From the Guidelines
Pleurisy is inflammation of the pleura, the thin membrane that lines the lungs and chest cavity, and its management focuses on treating the underlying cause while providing symptomatic relief, with the most recent guidelines from the British Thoracic Society 1 emphasizing patient choice and informed decision-making in treatment modalities. The definition of pleurisy involves inflammation of the pleura, leading to sharp chest pain that worsens with breathing, coughing, or sneezing.
Causes and Management
The management of pleurisy depends on the underlying cause, which can range from infections to inflammatory diseases.
- For bacterial infections, antibiotics such as amoxicillin-clavulanate or azithromycin are commonly prescribed, as seen in the BTS guidelines for pleural infection 1.
- For viral causes, supportive care is the mainstay of treatment, including rest, breathing exercises, and pain management with NSAIDs like ibuprofen or naproxen.
- In cases with significant pleural effusion, thoracentesis may be performed to drain fluid and relieve symptoms, with the choice of treatment modality depending on patient choice and informed decision-making 1.
Treatment Approaches
The choice of surgical approach for pleural infection, when medical therapy fails, should be based on the best clinical outcomes, with options including endoscopic techniques (VATS) or open techniques (thoracotomy) 1. The British Thoracic Society guidelines for pleural disease 1 provide a framework for managing pleurisy, emphasizing the importance of patient-centered care and evidence-based treatment modalities. By prioritizing the most recent and highest-quality evidence, healthcare providers can optimize outcomes for patients with pleurisy, minimizing morbidity, mortality, and improving quality of life.
From the Research
Definition of Pleurisy
- Pleurisy is characterized by sudden and intense sharp, stabbing, or burning pain in the chest when inhaling and exhaling, known as pleuritic chest pain 2.
- The pleura is a monolayer of mesothelial cells covering the lung and inner surface of the chest cavity, creating the pleural space 3.
Management of Pleurisy
- Treatment is guided by the underlying diagnosis, with nonsteroidal anti-inflammatory drugs (NSAIDs) being appropriate for pain management in those with virally triggered or nonspecific pleuritic chest pain 2.
- However, NSAID exposure at the early stage of community-acquired pneumonia is associated with a more complicated course, including pleuropulmonary complications such as pleural empyema and lung cavitation 4.
- Prehospital use of NSAIDs for more than 6 days can prolong hospitalization in patients with pleuropulmonary infection, and early prehospital antibiotic use can prevent the development of empyema 5.
- It is essential to rule out serious causes of pleuritic chest pain, such as pulmonary embolism, myocardial infarction, pericarditis, aortic dissection, pneumonia, and pneumothorax, using history and physical examination, electrocardiography, troponin assays, and chest radiography 2, 6.