Pleurisy after pneumonia terms of treatment. Pleurisy of the lungs - what is it? Symptoms and treatment. Dry and exudative pleurisy

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Pleurisy treatment

Causes of pleurisy

Pleurisy- an inflammatory process localized in the pleura and accompanied by accumulation of exudate (fluid) in the pleural cavity or loss of fibrin sheets on the surface. Depending on the presence of exudate, pleurisy is distinguished between exudative and fibrinous or dry, and depending on the nature - bacterial, viral and allergic. Often the nature of pleurisy remains unexplained. It is characteristic that this disease develops as a complicated form of other pathological conditions.

Causes of pleurisy called:

• infectious damage to the body by bacteria (staphylococcus aureus, pneumococcus), fungi (candidiasis, blastomycosis), viruses (amebiasis, echinococcosis), mycoplasma and mycobacteria (tuberculosis);
• complications of respiratory diseases;
• diffuse lesions of the connective tissue;
• malignant tumors (metastases to the pleura, cancer of the lungs, pleura, breast, ovaries, etc.);
• chest trauma;
• surgical interventions and complications after operations.

Symptoms of pleurisy are:

• expressive pain in the chest, accompanying breathing;
• cough;
• an increase in body temperature - from slight to fever;
• shortness of breath and difficulty breathing;
• pallor, and sometimes cyanosis of the skin;
• general weakness and fatigue.

Dry (fibrinous) pleurisy usually has no independent significance. They are found in various lung diseases (pneumonia, suppurative lung diseases, pulmonary infarction, etc.), as a concomitant pathological process in extrapulmonary diseases (subdiaphragmatic abscess, cholecystitis, cholangitis), as well as in inflammatory diseases (tuberculosis, rheumatism, systemic lupus erythematosus , rheumatoid arthritis, systemic scleroderma).

How to treat pleurisy?

Pleurisy treatment appointed by a specialized specialist after reviewing the history of diseases and the characteristics of its course in a particular patient. Therapeutic therapy combines measures that promote resorption and elimination of exudate, symptomatic and restorative treatment, antibacterial and vitamin therapy. Therapy must certainly be comprehensive and aimed at eliminating the causes of pleurisy, because in the majority of cases, pleurisy is preceded by an untreated respiratory disease.

Symptomatic treatment does not produce an exhaustive effect, but is aimed only at pain relief and prevention of complications after pleurisy. Symptomatic treatment must certainly be accompanied by measures aimed at eliminating the disease preceding pleurisy (for example, tuberculosis or pneumonia) and eliminating the inflammatory process.

The appointment of antibacterial drugs should be carried out solely taking into account the variety of pathogenic flora and the sensitivity of the drug to it. You can reinforce the effect with immunostimulating therapy. Anti-inflammatory and desensitizing drugs are appropriate to reduce pleural pain, their use speeds up the healing process.

The underlying disease should be treated symptomatically. If dry pleurisy of tuberculous etiology is diagnosed, then specific anti-tuberculosis therapy is carried out. When a diffuse connective tissue disease is diagnosed, non-steroidal anti-inflammatory drugs and glucocorticoids are prescribed. If the underlying disease is pneumonia, antibiotic therapy is prescribed (penicillins, cephalosporins, carbapenems, aminoglycosides, tetracyclines, macrolides, chloramphenicol, fluoroquinolones).

With pleurisy of pneumococcal etiology, the antibacterial drug of choice is benzylpenicillin, which is administered intramuscularly at 1000,000-2,000,000 units every 4 hours. In cases of purulent inflammation, the dose is doubled. If the disease is caused by penicillin-resistant strains of pneumococcus, cephalosporins or carbapenems (thienam) or vancomycin are prescribed. Of the cephalosporins, cefoxitin (mefoxin), cefotetan (Katen), moxolactam (latamoxef) are used. Of the carbapenems, imipenem-cilastatin (thienam) is more commonly used. It is also a p-lactam antibiotic with a bactericidal effect.

Treatment streptococcal etiology is the same as pneumococcal. With pleurisy of staphylococcal etiology, broad-spectrum penicillins (ampicillin, amoxicillin), cephalosporins of III-IV generations are prescribed.

With legionella, mycoplasmal and chlamydial etiology of the disease, the drugs of choice are macrolides - azithromycin (sumamed), clarithromycin (yutacid), spiramycin (rovamycin), roxithromycin (rulid). For the treatment of patients with fibrinous pleurisy, non-steroidal anti-inflammatory drugs and desensitizing agents (calcium chloride, diphenhydramine, suprastin) are also used.

The main methods of treating patients with exudative pleurisy are etiotropic therapy (antimicrobial treatment), the use of anti-inflammatory and desensitizing agents, exudate evacuation, an increase in the overall reactivity of the body, immunocorrection, detoxification, physiotherapy rehabilitation, and spa treatment.

Antibacterial therapy of exudative pleurisy is based on the same principles as in pneumonia. Now, in the treatment of parapneumonic exudative pleurisy (as well as pneumonia), preference is given to modern macrolides. These include spiramycin, azithromycin, roxithromycin, clarithromycin.

Exudative pleurisy of tuberculous etiology is treated according to the principles of tuberculosis therapy. Etiotropic treatment lasts 10-12 months. In the acute period, anti-TB drugs are prescribed: isoniazid (10 mg/kg per day), streptomycin (1 g per day), ethambutol (25 mg/kg per day). With severe intoxication, confirmed by the pathomorphological picture (according to pleural biopsy) of a massive lesion with caseous necrosis, rifampicin is additionally prescribed orally (400-600 mg per day), and isoniazid is administered into the pleural cavity (every other day, 6 ml of 10% solution). After 3 months from the start of treatment, streptomycin is canceled.

