Our grandparents found it to be an elusive and confusing disease. Often the pain disappeared, even though the doctor told them they still had "trouble on the chest". The ailment came often and stayed long, the pain appearing or disappearing without rhyme or reason. It still does, but now we know.

Our grandparents treated pleurisy with mustard plasters, cupping, flaxseed poultices and other fine old remedies. They may have relieved the pain, but probably did little to clear up the underlying condition.

Folks in those days expected long and painful bouts with pleurisy, but knew that it was not – and is not today – a "killer." It was – and is today – chiefly a complication of other, more dangerous chest conditions, an added burden that increased the suffering from pneumonia or tuberculosis. It often hung on as a painful aftermath when the main disease had been conquered. It still does.

What is Pleurisy?

Pleurisy is an inflammation of the pleura. There are two pleurae, one around each lung. The pleura is a two-ply membrane that both encloses the lung and lines the chest cavity.

This two-layer protective wrapping fits closely around the lung, with, normally, no actual space between the inner and outer layers. The layers are joined at the edges, so that the pleura might be compared to a closed balloon, completely empty of air and wrapped tightly around the outside of each of the lungs.

Only a thin Iubricating layer of fluid is between the inner pleural lining and the outer one. Ordinarily, the smooth linings and lubricating fluid serve to allow the lung free movement within the chest for normal breathing. The almost non-existent space occupied by the lubricant can develop into what is called a pleural cavity if its fluid contents increase.

What causes Pleurisy?

As our grandparents learned through hard experience, pleurisy can arise from various causes and take various ways to develop, sometimes with excess fluid in the pleural cavity ("wet pleurisy") and sometimes without ("dry pleurisy"), sometimes accompanied by no pain sometimes very painful.

There are two kinds of pleurisy. A "primary" pleurisy is an inflammation arising in the pleural tissues themselves, from a germ that attacked them directly, or perhaps from an injury or growth. A "secondary" pleurisy is an added effect from some other chest disease – pneumonia, for instance – in which the germs reach the pleura as well as the lungs themselves, or tuberculosis, or lung abscess, or tumor of the lung; almost anything wrong in the chest.

The symptoms and course of primary and secondary pleurisy may be exactly the same, with only the cause different.

How Pleurisy Happens

Pleurisy may be acute – appearing, giving trouble for a period, and then disappearing. It may be chronic – hanging on, the pain steady or recurring often, the interference with breathing and other normal activity an enduring burden. Whether acute or chronic, pleurisy can be either dry or wet, painful or free of pain.

Dry pleurisy is an inflammation that has not formed fluid. It can be very painful, especially when the swollen outer layer is stretched on breathing. A grating sensation may be distinctly felt by the victim when the two layers, both perhaps stiffened and swollen, rub against each other. Oddly enough, however, it is only the outer lining, next to the chest wall, that feels pain. The one next to the lung has no pain nerves.

Again, the inflammation of dry pleurisy may subside and the pain go away, even though the grating of the roughened tissues may still be felt. Or it may turn into wet pleurisy, with the accumulation of fluid. The fluid may be absorbed and become a dry pleurisy again.

Wet pleurisy ("pleurisy with effusion") involves fluid that may arise from any of several causes. One may be the inflammation itself, which causes an outpouring of blood and lymph (supplementary body fluid). A chest injury with bleeding is an example of another possible source of fluid.

The Effects of Pleurisy

When dry pleurisy heals, it leaves strands of fibrous tissue (adhesions) strung between the lung and the wall of the chest, tying them together. Sometimes these adhesions are so extensive that they limit the movement of the lungs. But usually the soreness disappears and the adhesions stretch so much that they no longer cause any difficulty.

In wet pleurisy, the fluid builds up in the pleural cavity. There may be enough to restrict the movement of the lungs and therefore the ability to breathe. On the other hand, the increasing fluid may separate the linings so that movement of the chest wall and of the sensitive outer lining is limited – causing pain to subside.

A large amount of fluid displaces the heart as well as the Iung. The lung may remain compressed or displaced and fail to return to its full capacity because of thickening of the pleura after the fluid has been absorbed.

Fluid that is relatively clear may give little trouble and be readily absorbed in time. But if the fluid becomes infected – as it may do – it turns into pus and may lead to further complications. This condition, called "empyema," is very serious.

The pus sometimes breaks through the lung wall and into the air passages, where it may be coughed up. Removal of the pus by drainage is usually needed for the patient to recover.

What are the Symptoms?

When pleurisy is painful, it cannot be ignored. Each movement of the chest wall, disturbing the outer layer of the pleura, is felt. Each breath taken in by the victim induces a stabbing, knifelike pain. With a deep breath or a cough or sneeze, the pain is severe. This may go on night and day.

Along with shallow and difficult breathing when pleurisy limits lung movement, other symptoms that might appear are dry coughing, weakness, headache and loss of appetite, as well as chills, fever and rapid pulse beat.

How is Pleurisy Treated?

The inflammation of pleurisy is treated by attacking the infection that may have caused it. A pleurisy caused by some lung disease is treated, first of all, by identifying the underlying disease and giving whatever treatment is available for it.

To limit the pain of pleurisy, limiting the movement of the lungs may be desirable. The doctor may suggest lying on the sore side in a special way – for example, on a firm surface – to limit breathing movement on that side enough to reduce the stretching of the sore tissues and therefore the pain. He may also prescribe medication for the pain itself.

For dry pleurisy, such treatment is generally enough. In wet pleurisy, the doctor may decide to remove the fluid by drawing it out with a needle. Timing of this is important, since the fluid may come back if it is removed too soon. On the other hand, if it’s not done early enough dense adhesions may form, resulting in permanent breathing difficulty.

The main treatment is that for the primary cause of the inflamed pleura.

If you have symptoms that may be Pleurisy:

1. See your doctor at once. Early diagnosis and treatment are important.
2. Follow your doctor’s advice. If he says you should stay at home, or in bed or in the hospital, stay there.