Pleurisy is an inflammation of the pleura, the thin, double membrane that covers the lungs and lines the chest cavity. Sometimes fluid accumulates in the space between the layers of the pleural membrane, a condition called pleural effusion. Pleurisy and plural effusion are not disease entities; instead, they are complications of other disorders, such as pneumonia, a collapsed lung (pneumothorax), a pulmonary embolism, tuberculosis, or cancer. Certain connective tissue disorders, such as lupus, can also cause pleural pain. A fractured rib or other chest injury may damage the pleura, causing inflammation and producing pleural effusion.
Other possibilities include congestive heart failure, kidney disorders, and liver disease. Typically, pleurisy comes on suddenly, and breathing produces a sharp pain when the two inflamed pleural layers rub against the lungs as they expand and contract. Coughing, sneezing, or other abrupt movement worsens the pain, which may be alleviated by holding the breath or pressing on the chest. Depending upon the cause, there may also be a fever and other symptoms. Shortness of breath is the major symptom of pleural effusion, which is not as painful as pleurisy. In fact, a lessening of pleural pain accompanied by increasing shortness of breath is a possible sign that pleural effusion is developing, and prompt medical attention is required.
Other Causes of Painful Breathing
Pericarditis, an inflammation of the heart covering, can produce pain and a rubbing sound similar to those of pleurisy. Various lung disorders, including pneumonia and a collapsed lung, also may be mistaken for pleurisy.
Diagnostic Studies And Procedures
Pleurisy usually can be diagnosed on the basis of symptoms and a chest examination. When a doctor listens to the chest sounds with a stethoscope, she can hear a characteristic rubbing sound. A chest X ray will be ordered to look for possible causes such as pneumonia. If plural effusion is present, a hollow needle may be inserted between two ribs to withdraw a fluid sample for laboratory analysis. Sputum analysis and a biopsy also may be done. Blood studies and other tests may be needed to determine the underlying cause.
Treating the underlying cause of the pleurisy is essential to achieving a cure. Antibiotics are prescribed if bacterial pneumonia or some other infection is responsible. Drainage usually alleviates any pleural effusion, although repeat drainage may be necessary. If the fluid contains pus, antibiotics may be administered through a tube inserted directly into the chest cavity. Acetaminophen will usually control the pain, which also may be relieved by wrapping the entire chest firmly with two or three wide elastic bandages; these should be loosened and reapplied once or twice a day.
Because pleurisy may indicate a serious underlying disease, treatment should always be overseen by a medical doctor, with alternative therapies used as adjuncts to alleviate symptoms.
A massage using camphor oil may help ease the discomfort. It should be given once a day for about three weeks. However, the chest area itself should not be massaged if the action causes any pain.
Western herbalists may prescribe drinking an infusion of Asclepias tube rosa, also known as pleurisy root, two or three times a day, or boneset, which may be taken as an infusion or decoction. Garlic either fresh or in capsules-is recommended sometimes for its anti infective properties. Chinese herbalists most often use a formula called Pu Chung I Chi Thng, made up of ginseng root, Chinese angelica, licorice root, mandarin orange peel, paichu, ginger rhizome, bupleu rum, cimicifuga, and astragalus.
Aconitum may be prescribed in the earliest stages of pleurisy, to be taken as often as three times an hour. When movement is painful, sulphur may be taken every two hours. Apis is used to treat pleural effusion, and hepar sulphuris may be used when pleurisy is chronic and a large amount of mucus is present.
Rest until pain and fever disappear, then gradually resume your normal activities. If coughing causes pain, use a coolmist humidifier to help loosen bronchial secretions and make them easier to cough up. Holding a pillow firmly against the chest wall when coughing can also help limit the pain. Do not take a cough suppressant, however, because coughing is essential to clearing the lungs and bronchial tubes. Try to breathe deeply and cough after taking a painkiller. Exposure to any form of tobacco smoke can aggravate pleurisy; refrain from smoking, and also stay away from second hand smoke.