Etiotropic treatment is combined with pathogenetic and desensitizing therapy. In case of severe pleural pain after exudate evacuation, electrophoresis of 5% novocaine solution, 10% calcium chloride solution, 0.2% platyfillin hydrotartrate solution is prescribed (for a course of 10-15 procedures). Inhalations with antibiotics and bronchodilators are also advisable. In order to prevent the organization of pleural effusion, lidase electrophoresis is used (64 IU every 3 days, 10-15 procedures per course of treatment).

The method of regular pleural punctures (every other day) with maximum exudate evacuation ensures recovery with favorable anatomical and functional consequences.

The use of glucocorticoids does not reduce the duration of treatment.

A positive effect is given by immunomodulators (levamisole, thymalin, T-activin, splenin).

Surgical treatment is indicated:

• with early folding and the formation of massive exudate;
• when serous or purulent exudates solidify without a tendency to melt the lungs and obliterate the pleural cavity;
• with pulmonary tuberculosis, which is treated surgically.

The optimal period of preoperative treatment should be considered 5-6 months from the start of etiotropic therapy, taking into account the characteristics of the course of the disease in each patient. Usually, a pleurectomy with decortication of the lungs or its resection with pleurectomy and decortication is performed.

The duration of treatment depends on the timeliness and adequacy of therapy: pleurisy can be overcome in a few days, or even in a few weeks. After that, you need to take time for the recovery period.

What diseases can be associated

• Hemorrhagic diathesis
• Lung infarction
• and pleura
• Systemic vasculitis

Treatment of pleurisy at home

Pleurisy treatment at home is possible, but medical monitoring of the patient's condition is required. In addition to taking all the drugs prescribed by the doctor and carrying out restorative procedures, the patient should be provided with appropriate conditions - bed rest and rest, good nutrition, vitamin therapy, antibiotic therapy, symptomatic and restorative treatment.

What drugs to treat pleurisy?

Medicines for therapy often include drugs that eliminate the causes of pleurisy - the infection or the disease that provokes it.

• - single dose from 40 mg to 1 g, daily - from 150 mg to 8 g; multiplicity of application - 2-6 times / day
• - 1-2 ml of a 50% solution 2-3 times a day, the maximum dose is 2 g / day
• - 3-4 g per day
• - intramuscularly 1000000-2000000 IU every 4 hours
• - 100 mg per day
• - 0.3 g 2-3 times a day
• - initial dose of 25 mg 2-3 times a day
• - intravenously drip (6 drops per minute), diluting 5-10 ml of a 10% solution in 100-200 ml of isotonic sodium chloride solution or 5% glucose solution
• - intravenously, 1-2 g of the drug is dissolved in 100 ml of isotonic sodium chloride solution or 5% glucose solution, injected drip for 30 minutes
• - administered both intravenously and intramuscularly every 8 hours, the average daily dose is 2 g (maximum daily dose is 12 g)
• - 250-500 mg 2 times a day orally
• - dosage is determined individually
• - 100 mg 2 times a day
• - intramuscularly 1-2 g every 6-8 hours
• - the initial daily dose is 20-30 mg, the maintenance daily dose is 5-10 mg
• - 600 mg 1 time / day or 10 mg / kg 2-3 times a week
• - 3000000-6000000 IU 2-3 times a day in the middle
• - 150-300 mg 2 times a day orally
• - on the first day, it is prescribed once orally at a dose of 500 mg, from the 2nd to the 5th day - 250 mg 1 time per day
• - intravenous drip in a daily dose of 1 g to 4 g, depending on the severity of the disease
• - 200 mg 2 times a day
• - intramuscularly or intravenously, 2 g 2 times a day (maximum daily dose - 6 g)
• - inside once, 20-25 mg / kg per day

Treatment of pleurisy with folk methods

Pleurisy treatment folk remedies can act as an addition to traditional medical methods of therapy.

Compresses:

• combine 30 grams of camphor oil, 2.5 grams of lavender and eucalyptus oils, mix thoroughly; rub into the area of ​​the affected lung 2-3 times a day, apply a warming compress on top;
• 2 tbsp fresh marigolds pour a glass of olive oil and leave in a dark place for two weeks (you can cook for future use and store in a dark bowl in the refrigerator); 2 tbsp combine calendula oil in 2 tbsp. mustard powder, 6 tbsp. flour, 2 tbsp. lime blossom and 4 tbsp. vodka, mix well, heat for 5 minutes in a water bath; apply the ointment on gauze folded several times, put on the chest under the compressor paper and a warm scarf; leave for half an hour.

Decoctions inside:

• combine in equal proportions the grass of the highlander bird, the leaves of the coltsfoot and the flowers of the black elderberry; 1 tbsp brew the resulting mixture with a glass of boiling water, sweat in a water bath for 15 minutes, cool, strain; take 1/3 cup three times a day;
• combine in equal proportions peppermint, licorice root, elecampane root, marsh cudweed grass, add 2 parts of coltsfoot leaves; 1 tbsp brew the resulting mixture in a glass of boiling water, after cooling, strain and take 1/3 cup three times a day before meals.

Treatment of pleurisy during pregnancy

Pleurisy refers to those diseases, the occurrence of which during pregnancy is easier to prevent than to treat. If the expectant mother belongs to the risk group, it is necessary to act proactively and treat the underlying disease, strengthen the immune system, and protect your body from negative influences.

If it was not possible to avoid the disease, then the treatment should be carried out under the supervision of a specialized specialist who is aware of the situation of his patient. Therapy in this case will be aimed at alleviating the patient's condition, at eliminating the inflammatory process. The drugs of choice will be herbal ingredients and gentle synthetic drugs (possibly local antibiotics). Self-medication and spontaneous change in dosage is inappropriate.

Which doctors to contact if you have pleurisy

The pleural sheets are thickened, hyperemic, with a hard, sometimes granular surface (fibrin layers). Peeling of the mesothelium with exposure of the fibrous structures of the pleura is observed. With a favorable course, the layering of fibrin resolves. However, more often it is organized with the formation of pleural moorings.

