Pleurisy

Inflammation of the lining of the lung. The pain has a distinctive character, and finding the cause is the whole job.

What it is

Pleurisy is inflammation of the pleura, the double membrane between the lung and the chest wall. The two layers rub instead of gliding, which causes a sharp pain on breathing in.

Pleurisy is not a diagnosis in itself. It is a sign, and the question is always what is causing it.

Common causes are viral infection and pneumonia. The one that must not be missed is pulmonary embolism, a clot in the lung, which classically causes pleuritic chest pain with breathlessness. See deep vein thrombosis.

Others include autoimmune conditions such as lupus and rheumatoid arthritis, injury, and less commonly cancer.

Signs you might notice

Sharp, stabbing chest pain that is clearly worse on breathing in, coughing or moving.

Pain often on one side, and sometimes felt in the shoulder.

Breathing shallowly to avoid the pain, which risks a chest infection.

A rubbing sound heard through a stethoscope.

Accompanying features that point to the cause: fever and a productive cough for infection; breathlessness, a fast pulse and leg swelling for a clot.

Sudden breathlessness with pleuritic pain is a pulmonary embolism until proved otherwise.

How it can affect day-to-day life

The distinctive feature that helps everybody is that the pain is clearly tied to the breath. Cardiac pain is not, and that distinction is useful at the front door of a hospital.

Shallow breathing to avoid pain leads to poor lung expansion and secondary infection, particularly in older people, so pain relief is a clinical intervention rather than comfort.

A pleural effusion, fluid collecting between the layers, can develop and paradoxically reduces the pain while causing breathlessness. Pain settling with increasing breathlessness is not improvement.

Supporting someone well

Treat pleuritic chest pain with breathlessness as urgent. Do not wait.

Take pain relief properly so that deep breathing is possible; anti-inflammatories are usually effective.

Do deep breathing exercises despite the pain, precisely to prevent a chest infection.

Lie on the affected side, which many people find splints the chest and helps.

Watch for pain settling while breathlessness increases, and report it.

Make sure the cause is found and named rather than the pain simply being treated.

Where to get help

Same-day assessment for new pleuritic chest pain.

999 for sudden breathlessness, chest pain with faintness, or coughing blood.

Asthma + Lung UK helpline: 0300 222 5800.