The Facts

The lungs are surrounded by a special lining called the pleura. This lining includes the tissue inside the chest wall and tissue that surrounds the lungs. It protects the lungs from the chest wall and allows them to easily slide against each other.

Although it is normally smooth, if this lining becomes inflamed, the surface of the pleura becomes rough and irritated, causing the condition known as pleurisy. Sometimes, a collection of fluid around the lungs may occur - this is called wet pleurisy. Without the buildup of fluid between the lungs and the lining, the condition is known as dry pleurisy.

Causes

Pleurisy is often caused by certain respiratory conditions. Pneumonia, tuberculosis, viral infections, or other lung infections may cause inflammation of the lining that leads to this condition.

Environmental factors such as asbestos in the air can also cause pleurisy.

Cancer that has spread from one area of the body or autoimmune disorders such as lupus may also result in inflammation of the lining of the lungs. In rare cases, certain medications can cause pleural inflammation.

A clot in a blood vessel of the lung, called a pulmonary embolism, can cause pleurisy.

Pancreatitis, an inflammation of the pancreas, can also lead to pleurisy.

Symptoms and Complications

The main symptom of pleurisy is chest pain. A person with pleurisy may feel pain with each breath; when a deep breath is taken; or while coughing, moving, or sneezing.

If pleurisy is associated with a lung infection (e.g., tuberculosis or pneumonia), then cough, shortness of breath, and fever are common.

Making the Diagnosis

Doctors use a combination of physical examination and diagnostic tests to diagnose pleurisy. Abnormal breathing sounds are often a clue that doctors search for during their examination. Some sounds that are not considered normal include crackles, wheezing, bubbling, clicking, and rattling. Decreased or muffled sounds may indicate a fluid buildup around the lungs.

Doctors usually check for a sound caused by pleurisy, often described as a pleural "rub," by listening for the creaky, scratchy sound of the pleura rubbing together during a breath.

Blood tests, images of the chest (e.g., X-ray or ultrasound), and analysis of fluids around the lungs may also help your doctor to diagnose the condition.

Treatment and Prevention

If the pleurisy is related to an infection, fighting the infection is the most common treatment. Antibiotics help fight off bacterial infections (e.g., pneumonia). Because antibiotics do not work for viral infections, these are often left to clear up without medication.

The pain associated with breathing is treated with anti-inflammatory medications (e.g., nonsteroidal anti-inflammatory drugs, or NSAIDs). Stronger pain medications may be required for more severe pain. Corticosteroids may be needed for other inflammatory conditions.

Pleurisy can be prevented by avoiding lung infections and environmental causes of pleurisy such as asbestos exposure. To prevent infections, wash your hands before touching your face or eating and after using the washroom, and avoid contact with people who have serious respiratory conditions.

If you work around asbestos (e.g., if you are involved in demolition or construction on older buildings), make sure you are properly trained in how to handle the material safely. If you think you might have asbestos in your home (it can be found in some older homes), do not disturb it by cutting, sanding, or scraping it. Asbestos fibres, which can stay in the air for a long time and can be inhaled into the lungs, have been linked to pleurisy and lung cancer. If you need to have asbestos removed, contact a licensed asbestos removal company.