The chest on the side of the lesion lags behind in the act of breathing. Most patients have a dry cough that worsens with movement. Percussion determines the limitation of mobility of the lower edge of the lungs. The decisive diagnostic sign is the auscultation of a pleural friction rub, which can be gentle (crepitus) or rough, resembling the creaking of snow or a new sole. Often, patients themselves experience a pleural friction rub. It is usually audible in the lateral and lower parts of the chest, where the excursion of the lungs is more pronounced.

Unlike small bubbling rales and crepitus, the pleural friction noise is heard throughout the entire inhalation and exhalation in the form of uneven noises, not changing after coughing. It can be felt with the palm of your hand. At the same time, small bubbling rales and crepitus are determined at the height of inspiration. If the mediastinal pleura is affected, it is necessary to differentiate the pleural friction rub from the pericardial friction rub. It should also be remembered that the pleural friction noise also occurs with exudative pericarditis - it is heard above the border of the exudate. Body temperature is normal or subfebrile, rarely exceeds 38 °C. In the course of a blood test, a slight leukocytosis is evident, a moderately increased ESR.

The X-ray picture is uncharacteristic: there is a slightly higher standing of the dome of the diaphragm on the side of the lesion, limitation of its mobility, sometimes a slight darkening of the lateral sections of the lung field is determined.

differential diagnosis is carried out in patients with pericarditis (noise pericardial friction, concordant elevation of the 5T segment on the ECG), intercostal neuralgia and myositis (local pain, no changes in the blood, etc.). Differential- diagnostic difficulties are possible with diaphragmatic dry. In cases of acute abdomen should be borne in mind the absence of increased pain with deep palpation of the abdomen compared with superficial palpation and pronounced leukocytosis, which is characteristic of the acute abdomen syndrome.

Treatment of other diseases with the letter - p

Pleurisy is called an inflammatory process that affects the lining of the lungs - the pleura.

The relationship of the pleural sheets.

At the same time, plaque can form on the sheets of the pleura, consisting mainly of the substance of fibrin: in this case, the pleurisy is called fibrinous or dry. Or there is an increase in the release of fluid, that is, the formation of an effusion, into the pleural cavity and a decrease in its absorption by the pleura: in this case, pleurisy is called effusion or exudative. In the normal state, the pleural sheets produce about 1-2 ml of fluid, which has a yellowish color and is somewhat similar in composition to plasma - the liquid part of the blood. Its presence reduces the friction of the pleura sheets against each other and ensures normal breathing.

Scheme of the anatomical relationships of the pleura and lung.

Symptoms of pleurisy are quite characteristic. Pleurisy itself is always a secondary pathological process that is part of the picture of any disease or is its complication. Dry and effusion pleurisy in adults can either be stages of a single process or proceed in isolation.

By origin, two main forms of pneumonia in adults can be distinguished: infectious, which is caused by a pathogenic microorganism, and non-infectious, which is most often based on systemic lesions of the body, tumor processes, as well as acute, life-threatening conditions.

With infectious pleurisy, there are several main ways in which pathogenic microorganisms reach the pleura and pleural cavity:

1. Direct infection of the lining of the lungs. This can occur if the infectious focus is located in the lung tissue, adjacent to the internal pleural sheet. This scenario is most often found in pneumonia, infiltrative tuberculosis and peripheral abscesses.
2. Infection by the lymphatic route. It is characterized by the spread of the process through the lymphatic vessels. Occurs in lung cancer. The course of such pleurisy is almost always combined with a syndrome of severe intoxication due to the tumor process.
3. By hematogenous way. This means that the bacterial agent spreads to the lining of the lungs through the bloodstream.
4. Microbial seeding of the pleura in case of chest trauma or surgery.
5. Infectious-allergic way. characteristic of Mycobacterium tuberculosis. This is due to the fact that when a mycobacterium enters the human body, sensitization occurs, that is, the development of hypersensitivity to it.

Micrograph: Mycobacterium tuberculosis.

In this regard, any new appearance of a bacterial agent can cause an active reaction in the form of inflammation of the lining of the lungs, which is usually exudative in nature.

Clinical manifestations of dry pleurisy

The main symptoms and signs of dry pleurisy are somewhat different from those in its effusion form. The first complaint characteristic of this disease is usually pain in the side: rather difficult for the patient to bear, aggravated during inspiration and coughing. This pain occurs due to the fact that pain nerve endings are scattered in the membrane of the lungs. If the patient assumes a position on his side on the side of the lesion, and his breathing becomes slow and calm, then the pain decreases somewhat. This is due to the fact that in this position, the mobility of the half of the chest on the side of the lesion and the friction of the pleura sheets against each other respectively decrease: this alleviates the patient's condition.

Breathing in the affected area is weakened, as the patient spares the affected side. Auscultation of the lungs may reveal a pleural friction rub. The patient's body temperature usually does not exceed 37-37.5 degrees, chills, night sweats may occur, accompanied by weakness and lethargy of the patient.

In general, the course of dry pleurisy in adults is very favorable: the time during which the symptoms of the disease appear usually does not exceed 10-14 days. However, within a few weeks after recovery, dry pleurisy may recur, that is, a relapse may occur, the signs and course of which will repeat the signs and course of the first inflammatory process. Unless, the patient's complaints may be somewhat less persistent: a repeated lesion may proceed more easily.

Clinical manifestations of effusion pleurisy

Symptoms that occur if effusion accumulates in the pleural cavity are usually in the background after, as a rule, more pronounced manifestations of the underlying disease. However, the course of effusion pleurisy may be accompanied by respiratory failure, which greatly complicates the treatment.

It is possible to distinguish the so-called triad of symptoms, which usually represent the main complaints of the patient:

1. Pain.
2. Unproductive cough.
3. Dyspnea.

Scheme of atelectasis resulting from compression of lung tissue by effusion.

It should be noted that pain and cough symptoms in effusion pleurisy are not as pronounced as in its dry form. The pain is usually a feeling of heaviness and may be acute in rare cases. Cough is due to the fact that inflammation affects the nerve endings that are in the sheets of the lining of the lungs, the pleura. It can also be the result of mechanical compression of the bronchi, if there is a collapse of the lung tissue - atelectasis, under the influence of exudate, which also exerts strong pressure on the organ.

