Pleuritic chest pain

An accurate diagnosis of the cause of pleuritic chest pain is important for appropriate management. Pleuritic chest pain may be associated with:

• inflammation of the pleura caused by viral or bacterial pneumonia
• pulmonary infarction caused by pulmonary embolism
• pneumothorax
• bronchiectasis
• connective tissue disease
• trauma
• benign asbestos pleurisy.

Provide sufficient analgesia during investigations to allow adequate respiratory movements; allowing adequate respiratory movements decreases the risk of atelectasis and pneumonia. Nonsteroidal anti-inflammatory drugs (NSAIDs) may be appropriate during investigations and for initial management of pleuritic chest pain. If opioids are needed, their respiratory depressant and cough suppressant actions must be considered; hospital admission is advised if giving opioids to patients with chronic obstructive pulmonary disease (COPD) or patients thought to be hypoxaemic.

For information on managing acute pain with analgesics in adults, see Using analgesics to manage acute pain.