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Pleurisy - Treatment
Last reviewed: 06.07.2025
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Pleurisy is an inflammation of the pleural layers with the formation of fibrin on their surface (dry, fibrinous pleurisy) or the accumulation of exudate of various types in the pleural region (exudative pleurisy).
Treatment of patients with pleurisy includes the following measures.
Etiological treatment of pleurisy
Treatment of the underlying disease, impact on the cause of the disease often leads to the elimination or reduction of pleurisy symptoms. The following etiological forms of pleurisy are distinguished:
- pleurisy of infectious etiology. Caused by bacterial pathogens (pneumococcus, staphylococcus, streptococcus, gram-negative flora, etc.), viruses, rickettsia, mycoplasma, fungi, protozoa (amebiasis), parasites (echinococcosis), tuberculosis, syphilis, brucellosis, the causative agent of typhoid fever. Most often, infectious pleurisy is observed in pneumonia of various etiologies and tuberculosis, but can also occur in isolation, being caused by the above-mentioned infectious pathogens;
- pleurisy of non-infectious etiology. Caused by the following reasons:
- tumors (40% of all pleurisy), this may be a primary tumor of the pleura mesothelioma; tumor metastases to the pleura; lymphogranulomatosis; lymphosarcoma and other tumors; Meigs syndrome (pleurisy and ascites in ovarian cancer);
- systemic connective tissue diseases (systemic lupus erythematosus, dermatomyositis, scleroderma, rheumatoid arthritis); rheumatism; systemic vasculitis;
- trauma and surgery;
- pulmonary embolism, pulmonary infarction;
- other causes: pancreatitis ("enzymatic" pleurisy), leukemia; hemorrhagic diathesis; post-infarction syndrome; periodic disease, chronic renal failure, etc.
In practice, the most common causes of pleurisy are pneumonia, tuberculosis, malignant tumors, and systemic connective tissue diseases.
If pleurisy has a tuberculous etiology, specific anti-tuberculosis therapy is carried out; in case of pneumonia, appropriate antibacterial therapy is carried out; if systemic diseases of connective tissue are diagnosed, treatment with immunosuppressants (glucocorticoids and cytostatics) is carried out.
If the etiology of exudative pleurisy cannot be established, it is regarded as an independent disease and antibacterial therapy is prescribed, as for acute pneumonia.
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Use of anti-inflammatory and desensitizing agents
Anti-inflammatory drugs help to quickly stop pleurisy and have an analgesic effect. Non-steroidal anti-inflammatory drugs are prescribed (acetylsalicylic acid - 1 g 3-4 times a day, voltaren or indomethacin - 0.025 g 3 times a day, etc.).
As desensitizing agents, a 10% solution of calcium chloride is used, 1 tablespoon 3 times a day, and other drugs.
For dry pleurisy and severe painful cough, antitussives are prescribed (dionine, codeine 0.01 g 2-3 times a day, etc.).
Evacuation of exudate
Evacuation of exudate using pleural puncture has two goals: preventing the development of empyema and eliminating functional disorders associated with compression of vital organs.
Pleural fluid should be evacuated in case of large exudates causing dyspnea, cardiac displacement or if the border of dullness reaches the 2nd rib in front. No more than 1.5 l of fluid should be removed at one time to avoid collapse. According to the above indications, pleural puncture is performed even in the early period of exudative pleurisy.
In other cases, pleural puncture with exudate removal is best performed in the stabilization or even resorption phase, since early evacuation of effusion leads to an increase in negative pressure in the pleural cavity, which contributes to the accumulation of exudate. In exudative pleurisy of non-specific infectious etiology, after exudate removal, it is advisable to introduce antibacterial agents into the pleural cavity.
In the development of acute pleural empyema, it is necessary to remove purulent exudate followed by the introduction of antibiotics into the pleural cavity.
Chronic pleural empyema is treated surgically.
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Increasing the overall reactivity of the body and immunomodulatory therapy
The indicated measures are carried out in the case of protracted fibrinous pleurisy in the same way as recommended in the treatment of protracted pneumonia and chronic bronchitis.
Detoxification and correction of protein metabolism disorders
These measures are performed in case of exudative pleurisy and pleural empyema. For detoxification purposes, intravenous drip infusions of hemodez, Ringer's solution, 5% glucose solution are prescribed.
To correct protein deficiency, 150 ml of 10% albumin solution is transfused once every 2-3 days 3-4 times, 200-400 ml of native and fresh frozen plasma once every 2-3 days 2-3 times, 1 ml of retabolil is administered intramuscularly once every 2 weeks, 2-3 injections.
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Physiotherapy, exercise therapy, massage for pleurisy
In the early stage of fibrinous pleurisy, semi-alcoholic warming compresses and electrophoresis with calcium chloride are recommended. In case of exudative pleurisy, physiotherapy is carried out in the resolution phase (exudate resorption) in order to quickly eliminate the exudate and reduce pleural adhesions. Electrophoresis with calcium chloride, heparin, decimeter waves (Volna-2 device), and paraffin therapy are recommended.
After the acute symptoms have subsided, manual and vibration massage of the chest is indicated.
After inpatient treatment, patients can be sent for spa treatment to local suburban sanatoriums and resorts on the southern coast of Crimea.