More pronounced than the above symptoms, shortness of breath is manifested. Dyspnea is difficulty breathing. It appears due to the fact that part of the lung tissue - the parenchyma, which is directly involved in gas exchange, ceases to perform its function due to the pressure of the effusion.

Signs that are usually detected when examining the chest and auscultating the lungs are reduced to a lag in breathing and some visual asymmetry of the affected half of the chest, which are accompanied by a weakening or complete absence of respiratory noise over the site of accumulation of exudate.

If you start percussing, that is, tapping, the chest, then the same sound will be detected above the exudate as above the thigh. The latter is called blunt or femoral and is an important, reliable diagnostic sign for pleural effusions, thanks to which you can immediately approximately determine the level of effusion fluid.

To confirm the presence of an effusion in the pleural cavity, an x-ray examination is now mandatory: an area of ​​​​blackout corresponding to the exudate is revealed on the x-ray.

Darkening (exudate) of white color.

It is also important to conduct an x-ray examination of the patient in the lateral position. If the exudative fluid is displaced at the same time, then its encystation can be excluded, that is, the restriction of mobility due to the formation of dense "walls" from the connective tissue, and the transition of this inflammatory process into a chronic one.

However, it should be noted that if the volume of the pleural effusion is small: 200-250 ml, radiography may give questionable results. In this case, an ultrasound examination should be performed, which will reveal an effusion of less than 200 ml. In addition, if it is technically possible to do this, it will not be difficult to identify fluid in the pleural cavity using computed tomography.
When the presence of pleural effusion is determined and beyond doubt, it is necessary to perform a surgical manipulation - thoracocentesis, that is, a puncture or puncture of the pleural cavity.

Thoracocentesis technique. Scheme.

This will allow you to get the exudate and examine it. In addition, the evacuation of exudate from the pleural cavity will allow the area of ​​the lung parenchyma that was previously compressed to be straightened out. At the same time, it will gradually begin to perform the function of gas exchange again. There are only two main indications for puncture of the pleural cavity. First, they include the unclear nature and origin of the effusion. Secondly, its quantity: if there is a lot of exudate, the patient can quickly develop respiratory failure.

What diseases usually accompany pleurisy

Most often, the symptoms of pleurisy are combined with pneumonia, heart failure, rheumatism and tumor metastases. A little less often, pleurisy occurs when infected with tuberculosis.

Pleurisy in pneumonia usually occurs if the main diagnosis sounds like "croupous pneumonia." As a rule, even at the first stage of the disease, that is, the stage of the tide, dry pleurisy occurs. Pleurisy usually ends at the stage of pneumonia resolution.

With heart failure, tuberculosis and metastasis, that is, the spread of tumors, there is usually an effusion form of pleurisy. The course of the latter depends on the initial, initial disease.

If the course of the disease is severe, and the patient's breathing is significantly weakened due to the pressure exerted by the exudate on the lung tissue, then the effusion must be evacuated from the pleural cavity. With tumors and heart failure, effusion can accumulate again and again.

When the contents from the pleural cavity are obtained, it is important to examine them in the laboratory: the composition of the effusion often reliably indicates the root cause of pleurisy.

Video: “Pleurisy. What to do if it hurts to breathe" from the program "Live healthy"

Pleurisy is dangerous for any patient, and for an elderly person - doubly so. Weakened immunity and age-related chronic diseases are far from conducive to a speedy recovery. Pleurisy - what is it and what are the features of its course in older people?

Anatomical reference

Pleurisy is inflammation of the pleura infectious or otherwise. To understand the specifics of the disease, you need to know how the human respiratory system works. The lungs are protected from other organs, muscles and bones by a dense serous membrane - the pleura. It consists of two layers.

The inner sheet of the pleura (visceral) envelops each lung, the outer one adjoins the ribs and diaphragm (parietal) and lines the inner surface of the chest.

The cells of the pleura sheets are located on an elastic fibrous tissue, densely permeated with nerve endings, blood and lymphatic vessels. The structure of the visceral membrane is such that in some places “pockets” are formed on it, where the lungs do not penetrate even with a deep breath.

These "pockets" are filled with a fluid called effusion or exudate. It seeps (sweats) into the cavity through the walls of blood vessels and is designed to facilitate friction of the pleura during respiratory movements.

Causes of pleurisy

In adults, for external reasons, pleurisy can develop only as a result of an injury, which by default is considered a potential source of infection. In other cases, pleurisy is associated with a disease that occurs in the body.

He can wear infectious And non-infectious character, while pleurisy itself not contagious. The non-infectious form is provoked by:

• pneumonia;
• obstructive bronchitis;
• bronchial asthma;
• tuberculosis;
• emphysema, COPD.

The risk of diabetes mellitus, alcohol abuse, gastrointestinal pathologies, in particular, gastric reflux, aggravate the risk.

In older people, pleurisy may be associated with a blockage in the pulmonary artery by a thrombus.

Another source of infection is pathogenic microbes in the oral cavity, especially in the presence of caries and other diseases of the teeth and gums. They are able to enter the respiratory tract with a deep breath, especially at night.

What is pleurisy?

Medicine distinguishes four types of pleurisy:

Exudative pleurisy for the formation of isolated cavities is called encapsulated.

Signs of pleurisy

Symptoms of pleurisy of the lungs in the elderly depend on the type of disease.

Symptoms of dry pleurisy

The following clinical manifestations are observed:

• severe pain on the side of the lesion, aggravated by coughing or sudden movement;
• unproductive cough;
• loss of appetite;
• general weakness.

Temperature rises are uncharacteristic for dry pleurisy, more often it does not exceed 37.1 - 37.5 ° C, although jumps up to 38 ° C are possible.

