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How Are Pleurisy and Other Pleural Disorders Treated?

Pleurisy and other pleural disorders are treated with procedures, medicines, and other methods. The goals of treatment include:

  • Relieving symptoms
  • Removing the fluid, air, or blood from the pleural space (if a large amount is present)
  • Treating the underlying condition

Relieving Symptoms

To relieve pleurisy symptoms, your doctor may recommend:

  • Acetaminophen or anti-inflammatory medicines (such as ibuprofen) to control pain.
  • Codeine-based cough syrups to control coughing.
  • Lying on your painful side. This might make you more comfortable.
  • Breathing deeply and coughing to clear mucus as the pain eases. Otherwise, you may develop pneumonia.
  • Getting plenty of rest.

Removing Fluid, Air, or Blood From the Pleural Space

Your doctor may recommend removing fluid, air, or blood from your pleural space to prevent a lung collapse.

The procedures used to drain fluid, air, or blood from the pleural space are similar.

  • During thoracentesis, your doctor will insert a thin needle or plastic tube into the pleural space. An attached syringe will draw fluid out of your chest. This procedure can remove more than 6 cups of fluid at a time.
  • If your doctor needs to remove a lot of fluid, he or she may use a chest tube. Your doctor will inject a painkiller into the area of your chest wall where the fluid is. He or she will then insert a plastic tube into your chest between two ribs. The tube will be connected to a box that suctions out the fluid. Your doctor will use a chest x ray to check the tube's position.
  • Your doctor also can use a chest tube to drain blood and air from the pleural space. This process can take several days. The tube will be left in place, and you'll likely stay in the hospital during this time.

Sometimes the fluid in the pleural space contains thick pus or blood clots. It may form a hard skin or peel, which makes the fluid harder to drain. To help break up the pus or blood clots, your doctor may use a chest tube to deliver medicines called fibrinolytics to the pleural space. If the fluid still won't drain, you may need surgery.

If you have a small, persistent air leak into the pleural space, your doctor may attach a one-way valve to the chest tube. The valve allows air to exit the pleural space, but not reenter. Using this type of valve may allow you to continue your treatment from home.

Treat the Underlying Condition

The fluid sample that was removed during thoracentesis will be checked under a microscope. This can tell your doctor what's causing the fluid buildup, and he or she can decide the best way to treat it.

If the fluid is infected, treatment will involve antibiotics and drainage. If you have tuberculosis or a fungal infection, treatment will involve long-term use of antibiotics or antifungal medicines.

If tumors in the pleura are causing fluid buildup, the fluid may quickly build up again after it's drained. Sometimes antitumor medicines will prevent further fluid buildup. If they don't, your doctor may seal the pleural space. Sealing the pleural space is called pleurodesis (plur-OD-eh-sis).

For this procedure, your doctor will drain all of the fluid out of your chest through a chest tube. Then he or she will push a substance through the chest tube into the pleural space. The substance will irritate the surface of the pleura. This will cause the two layers of the pleura to stick together, preventing more fluid from building up.

Chemotherapy or radiation treatment also may be used to reduce the size of the tumors.

If heart failure is causing fluid buildup, treatment usually includes diuretics (medicines that help reduce fluid buildup) and other medicines.

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September 21, 2011