From the Guidelines
Pleurisy treatment should prioritize addressing the underlying cause and managing symptoms, with a focus on reducing inflammation and preventing complications, as recommended by the most recent guidelines 1.
Treatment Approach
The treatment approach for pleurisy depends on the underlying cause, which can include bacterial infections, viral infections, autoimmune conditions, or pneumothorax.
- Bacterial infections require antibiotics, with the choice of antibiotic guided by bacterial culture results or covering community-acquired bacterial pathogens and anaerobic organisms 1.
- Viral infections generally resolve with supportive care.
- Autoimmune conditions may need immunosuppressants.
- Pneumothorax might require chest tube placement.
Pain Management
For pain relief, nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (400-800mg every 6-8 hours) or naproxen (500mg twice daily) are typically recommended.
- If pain is severe, stronger pain medications or corticosteroids may be prescribed to reduce inflammation.
- Applying heat to the painful area can provide additional comfort.
Surgical Intervention
Surgical intervention may be required for patients with pleural infection who fail to improve with optimal medical therapy, with the choice of surgical approach depending on the individual patient's needs 1.
- The use of small bore chest tubes (14F or smaller) is recommended for initial drainage of pleural infection 1.
- Different surgical methods can be deployed, including drainage, debridement, and visceral decortication.
Recovery and Prevention of Complications
While recovering, rest is important, and breathing exercises can help prevent complications.
- Most cases improve within a few days to weeks with appropriate treatment.
- If breathing becomes difficult or pain worsens despite treatment, immediate medical attention is necessary as this could indicate a worsening condition.
From the Research
Pleurisy Treatment Overview
- Pleurisy treatment typically consists of pain management with nonsteroidal anti-inflammatory drugs, as well as specific treatments targeted at the underlying cause 2
- The diagnosis of pleurisy can be made after excluding other significant causes of pleuritic pain, such as pulmonary embolism, pericarditis, pneumonia, myocardial infarction, and pneumothorax 2
Diagnostic Approach
- History, physical examination, and chest radiography are recommended for all patients with pleuritic chest pain 2
- Electrocardiography is helpful, especially if there is clinical suspicion of myocardial infarction, pulmonary embolism, or pericarditis 2
- Thoracocentesis should be performed for new and unexplained pleural effusions to determine the etiology of the effusion 3
Management of Pleural Effusion
- Transudative effusions are usually managed by treating the underlying medical disorder 3
- Exudative effusions require management based on the underlying etiology of the effusion 3
- Malignant effusions are usually drained to palliate symptoms and may require pleurodesis to prevent recurrence 3, 4
- Empyemas need to be treated with appropriate antibiotics and intercostal drainage 3