If the pleurisy is one-sided, the patient takes a characteristic pose - he tries to lie on his sore side. This is due to the fact that when the movement of the chest is limited, the pain subsides a little.

Symptoms of exudative pleurisy

It differs from the dry exudative form by a more abrupt onset, a rise in temperature up to 40 ° C is possible. Other symptoms:

As the effusion increases, the pain subsides a little, as the fluid softens the friction of the pleura. The skin may take on a mild bluish tint. The patient tries to take a semi-sitting position with an emphasis on the affected side.

From the side of fluid accumulation, an asymmetric increase in the chest is observed. There may be sputum with an admixture of blood. The same picture is observed with pleurisy on the background of lung cancer.

If the disease is severe, the prognosis for the elderly is unfavorable: in half of the cases, exudative pleurisy ends in death.

Exudative Pleurisy is very dangerous for older people. The consequences of the disease can be damage to the cardiovascular system.

How is pleurisy treated?

The basis of the treatment of pleurisy of the lungs - antibiotic therapy. Also, the efforts of doctors are directed to the treatment of the disease that caused it. Depending on this, anti-tuberculosis and anti-inflammatory drugs are used. In addition, the complex uses:

• painkillers;
• antitussive drugs;
• chemotherapy drugs for exudative pleurisy.

With a large accumulation of fluid, a pleural puncture is practiced. If the exudate is poorly absorbed, apply hormone therapy(corticosteroids). Severe intoxication is removed by transfusion of plasma and protein preparations.

When the purulent contents of the lung abscess enter the pleural cavity, surgical treatment is used. Surgery is required if large fibrin clots and many foci of infection form.

Of the physiotherapeutic methods used electrophoresis, inductotherapy(heating of a part of the body by a directed high-frequency magnetic field). Recovering patients are shown chest massage, physiotherapy exercises and breathing exercises.

After the cure, the patient is placed on a dispensary record, after six months he must undergo a control X-ray examination.

The use of traditional medicine

It is possible to treat pleurisy with alternative methods only in combination with medications and other methods prescribed by the attending physician. Recipes of traditional medicine will help alleviate the condition and relieve painful symptoms:

Diet for pleurisy

With pleurisy, the doctor prescribes a sparing diet. It includes:

These products are the sources necessary during the period of illness. vitamins A, P and D. Any smoked meats, pickles, spicy foods are excluded from the diet.

Elderly people with a high risk of lung disease need to carefully monitor their health. At the first signs in the form of cough, shortness of breath and pain in the chest, you should immediately consult a doctor. This will save you from such a serious disease as pleurisy.

In the pulmonological branch of medicine, among the many pathologies of the pleural cavity, the most common disease is pleurisy (pleurasia).

What it is? Pleurisy is a term that generalizes several diseases that cause inflammation of the serous membrane of the lung - the pleura. As a rule, it develops with already existing pathologies, accompanied by an outpouring of exudate or fibrin clots into the pulmonary pleural cavity.

The process of development of pleurisy

The pleura is a two-layer (in the form of two sheets) serous membrane surrounding the lungs - the inner (visceral) sheet and the outer (parietal) layer. The pleural inner sheet directly covers the lung tissue itself and its structures (nervous tissues, vascular network and bronchial branches) and isolates them from other organs.

The outer pleural sheet lines the intracavitary chest walls. It ensures the safety of the lungs, and the sliding of the sheets, preventing them from rubbing during breathing.

In a healthy, normal state, the distance between the pleural leaf membranes does not exceed 2.5 cm and is filled with serous (serum) fluid.

The fluid enters between the sheets of the pleura from the vessels of the upper zone of the lung, as a result of the processes of plasma blood filtration. Under the influence of any injuries, serious illnesses or infections, it rapidly accumulates between the pleural membranes, causing the development of inflammatory reactions in the pleura - pleurasia.

The normal functioning of the vascular functions ensures the absorption of excess exudate, leaving a deposit in the form of fibrin proteins on the pleural sheet, so a dry (fibrinous) form of pleurisy appears.

The failure of vascular functions provokes the formation of bloody, purulent or lymphoid fluid in the cavity of the pleural membrane - a type of exudative pleurasia.

Causes of pleurisy, etiology

The reason for the development of pleurisy is due to two broad groups of provocative factors - infectious and non-infectious.

The most common non-infectious factors are due to the influence of:

• Malignant neoplasms on the pleura or metastases of tumors located outside it. The tumor process damages the membrane of the pleura, contributes to a significant increase in the secretion of exudate and the development of exudative pathology.
• Systemic diseases causing vascular and tissue lesions;
• Pulmonary embolism, when inflammation passes to the membrane of the pleura;
• Acute pathology of the heart muscle, due to a decrease in the immune factor;
• Uremic toxins in renal pathology;
• Diseases of the blood and gastrointestinal tract.

The manifestation of clinical forms of the disease is classified:

• in form or appearance;
• by the nature of the exudate and its quantity;
• at the site of inflammatory reactions;
• according to clinical signs, as it manifests itself - acute pleurisy, subacute or chronic, with a bilateral inflammatory process of the pleura or left-sided and right-sided pleurisy.

The disease develops, as a rule, with a dry (fibrinous) form of pleurisy, lasting from 1 to 3 weeks. The absence of positive dynamics of treatment contributes to its flow into exudative pleurasia, or chronic.

Dry (fibrinous) pleurasia characterized by suddenness and severity of manifestation. The first symptoms of pleurisy are manifested by especially sharp chest pain in the area of ​​development of inflammatory reactions. Coughing, sneezing and oscillatory movements cause an increase in pain.

Deep breathing is accompanied by a dry, hot cough. The temperature is absent, or rises slightly.

Are noted:

• migraine, painful condition and weakness;
• joint aches and periodic muscle pain;
• hoarseness and noises are heard - evidence of friction of the pleura sheets due to fibrin sediment.

Symptoms of dry pleurisy of various types of manifestation are distinguished by special signs.

