Inflammation of the parietal pleura-outer, epithelial lining of the lungs is known as pleurisy (or pleuritis). The fast moving pain signals in the parietal pleura cause severe and local pain in the chest. Pleurisy leads to inadequate exchange of oxygen and carbon dioxide.
A pleural rub, that is friction between the parietal and visceral pleurae, is a frequent symptom of pleurisy. The sharp pain worsens with any chest movement including a cough, sneeze or deep breath and is accompanied by wheezing, phlegm and fast breathing.
AdvertisementPleurisy can occur in a variety of diseases, e.g. pulmonary embolism, pneumonia, pleural malignancy, myocardial infarction or pneumothorax, which are diagnosed based on chest x-ray or CT scan findings. An ECG is performed if myocardial infarction, pulmonary embolism or pericarditis is suspected. Often the source of pleurisy is determined by the when the onset of symptoms occurs: acute, sub-acute, chronic or recurrent.
Trauma, cardiac injury, infection, respiratory illness, medication toxicity, autoimmune disease and cancer are frequent causes of pleurisy. A 1966-1998 review by Morelock and Sahn documented which drugs are linked to pleural disease.
Treatment options for pleurisy are based on reducing chest pain and treating the fundamental disease. Pleuritic chest pain is treated with NSAIDs (non-steroidal anti-inflammatory drugs) such as indomethacin to reduce pleural inflammation and, if need be, opioid analgesics are used. Indomethacin provided pain-relief in nearly 65% of the patients. Tricyclic antidepressants or anticonvulsants may be used to treat neuropathic and pleuritic pain syndromes.
For pneumothorax (air in the pleura space causes inflammation) there are no definitive drug treatments. The patients with tension pneumothorax is closely monitored and treated with local anesthetic drugs. In the case of pulmonary embolism (embolus causes inflammation) treatment is based on latest clinical guidelines.
Pleural malignancies may be localized or result from external cancers (e.g., mesothelioma). Initial treatment includes NSAIDs and opioid analgesics for pain management. Radiotherapy is an option for managing pain and has been reported to be effective in nearly 60% of mesothelioma patients. Pneumonia patients are treated, based on micro-organism involved, with antimicrobial agents.
Pleurisy is a disorder in which chest pain appears as a symptom of another primary disease. Treatment options include NSAIDs (indomethacin) and opioid analgesics.
Reference: Pleurisy: Symptom or Condition?; Jennifer Confer et al; US Pharm. 2012;37(7):HS-9-HS-12.
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