Pleurisy (Pleural Inflammation)

Pleurisy, the technical name of which is pleuritis, is actually a series of symptoms rather than a disease itself. It is an inflammation of the pleura, or the lining of the pleural cavity, which surrounds the lungs.

Pleurisy can have any number of causes, including viral, bacterial, and non-infectious disease such as those caused by asbestos. Those suffering from pleurisy typically find breathing quite painful, and effects may linger long after the condition itself has cleared up (1).

The Pleural Lining

All the internal organs and surfaces of the body have a lubricating layer over them known as the mesothelium. This layer develops from the embryonic mesoderm, or inner tissues of the embryo. Eventually, these cells develop into a slippery layer that lines the inside of the chest and abdomen as well as the internal organs, allowing them to slide against each other without irritating the tissues.

Mesothelium is the name that is applied to all of these surfaces throughout the body; the pleural lining or pleura is that part of the mesothelium specific to the lungs (2).

Diagnosing Pleuritis

The pain associated with pleuritis or pleurisy originates from the lungs’ pleural lining, the nerves of which are connected to those situated between the ribs (known as intercostal). This pain is usually intesified when the victim attempts to breathe deeply. It can also be exacerbated by coughing and sneezing.

The usual cause of pleurisy is pneumonia, but as indicated above, the condition may be symptomatic of any number of conditions. These include pulmonary embolism, or blockage of a pulmonary artery; systemic lupus erythematosus (SLE), a disease in which the immune system attacks the body’s own tissues; and serositis (inflammation of the pleura itself) that occurs with diseases of connective tissues (3).

Pleurisy and Asbestos Disease

Pleurisy is associated with a condition known as pleural effusion. This is essentially a build-up of fluid between the outer surface of the lungs and the inner pleural lining.

People with healthy respiratory systems normally have less than 15 milliliters of fluid in the space between the lung surface and the pleura, known as the pleural cavity. It is a fluid that circulates though the body’s lymphatic system, a major component of the body’s immune defenses.

Part of the function of the lymphatic system is to remove excess fluids from the body’s tissues, including the pleural cavity. Under normal conditions, this system can drain up to 300 milliliters at a time from this area.

While the specific ways in which asbestos fibers affect living cells is not yet fully understood by medical science, one of the effects is an excess production of pleural fluids. Eventually, this production overwhelms the lymphatic system’s ability to drain the access. As a result, these fluids build up within the pleural cavity, causing pleural effusion.

Pleural effusion may be transudate or exudate. In the case of the former, pleural fluid results from systemic causes not directly related to the respiratory system. Examples are heart failure, blockage of a pulmonary artery (embolism), and cirrhosis of the liver.

When cancers such as those caused by asbestos are involved however, the effusion is considered exudate, meaning that the cause is directly related to a condition of the respiratory system.

Pleurisy is one of the symptoms of pleural effusion. When a physician encounters pleurisy and has eliminated all other causes, s/he may need to make an analysis of the pleural fluid, comparing its chemical structure to that of the blood in order to make an accurate diagnosis.

Pleurisy and Malignant Asbestos Disease

Usually, pleurisy is indicative of a benign condition – meaning that the condition typically does not spread to other parts of the body.

However, cancer – including the three types caused by asbestos exposure – is one of the exudates causes of pleural effusions that can result in symptoms of pleurisy.

Mesothelioma

This is the form of asbestos-caused cancer that has had the most attention in the media. It is a cancer of the mesothelium that starts in the pleural lining, then usually spreads aggressively. The growth of the cancer on the pleura can cause the build-up of fluids in the pleural cavity.

Bronchogenic Carcinoma

This is the medical term for lung cancer, affecting the bronchial passages inside the lungs. Most forms of this cancer do not necessarily result in the pleural effusion that results in symptoms of pleurisy (4).

Available Treatments

There are a few treatments for pleural effusion designed to drain and eliminate excess fluid, which in turn can relieve the victim’s pain. These treatments, known as pleurodesis, are invasive however, and can be very uncomfortable for the patient, requiring local anesthetics and analgesic medication.

Sometimes, pleurodesis can be performed chemically with the use of tetracycline, a type of antibiotic, iodine or talc slurry, which is introduced into the pleural cavity by means of a chest tube. In this procedure, a surgeon inserts a flexible tube through the chest wall and into the pleural cavity. Once the excess fluid is drained, these chemicals may be introduced in order prevent a new build-up of fluid (5).

Surgical pleurodesis involves thoracotomy, which is a procedure in which an incision is made into the chest. The pleural lining may then be purposely irritated with a rough pad, or removed completely.

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