1. Parietal type of inflammation, the most common disease. Its main symptom is a constant increase in pain symptoms during reflex coughing and sneezing.
2. The diaphragmatic process of inflammation is characterized by signs of pain radiating to the shoulder area and the anterior peritoneal zone. Hiccups and swallowing movements cause discomfort.
3. Apical pleurisy (dry) is recognized by pain signs in the shoulder-scapular zone and neuralgic pathologies in the hands. This form develops with tuberculous lung damage, which subsequently turns into encysted pleurasia.

Exudative, effusion form of pleurisy. Symptoms of pleural effusion of the lungs, in its various forms, at the stage of initial development are similar to dry pleuresia. After a certain time, they become "blurred", as the voids between the sheets are filled with exudate and contact ceases.

It happens that the exudative appearance develops without previous fibrous pleurasia.

For some time, patients may not feel changes in the thoracic region, the characteristic symptoms appear after a while:

• fever with very high temperatures;
• tachypnea and shortness of breath;
• swelling and cyanosis of the facial and cervical zones;
• swelling of the veins and venous pulsation in the neck;
• expansion of the sternum in the area of ​​inflammation;
• bulging or smoothing of intermuscular costal cracks;
• swelling in the lower skin folds in the area of ​​pain.

Patients try to avoid unnecessary movements, lie down only on the undamaged side. Possible expectoration of bloody sputum.

Purulent pleurasia. It is formed in rare cases, a very severe pathology with serious consequences, which, for the most part, end in death. Very dangerous in childhood and old age. Purulent pleurisy begins its development against the background of inflammation or lung abscess. Appears:

• pains of a stabbing nature in the sternum, subsiding with purulent filling of the pleural cavity;
• subcostal cuts and heaviness;
• failure to take a deep breath and a feeling of lack of air;
• gradual increase in dry cough;
• critical temperature and purulent expectoration.

If the disease is the result of a lung abscess, then as a result of its rupture, a painful prolonged cough appears, causing sharp pain symptoms in the side.

Purulent exudate causes intoxication in the form of blanching of the skin and cold sweat. Pressure may rise and shortness of breath may increase, making it difficult to breathe properly. With these symptoms of pleurisy of the lungs, both treatment and subsequent monitoring of its effectiveness should take place within the walls of a hospital.

tuberculosis form. It is characterized by the greatest frequency of development in childhood and young age. It manifests itself in three main forms - para-specific (allergic), perifocal (local) and tuberculous pleurasia.

Para-specific begins with high fever, tachycardia, shortness of breath and pain in the side. Symptoms disappear immediately after filling the pleural cavity with fluid.

The perifocal form manifests itself already in the presence of tuberculous lesions of the lung tissue, which proceeds for a long time with periods of exacerbation and spontaneous remissions.

Symptoms in the dry form of tuberculous lesions are due to signs of friction of the pleural sheets, causing noise during breathing and pain in the sternum. The presence of effusion is accompanied by distinct symptoms:

• fever and sweating;
• fast heartbeat and suffocation;
• lateral and sternal pain muscle spasms;
• hoarse breathing and feverish condition;
• cone-shaped bulge and compaction in the chest in the area of ​​the inflammatory reaction.

There is no single treatment regimen for pleurisy. The basis of the treatment process is the physical diagnosis of the doctor, after which the appropriate methods of instrumental diagnostics are prescribed, according to the results of which, individual therapy is selected taking into account all the parameters of the pathology (form, type, localization, severity of the process, etc.).

As a conservative treatment, drug therapy is carried out.

1. Antibacterial drugs, even before obtaining bacteriological results - drugs and analogues of Bigaflon, Levofloxacin, Cefepime or Ceftriaxone, with their subsequent replacement with drugs for a specific pathogen.
2. Painkillers and anti-inflammatory drugs used in diseases of an inflammatory and degenerative nature (Mefenamic acid, Indomethacin or Nurofen);
3. Antifungal therapy, with a fungal cause of pathology.
4. With pleurasia, as a result of tumor processes, preparations of natural hormones and antitumor drugs are prescribed.
5. In the treatment of exudative pleurisy, the use of diuretics is justified. And vascular drugs (as indicated).
6. In the dry form of pleurasia, cough suppressant drugs (Codeine or Dionin), thermal physiotherapy methods and methods of tight bandaging of the sternum are prescribed.
7. To prevent the development of pleural empyema, as a consequence of complication of exudative pleurisy, puncture removal of purulent exudate is performed, followed by washing the cavity of the pleural sheets with antibiotic solutions.

Possible complications and consequences

The neglect of inflammatory processes in the pulmonary pleura leads to dangerous complications of pleurisy - gluing of the pleural sheets by the adhesive process, local blood circulation disorders caused by squeezing of the vessels with effusion, the development of single and multiple pulmonary-pleural communications (fistulas).

The most dangerous complication is pleural empyema (pyothorax), in which, the lack of adequate drainage of pus causes the development of multi-chamber empyema processes.

With processes of scarring and thickening of the pleural membrane, development in adjacent tissues (septicopyemia), pathological changes in the bronchi (bronchiectasis), amyloid degeneration.

All this, in more than 50% of cases, can end in death. The mortality rate is much higher in children and elderly patients.

Pleurisy (code R09.1 according to ICD-10) is a pathological condition of the pleural sheets, manifested in inflammation and sweating of exudate into the pleural region. Pleurisy is not distinguished as an independent disease, since the formation of inflammatory foci in the pleura almost always occurs as a result of complications of underlying diseases.

Pleurisy is also called non-inflammatory processes in the pleura, which are characterized by the accumulation of fluid (chylous, carcinomatous pleurisy). In addition, this term is used for irreversible pathological changes due to the inflammatory process (ossifying, adhesive pleurisy).

Causes

This pathological process occurs more often as a complication of diseases of the lungs, cardiovascular system, and a number of others. Infection of the pleura from other foci occurs with the flow of blood or lymph. It is also possible direct contact with pathogens if the focus of infection is located in the lungs, in close proximity to the pleura.

