain.
- Thoracentesis is a procedure where the fluid is removed from the lungs and sent to the lab for testing. A local anesthetic is injected between the ribs in the region where fluid is seen on the imaging studies. A needle is then inserted (sometimes with ultrasound guidance) through the chest wall between the ribs, which removes the fluid, which is then sent for laboratory analysis.
- Thoracoscopy is a procedure, which is done under general anesthesia where the surgeon can see inside the chest and retrieve a tissue sample from the pleura to send it for analysis.
- Pleural biopsy is done if cancer or tuberculosis is suspected to be the underlying cause of pleurisy. In such cases, thoracentesis with pleural biopsy is done. This procedure can also be done under ultrasound guidance.
Treatment for Pleurisy
- Treatment depends on the underlying cause of pleurisy and the pleural effusion; and is done accordingly.
- If bacterial pneumonia is causing the pleurisy, then antibiotics are given to control the infection. If any viral infection is the cause, then pleurisy will often resolve on its own.
- In any case, patient is advised to take complete bed rest and lie in a position which causes the least discomfort. Patient should also not perform activities which consist of physical exertion.
- Medications, such as over-the-counter pain killers or NSAIDs like ibuprofen, help in relieving pain and inflammation associated with Pleurisy.
- If the patient has lot of pleural effusion, then that excess fluid is drained.
How long does the Pleurisy Last?
Pleurisy commonly lasts for a few days to a couple of weeks. Very rarely, the bacteria or virus can spread and cause pleurisy in others.
Is Pleurisy Contagious?
Pleurisy itself is not a contagious condition. However, other medical conditions which lead to pleurisy can be contagious. Some of the examples of underlying medical conditions, which can lead to pleurisy and can be contagious include infections like pneumonia, influenza, tuberculosis….all these are some of the common causes of pleurisy and they are contagious. It is better to take precautions, such as, if you come in close contact with a person who has had viral infection which has lead to pleurisy; then it is advised to restrict the physical contact and wash your hands, etc., afterwards.
Prognosis of Pleurisy
The prognosis of the pleurisy is good and patient is expected to make full recovery if the underlying cause is diagnosed and treated early. Prognosis also depends on the severity of the underlying medical condition causing pleurisy.
Home Remedies for Pleurisy
- Patient should avoid solid as well as liquid foods and should take only water for a few days and gradually increase the amount.
- A milk diet can be started when there is any reduction in the symptoms.
- Foods which contain vitamin C & A, such as oranges should be taken, as they strengthen the immune system.
- Spicy, cold, fermented and fried foods should be avoided.
- Vegetable soups can also be taken.
- Tea made from pleurisy root is beneficial in pleurisy. It will help in clearing the mucus and the lungs.
- Application of hot packs to the chest also helps in pleurisy. Avoid them, however, if you have fever.
- Taking a hot water bath to which olbas oil has been added also helps in pleurisy.
- Eating 20 grams of basil leaves before breakfast and evening time helps in drying the pleura fluid and provides relief to the patient.
- Application of loose poultice consisting of linseed to the chest and back helps in relieving the pleurisy symptoms.
- Black seed is used in cooking food and greatly helps with pleurisy. The oil of black seed can be taken in the form of capsules to make the immune system strong.
- Similarly, seeds and oil of celery also help in curing pleurisy.
- Oleuropein is an ingredient in the olive leaves, which helps in fighting all types of infections, cancer and in lowering blood pressure. The extract from the olive leaf can be taken in the form of powder or capsule. Olive leaf can also be taken in the form of dry or liquid leaf tea.
- Using a humidifier helps in moistening the air and in thinning and expelling the mucus from the lungs.
- Sun bathing and air bathing are also beneficial in pleurisy.