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What is the treatment for pleurisy?

What is the treatment for pleurisy?

Pleurisy means inflammation of the pleura, the lining of the outside of the lungs and the inside of the ribcage. The main symptom of pleurisy is a sharp chest pain, worse on breathing in.

Pleurisy treatment depends on the underlying cause.

The most common cause of pleurisy is a viral infection (viral pleurisy).

Viral pleurisy usually gets better within a few days and doesn't need any specific treatment, but paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs) can help to control pain symptoms until it goes away.

Other treatments differ depending on the cause. For example, bacterial pneumonia is treated with antibiotics. If there is a large amount of fluid in the pleural space - the area between the outside of the lungs and the inside of the chest wall - this might need to be drained.

In this series of articles centred around pleurisy you can read about symptoms of pleurisy, pleurisy treatment, and pleurisy causes - all written by one of our expert GPs.

The rest of this feature will take an in-depth look at treatments for pleurisy as, at Patient, we know our readers sometimes want to have a deep dive into certain topics.

Pleurisy treatment

Treatments for pleurisy include treatments for the symptoms - chest pain - as well as treatments for the underlying cause.

Treating chest pain

The main symptom of pleurisy is pleuritic chest pain - sharp pain that's worse on taking a deep breath, sneezing, or coughing.

Pain-relieving medications like paracetamol, non-steroidal anti-inflammatory drugs - such as ibuprofen - and codeine can all help.

Because coughing makes the pain worse, and people with pleurisy often have a cough too, cough suppressants might be recommended.

There's not much evidence that cough suppressants actually work, though. Some evidence suggests that honey, pelargonium - a herbal medicine - and guaifenesin-containing cough mixtures may help coughs. Codeine-based cough syrups don't seem to help cough symptoms.

Treating the underlying cause

It's important to identify and treat the underlying cause of pleurisy. Different causes are treated in different ways.

  • Viral pleurisy, the most common cause of pleurisy, has no specific treatment. It usually gets better after a few days. Pain relief (as above) can help with symptoms.
  • Bacterial lung infections (pneumonia) are treated with antibiotics. In severe cases, people might need to be treated in hospital with oxygen, intravenous fluids, and sometimes breathing support with a ventilator.
  • Tuberculosis is treated with a long course of special anti-tuberculosis medications.
  • A pulmonary embolism (blood clot in the lung) is treated in hospital initially with blood-thinning medication. Sometimes, oxygen is required. In severe cases, when it's putting severe strain on the heart, clot-busting medication may be given in hospital.
  • A pneumothorax (collapsed lung) can be treated in several different ways. Sometimes, a pneumothorax can be left for the air to re-absorb on its own. Other times, it may need a procedure to remove air from the pleural cavity, either using a needle and syringe, or inserting a tube into the chest wall.
  • Injuries to the chest wall heal with time. Pain relief is helpful to control symptoms. Further treatments are only required if there is a severe injury, such as bleeding into the pleural cavity or a pneumothorax.
  • Inflammatory arthritis (a type of connective tissue disease) is treated with pain relief and immune-suppressing medication. See the rheumatoid arthritis and systemic lupus erythematosus leaflets for more.
  • Lung cancer has various different treatments depending on the type of cancer, and how advanced it is. See the lung cancer leaflet for more.
  • Pericarditis (inflammation of the lining around the heart) treatment depends on the cause. Viral pericarditis is often treated with non-steroidal anti-inflammatory drugs and colchicine.

Treating pleural effusions

The area between the outside of the lung and the inside of the chest cavity is called the pleural space. Normally, there is a small amount of fluid in this space (around 10ml).

Many of the causes of pleurisy can also lead to fluid collecting in the pleural space, which is called a pleural effusion. These can be seen on a chest X-ray or a CT scan.

Treatment of a pleural effusion involves:

  • Treating the cause of the effusion.
  • Sometimes, draining the effusion.
    • Smaller pleural effusions can be drained with a needle, but usually a chest drain - a tube inserted into the chest - is used to drain the fluid. For some people with pleural effusions that are likely to come back, a catheter (tube) might be left in long-term to allow for repeated drainage.
    • Pleural effusions may be drained if it's thought it will improve symptoms (such as shortness of breath), but not all effusions are suitable for drainage.

What causes pleurisy?

Pleurisy means inflammation of the pleura, the lining of the outside of the lungs and the inside...

Can pleurisy go away without treatment?

This depends on the cause of the pleurisy. Viral pleurisy does go away without any treatment, as do minor injuries to the chest wall.

Other causes of pleurisy are likely to need treatment.

Complications of pleurisy

Potential complications also depend on the cause. Viral pleurisy normally improves without causing any further problems. Other, more serious, causes of pleurisy can cause complications, such as:

  • Fluid around the lung (a pleural effusion).
  • Pus collecting around the lung with bacterial pneumonia (an empyema).
  • A trapped lung that won't inflate fully (atelectasis).
  • Sepsis, with bacterial infections.
  • Breathing difficulties.
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