Trauma can also be the cause. Any penetrating injury is potentially dangerous as a possible source of infection of the pleura, including surgical interventions. As a result of inflammation caused by pathological microorganisms, the pleural fluid accumulates and an effusion is formed (serous, chylous, cholesterol, purulent, etc.)

Also, diseases of a non-infectious nature may be involved in the onset of the disease, especially in the case of a chronic course and the presence of additional risk factors, including age-related ones.

infectious causes

• tuberculosis;
• abscesses in the lungs and other organs;
• purulent cysts;
• candidiasis;
• various types of mycoses;
• mycoplasmosis;
• echinococcosis;
• typhus (typhoid, typhus);
• tularemia;
• brucellosis;
• venereal diseases;
• blood sepsis, etc.

The most common infectious forms of this disease are a complication of lung diseases, in particular pneumonia, bronchitis, and severe viral diseases. The likelihood of infection increases with high virulence of microorganisms.

Factors that increase the risk are diseases and conditions that reduce immunity: diabetes mellitus, peptic ulcer, HIV, pregnancy, a tendency to allergic reactions, chronic diseases, including diseases of a non-communicable nature. A negative background is also created by taking drugs to suppress the immune system, drinking alcoholic beverages.

Non-infectious causes

In the pleural region, hydrothorax may also form - an effusion that has a non-infectious nature. Among the main reasons leading to this pathology:

• heart failure;
• myocardial infarction;
• kidney damage;
• liver disease;
• diseases of the pancreas;
• pathological processes in connective tissues;
• malignant formations in the pleura;
• metastases in tumor processes in other organs.

Usually, inflammatory processes of non-infectious origin begin against the background of weakened immunity, pathologies of the endocrine system, and the gastrointestinal tract. Risk factors are also alcoholism and smoking, uncontrolled intake of certain medications, chronic stress, unbalanced diet.

Classification of pleurisy

Inflammations in the pleura differ in course, symptoms, location, etc. Depending on this, a classification of pleural pathologies has been developed according to various criteria, including etiological factors, the mechanism of development, the presence of effusion, and localization. This allows you to differentiate the pathology and choose the right treatment tactics.

By etiology:

• infectious;
• aseptic;
• idiopathic.

By the presence of effusion:

• fibrous (dry);
• exudative (effusion).

In the course of inflammation:

• spicy;
• sluggish (subacute);
• chronic.

According to the localization of the effusion:

• diffuse;
• encysted:
  • bilateral or unilateral (left-sided and right-sided pleurisy);
  • diaphragmatic, costal diaphragmatic and costal;
  • apical;
  • interlobar;
  • in the region of the mediastinum.

Determination of the type is necessary for the appointment of adequate treatment. In addition, an accurate diagnosis of the form of the lesion makes it possible to detect the main diseases that occur in a latent form (for example, tuberculosis).

Symptoms of various types of disease

The clinical manifestation of different types of the disease differs depending on the etiology, localization, severity of the process, the presence of other diseases, etc. However, there are also general symptoms. A characteristic symptom for all forms of pleurisy of the lungs is chest pain, aggravated by coughing and deep breathing.

Also, all forms are accompanied by fever, weakness, general poor health. Breathing becomes rapid and superficial, heaviness in the sternum is felt. One of the initial symptoms is a dry cough and shortness of breath.

Dry pleurisy

The symptoms of the dry form can be "blurred" by the signs of the underlying disease. But in some cases, the symptoms of inflammation come to the fore.

With dry forms of the disease, there are:

• localized severe pain when breathing;
• increased pain when tilted to the opposite side of the affected;
• asymmetric limitation of respiratory excursions on the affected side;
• pleural friction noise;
• soreness in the muscles;
• dyspeptic disorders;
• feeling of weakness.

In general, the general condition can be satisfactory and worsens when exudate begins to accumulate. At this time, some symptoms subside and signs of the exudative form begin to appear.

Exudative pleurisy

This species is characterized by two variants of development. If the inflammatory process began with a dry form, then patients note a decrease in pain. They are replaced by a feeling of heaviness in the chest. Acute exudative pleurisy begins with fever and general malaise. The clinical picture may also include:

• shortness of breath
• dry cough;
• feeling of lack of air in a calm state;
• forced position on the sore side;
• swelling of the skin in the lower chest;
• swelling of the neck veins;
• cyanosis.

The intensity of the symptoms and complaints of patients vary depending on the amount of accumulated fluid, the disease that caused the inflammatory process in the pleura, etc.

Purulent pleurisy

The purulent form is characterized by the same manifestations as for the exudative form. The intensity of the symptoms depends on the type of purulent pleurisy, as well as the age of the patient. Often in old age and in young children there is a severe picture of the disease. In general, this form is characterized by:

• elevated temperature (in acute course - very high);
• increasing shortness of breath;
• dry cough;
• forced half-sitting position;
• respiratory failure;
• manifestations of general intoxication.

With the accumulation of pus, the mediastinum shifts to the healthy side. There is also pain in the sternum. When an abscess breaks, purulent discharge appears, fetid sputum during coughing.

Tuberculous pleurisy

This is one of the frequent complications of tuberculosis, especially at a young age. The symptoms of the tuberculous type of the disease differ depending on the form - dry or exudative. Also, in patients with tuberculosis, an allergic form of pleurisy is observed, manifested in:

• a sharp increase in temperature;
• intensive accumulation of exudate;
• pain in the side;
• tachycardia;
• sweating.

This species is characterized by an acute onset and an equally rapid subsidence of symptoms. With further spread of inflammation, perifocal forms of the disease develop with a more protracted course.

