Inflammation of the parietal
pleura-outer, epithelial lining of the lungs is known as pleurisy
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.
Pleurisy 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
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.