Pleuritis and pleurisy are different names for the same thing: inflammation of the pleural tissue around the lungs. Pleuritis may be benign but can also be caused by pleural mesothelioma. Treatment involves finding and managing the underlying condition.
What Is Pleurisy?
Pleurisy, or pleuritis, is an inflammation of the pleura that surrounds the outside of both lungs and lines the inside of the chest cavity.
A small amount of fluid between the tissue layers allows them to move smoothly against each other during inhalation and exhalation. When the tissue becomes inflamed, the two layers rub painfully against each other.[1]
What Are The Symptoms of Pleurisy?
Pleurisy can cause several uncomfortable symptoms, including chest pain that worsens during breathing. The pain typically intensifies when taking a deep breath or when coughing or sneezing. The pain may also be localized in the back or around the shoulders.
Pleurisy causes shortness of breath as the individual experiencing the pain of breathing begins to avoid breathing deeply. Pleuritis can also cause a cough or fever, although these symptoms are less common.[1]
Pleuritis may cause extra fluid to build up between the two pleural layers. This can relieve the pain caused by inflammation but also puts pressure on the lungs. This added pressure makes breathing even more difficult and can trigger a persistent cough. Infections may develop in the extra fluid as well, causing a fever.
How Does a Person Get Pleurisy?
The inflammation of pleural tissue causes the two layers to rub against each other, resulting in pain when breathing. Pleuritis inflammation can be caused by several underlying conditions, including:
- Infections like the flu or pneumonia
- COVID-19 may cause pleurisy
- Fungal infections
- Autoimmune disorders, such as lupus and rheumatoid arthritis
- Injuries to the chest and ribs
- Pulmonary embolism
- Sickle cell anemia
- Lung cancer
- Mesothelioma
- Other cancers
- Certain medications
It also often co-occurs with similar conditions that affect the pleura:
- Pleural effusion – the buildup of fluid in the pleural space
- Atelectasis – the collapse of part of a lung
- Empyema – pus buildup in the pleural space
How Serious Is Pleurisy?
Any case of pleuritis should be taken seriously. If you have symptoms of inflammation, you need to see a doctor for evaluation and diagnosis.
Underlying Causes
Pleurisy can be serious, but it depends on the underlying condition. An infection can often be treated quickly, resolving the symptoms and its cause. On the other hand, lung cancer or mesothelioma is much more serious and life-threatening.
Fibrosing Pleuritis
Pleurisy can be very serious if not addressed. If the underlying condition is left untreated, pleuritis can develop into a serious illness described as fibrosing or sclerosing pleuritis.[2]
These terms refer to a hardening of the tissue. Fibrosing pleuritis means fibrous tissue forms in the pleura, making it more rigid. Sclerosing pleuritis occurs when fibrous, rigid scar tissue builds up.
This rigidity significantly reduces lung volume and capacity, making breathing more difficult. Ultimately, the condition can be fatal. Not everyone who has pleurisy will develop fibrosis or sclerosis. Why some do and others do not is not well understood.[2]
Asbestos and Benign vs. Malignant Pleurisy
Although asbestos is a known cause of mesothelioma and some lung cancer cases, exposure to this mineral can also cause benign pleuritis.
Asbestosis
Benign asbestos-triggered pleurisy can occur with and without asbestosis. Asbestosis is a non-cancerous disease caused by asbestos exposure. It is characterized by scarring and fibrosis in the lungs. This can trigger pleuritis, but the inflammation may also occur after asbestos exposure without developing asbestosis.
Benign pleurisy related to asbestos is fairly common in cases of asbestosis. It tends to be chronic and worsens as the disease progresses; however, there have been reported cases of acute pleurisy resulting from asbestos exposure.
Pleural Mesothelioma
Mesothelioma is a cancer of the pleural tissue and is most often caused by asbestos exposure. Mesothelioma may occur alongside pleurisy triggered by asbestos, but the cancer itself can also trigger pleural inflammation.
In these cases, pleuritis is a symptom or complication of cancer. Symptoms like these can be very uncomfortable. Pleurisy caused by mesothelioma may be treated with anti-inflammatory drugs like steroids.
How Is Pleurisy Diagnosed?
Because several causes can trigger pleuritis, diagnosis is challenging. While identifying pleuritis is not difficult, determining its cause is more complicated. There are cases noted of patients misdiagnosed with mesothelioma when they only had a benign type of pleurisy.
A worse scenario is a patient diagnosed with benign inflammation when they actually have mesothelioma. When this occurs, the cancer continues to develop, making treatment more complicated when it is finally diagnosed. Diagnosis typically follows these steps:[3]
- Diagnosing pleuritis starts with blood tests to determine if there is an underlying infection.
- The next step is typically chest X-rays to look for inflammation and fluid buildup.
- To get a better look, doctors may order a CT scan. This can help identify blood clots, tumors, cysts, or fibrous tissue.
- If a malignancy is suspected, a specialist may take a biopsy of the fluid from the lungs or a piece of tissue from the pleura or lungs.
- A pathologist then examines these samples to determine if there are cancerous cells.
Treating Pleuritis
An accurate diagnosis is the key to getting appropriate treatment. The underlying cause of inflammation must be identified. If the cause can be treated, the patient will recover.
However, in cases of cancer, fibrosing pleurisy, and asbestosis, treating the underlying cause will not cure the condition. Treatment for these progressive conditions mostly focuses on reducing symptoms. Pain medication, anti-inflammatory drugs, draining of pleural fluid, or surgery may be used to manage symptoms and provide relief.[3]
Home Care for Pleurisy
In addition to getting treatment from medical professionals, you can do things at home to relieve the pain and discomfort of pleuritis:
- Use anti-inflammatory pain relieving medication as recommended by your doctor.
- Avoid smoking, and get help quitting smoking if necessary.
- Get plenty of rest and avoid activities that make it worse.
- Experiment with sleeping positions that cause the least amount of pain.
What Is the Prognosis for Pleurisy?
Pleurisy can be mild and temporary or lasting and serious. The prognosis depends on the underlying cause, the patient’s overall health, and the treatments used.
If your pleurisy results from a treatable infection, the prognosis is good. You should get quick relief with the treatment of the infection and be back in good health.
If the cause is more serious, like mesothelioma, the prognosis is poor. Treating the cancer will relieve symptoms to some degree, but it is considered incurable cancer.
Pleurisy is a wide-ranging condition that many factors can cause. Treatment primarily depends on the underlying cause, making accurate diagnosis crucial. Asbestos is a known potential cause for patients with or without mesothelioma or lung cancer. If you experience these symptoms, insist on careful diagnostic procedures and inform your doctor of previous asbestos exposure.