Diagnostics

Diagnostic measures for suspected inflammatory process in the pleura may include a variety of studies. This is due to the fact that it is extremely important to establish the cause of this pathology. Therefore, in addition to standard examinations and analyzes, additional studies are often prescribed. After examination, questioning and clinical examination, the doctor decides which diagnostic methods to use in a particular case. Among the main diagnostic methods:

• X-ray - X-ray makes it possible to detect inflammatory foci and accumulated fluid. In addition, x-ray examination can help in some cases to establish the root cause of the disease (tuberculosis, pneumonia, tumors).
• Exudate analysis - the study of exudate allows you to draw conclusions about the cause of the pathology.
• General and biochemical blood tests - signs of inflammation and other pathological changes are established.
• Microbiological examination - reveals a possible pathogen.

In addition, urine is analyzed for the presence of protein. Additionally, angiography, pleurography, MRI can be prescribed. In some cases, a pleural biopsy is required, which is the most accurate diagnostic method.

Treatment Methods

Treatment of the disease complements the basic medical procedures aimed at eliminating the disease that provoked inflammation of the pleura. The primary task is to restore normal respiratory function and stabilize the patient's condition. For this, a complex of medications and various physiotherapeutic procedures are used.

In case of complications (purulent pleurisy, oncology, etc.), surgical intervention is performed. You can also additionally be treated with folk remedies. Patients need to adhere to strict bed rest and diet. It is very important to avoid stressful situations. In most cases, treatment is carried out in a hospital setting.

Medical treatment

Since pleurisy is most often associated with infection, antibiotics are used for treatment. To ensure maximum effectiveness of treatment, the antibacterial drug is selected on the basis of microbiological studies. In addition to antibiotics, for drug therapy use:

• diuretic drugs;
• non-steroidal anti-inflammatory drugs;
• glucocorticosteroids;
• regulators of water and electrolyte balance;
• anti-inflammatory drugs;
• antihistamines;
• cough suppressants/expectorants;
• immunomodulators;
• painkillers;
• vitamin complexes.

Also, if necessary, the complex is supplemented with specialized treatment (for example, anti-tuberculosis). The doctor selects drug doses individually, taking into account the severity of the condition and taking other medications.

Alternative treatment

It is impossible to cure this disease exclusively by folk remedies. However, traditional medicine recipes have a positive effect and help to quickly cope with symptoms and improve inflammation.

1. Black radish juice mixed with honey in equal proportions. The mixture is taken on the table. spoon three times a day.
2. Beetroot juice (2 parts) with honey (1 part). Reception after meals twice a day for a tablespoon. Prepare the mixture immediately before use.
3. Lemon juice (1 part) with grated horseradish root (1 part). The mixture is consumed in half a teaspoon on an empty stomach in the morning and evening. Store in refrigerator for up to five days.
4. Infusion of plantain (2 tablespoons of a dry plant for 0.5 liters of boiling water). Drink 100 ml several times a day.
5. Onions with wine and honey. Chop the onion, pour red wine, add a little honey. Leave the mixture for a week in a dark place, strain and consume 3 times a day at the table. spoon.
6. Badger fat with aloe and honey. Equal portions of the components are mixed (pre-grind the aloe leaves). The mixture is aged in the oven for 15 minutes at a low temperature. It is taken three times a day for a table. spoon.
7. Herbal infusion of mint, elecampane, coltsfoot. It is taken three times a day for one third of a glass.

You can not use folk remedies instead of medical treatment and without prior discussion with your doctor, this is fraught with suppuration and other complications.

Surgery

Operative methods are used in the purulent form of the disease and chronic course, not amenable to conservative treatment. Indications for surgical intervention are:

• purulent form;
• the presence of multiple infectious foci;
• large fibrin clots in the pleural cavity;
• mediastinal displacement;
• prolonged discharge of pus from a lung abscess;
• lungs' cancer.

In this case, exudate, pleural scars, destroyed remnants of the pleura, affected lung tissue, and part of the ribs can be removed. The amount of intervention required depends on the type of disease and other factors. Sometimes a combination of types of surgery is required. So decortication - removal of scars - is supplemented with pleurectomy and resection of the affected part of the lung. Thoracoplasty (removal of ribs) is resorted to in chronic cases and the impossibility of decortication and pleurectomy. Most often, a puncture is performed, and the accumulated fluid is removed from the affected area.

Features of the treatment of the elderly

Pleurisy in the elderly usually proceed more severely and aggravate the clinic of the underlying disease. In addition, in the elderly, pleural lesion occurs much more often against the background of chronic diseases of the cardiovascular system, after a heart attack, and with oncological diseases. But often there is a sluggish course, in which the symptoms are mild. Therefore, it is necessary to carefully monitor the condition and conduct an examination if there are:

• dyspnea;
• hiccups
• night chills;
• soreness when coughing;
• drop in blood pressure;
• increased heart rate;
• cyanosis;
• general weakness;
• fast fatiguability.

If any of these symptoms are present, the patient needs immediate treatment, as in old age, respiratory and cardiovascular insufficiency and other complications develop much faster. Treatment of pathology, as a rule, is longer, and the inflammatory focus resolves more slowly. Elderly patients are prescribed complex therapy, including restorative measures. Also, special attention is paid to the selection of the dose of antibiotics, taking into account violations of the liver and kidneys.

Prevention

To prevent the development of pathology, treatment of diseases complicated by inflammation of the pleura should be started as early as possible. Early diagnosis of tuberculosis, pneumonia, rheumatism and other diseases can significantly reduce the risk of inflammation. Prevention of the purulent form provides for the timely evacuation of exudate and other accumulations from the pleural region. In addition, to reduce the likelihood of complications will help:

• correction of chronic diseases;
• rational way of life;
• hardening of the body;
• strengthening the respiratory system;
• increased immunity;
• to give up smoking;
• diet food.

It is extremely important not to self-medicate acute respiratory infections, even if the temperature is low and there are no pronounced symptoms of inflammation. Pathogenic microflora can penetrate the pleural cavity, so infectious diseases require urgent treatment. With frequent infectious lesions of the respiratory tract, climate change may be recommended.

The prognosis of recovery generally depends on the severity of the underlying disease. Timely detection and early treatment of pathology contribute to a favorable outcome.