Pleurisy Treatments and Medications

Pleurisy is a condition in which the pleura (the thin membranes that surround and cushion the lungs) become inflamed, causing them to rub together instead of gliding smoothly during breathing. This irritation leads to sharp, stabbing chest pain that often worsens with deep breaths, coughing, or sneezing, and may radiate to the shoulders or neck. Because breathing can become painful, people may take rapid, shallow breaths and experience shortness of breath, a dry cough, or even bluish skin if oxygen levels drop. While pleurisy often resolves within a few days, it can be triggered by underlying issues such as infections or more serious conditions, so anyone experiencing painful breathing should seek medical evaluation to identify the cause and determine appropriate care.

How is pleurisy diagnosed?

Because pleurisy is a condition arising from an underlying cause, the goal of diagnosis is to identify the underlying cause. Most patients will first typically visit a general practitioner or an emergency room provider. That provider will immediately begin to rule out the most common life-threatening conditions that cause pleuritic pain: pulmonary embolism, heart attack, pericarditis (inflammation of the membrane surrounding the heart), aortic dissection (a tear in the main artery, the aorta, coming off the heart), pneumonia, or a collapsed lung.

Diagnosis of the underlying condition will typically involve a medical history, physical examination, and, in most patients, a chest X-ray.

The most important information is how quickly the pleuritic pain started. A very sudden onset may point to a more serious condition, while a more gradual onset may be due to a condition such as infection or rheumatoid arthritis. Be prepared to describe the onset of the condition along with other symptoms that started at the same time.

During the physical, the healthcare provider will listen to the lungs and heart through a stethoscope to differentiate pleurisy from other pleural disorders, pericarditis, or other heart disorders. Other symptoms examined during a physical, such as shallow breathing, pulse abnormalities, or fever, can help point a healthcare provider to the right diagnosis.

Depending on the results of the history and physical, one or more other tests may be necessary to definitively nail down the cause:

• Blood tests can identify substances unique to infections, inflammatory disorders, pulmonary embolism, pancreatitis, or heart problems.

• A CT scan can help define the extent of the problem if an X-ray shows an infection, collapsed lung, aortic dissection, cancer, or pleural disorders.

• An electrocardiogram (ECG) or echocardiogram can help identify heart problems.

• Thoracentesis, removing excess pleural fluid through a syringe and testing it, primarily helps identify the source and cause of the pleural fluid buildup. This can also help relieve pain.

Pleurisy treatment options

Pleurisy is treated by fixing the underlying condition. Bacterial infections will be treated with antibiotics, viral infections will be treated with supportive care and antiviral medicine when appropriate, pulmonary embolism will be treated with blood thinners, and other conditions will be treated appropriately. Pleuritic pain and swelling may be relieved with over-the-counter pain medicines, although some cases may require corticosteroids.

Types of pleurisy medication

Treatment of pleurisy involves medications that vary depending on the underlying cause. The actual inflammation is often treated with over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs). Depending on the cause or severity, the healthcare team may use corticosteroids to reduce pleural swelling and pain.

NSAIDs

NSAIDs work by blocking the body’s production of prostaglandins, substances that cause swelling, fever, and pain. Because NSAIDs also impair the body’s ability to form blood clots, pleurisy patients on blood thinners or with bleeding problems will be put on an alternative like celecoxib, an NSAID that has less effect on blood clotting. Some NSAIDs are available over the counter, and some NSAIDs are also available in higher doses by prescription. 

Corticosteroids

When pleuritis is particularly severe or caused by certain conditions, such as lupus or tuberculosis, a physician might use a short course of corticosteroids, such as prednisone, dexamethasone, or methylprednisolone, to reduce swelling and help relieve pleural effusion.

Over-the-counter pleurisy medicine

Over-the-counter NSAIDs such as aspirin, ibuprofen, or naproxen may help relieve pleurisy swelling and pain while the underlying condition resolves. People taking blood thinners or those who have bleeding problems will be put on an alternative pain reliever, like over-the-counter Tylenol (acetaminophen), which is not an NSAID.

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