Pleurisy medical therapy: Difference between revisions
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==Medical Therapy== | ==Medical Therapy== | ||
Management of pleurisy has two primary goals: (1) control the pleuritic chest pain, and (2) treat the underlying condition. To achieve pain control, nonsteroidal anti-inflammatory drugs (NSAIDs) commonly are prescribed as the initial therapy. Narcotic analgesics may be required to relieve severe pleuritic chest pain; however, NSAIDs do not suppress respiratory efforts or cough reflex and are the preferred first-line agent.Although a class effect is presumed, human studies on the use of NSAIDs to treat pleuritic chest pain have been limited to indomethacin (Indocin). Indomethacin, in dosages of 50 to 100 mg orally up to three times per day with food, has been found to be effective in relieving pleural pain, with associated improvement in mechanical lung function.<ref name="pmid4583171">{{cite journal | author = Sacks PV, Kanarek D | title = Treatment of acute pleuritic pain. Comparison between indomethacin and a placebo | journal = [[The American Review of Respiratory Disease]] | volume = 108 | issue = 3 | pages = 666–9 | year = 1973 | month = September | pmid = 4583171 | doi = | url = | accessdate = 2013-04-30}}</ref> | |||
To achieve the second management goal, therapies are selected based on the underlying condition.[[Bacterial infections]] are treated with [[antibiotics]]. Some [[bacterial infections]] require a [[surgical procedure]] to drain all the infected fluid. | |||
[[Viral infections]] normally run their course without [[medications]]. If a patient has suspected drug-induced pleuritis or drug-induced lupus pleuritis, the causal agent should be discontinued.<ref name="pmid15062606">{{cite journal | author = Huggins JT, Sahn SA | title = Drug-induced pleural disease | journal = [[Clinics in Chest Medicine]] | volume = 25 | issue = 1 | pages = 141–53 | year = 2004 | month = March | pmid = 15062606 | doi = 10.1016/S0272-5231(03)00125-4 | url = | accessdate = 2013-04-30}}</ref>.<ref name="pmid15767026">{{cite journal | author = Rubin RL | title = Drug-induced lupus | journal = [[Toxicology]] | volume = 209 | issue = 2 | pages = 135–47 | year = 2005 | month = April | pmid = 15767026 | doi = 10.1016/j.tox.2004.12.025 | url = | accessdate = 2013-04-30}}</ref> | |||
Smoking cessation should be advised for patients with pleurisy caused by asbestosis.<ref name="pmid12379872">{{cite journal | author = Nelson HH, Kelsey KT | title = The molecular epidemiology of asbestos and tobacco in lung cancer | journal = [[Oncogene]] | volume = 21 | issue = 48 | pages = 7284–8 | year = 2002 | month = October | pmid = 12379872 | doi = 10.1038/sj.onc.1205804 | url = | accessdate = 2013-04-30}}</ref> | |||
[[Viral infections]] normally run their course without [[medications]]. | Antimicrobial and antiparasitic agents are selected empirically based on the suspected underlying organism. Decortication is considered in cases of pleuritis associated with refractory pleural effusions resulting from malignancy, chronic renal failure, or rheumatoid pleurisy.Colchicine (1.2 to 2.0 mg orally once per day, or twice per day in a divided dose) is the mainstay of treatment for familial Mediterranean fever.<ref name="pmid9500348">{{cite journal | author = Ben-Chetrit E, Levy M | title = Familial Mediterranean fever | journal = [[Lancet]] | volume = 351 | issue = 9103 | pages = 659–64 | year = 1998 | month = February | pmid = 9500348 | doi = 10.1016/S0140-6736(97)09408-7 | url = | accessdate = 2013-04-30}}</ref>. NSAIDs are first-line therapy for patients with post–cardiac injury syndrome; corticosteroids are reserved for those who are intolerant of or experience no response to NSAIDs.<ref name="pmid16553111">{{cite journal | author = Wessman DE, Stafford CM | title = The postcardiac injury syndrome: case report and review of the literature | journal = [[Southern Medical Journal]] | volume = 99 | issue = 3 | pages = 309–14 | year = 2006 | month = March | pmid = 16553111 | doi = | url = http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0038-4348&volume=99&issue=3&spage=309 | accessdate = 2013-04-30}}</ref>.Although oral corticosteroids are recommended for patients with lupus pleuritis, they have not been demonstrated to influence the course of rheumatoid pleuritis.<ref name="pmid15584892">{{cite journal | author = Aiello M, Chetta A, Marangio E, Zompatori M, Olivieri D | title = Pleural involvement in systemic disorders | journal = [[Current Drug Targets. Inflammation and Allergy]] | volume = 3 | issue = 4 | pages = 441–7 | year = 2004 | month = December | pmid = 15584892 | doi = | url = http://www.eurekaselect.com/91288/article | accessdate = 2013-04-30}}</ref>.The role of systemic corticosteroids in the treatment of tuberculous pleuritis is controversial. Tuberculous pleuritis is associated with inflammation and fibrosis, and a small number of randomized and quasi-randomized studies with patients who did not have human immunodeficiency virus have assessed the impact of steroids on this process.<ref name="pmid10796669">{{cite journal | author = Matchaba PT, Volmink J | title = Steroids for treating tuberculous pleurisy | journal = [[Cochrane Database of Systematic Reviews (Online)]] | volume = | issue = 2 | pages = CD001876 | year = 2000 | pmid = 10796669 | doi = 10.1002/14651858.CD001876 | url = | accessdate = 2013-04-30}}</ref>. Although these studies did show a trend toward benefit (reduction in the number of patients with pleural effusions, thickening, or adhesions), there is insufficient evidence to determine whether steroids are an effective treatment. | ||
==References== | ==References== | ||
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{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
[[Category:Needs content]] | [[Category:Needs content]] | ||
[[Category:Disease]] | [[Category:Disease]] | ||
[[Category: | [[Category:Inflammations]] | ||
[[Category:Pulmonology]] | [[Category:Pulmonology]] | ||
[[Category: | [[Category:Emergency medicine]] | ||
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Medical Therapy
Management of pleurisy has two primary goals: (1) control the pleuritic chest pain, and (2) treat the underlying condition. To achieve pain control, nonsteroidal anti-inflammatory drugs (NSAIDs) commonly are prescribed as the initial therapy. Narcotic analgesics may be required to relieve severe pleuritic chest pain; however, NSAIDs do not suppress respiratory efforts or cough reflex and are the preferred first-line agent.Although a class effect is presumed, human studies on the use of NSAIDs to treat pleuritic chest pain have been limited to indomethacin (Indocin). Indomethacin, in dosages of 50 to 100 mg orally up to three times per day with food, has been found to be effective in relieving pleural pain, with associated improvement in mechanical lung function.[1] To achieve the second management goal, therapies are selected based on the underlying condition.Bacterial infections are treated with antibiotics. Some bacterial infections require a surgical procedure to drain all the infected fluid. Viral infections normally run their course without medications. If a patient has suspected drug-induced pleuritis or drug-induced lupus pleuritis, the causal agent should be discontinued.[2].[3] Smoking cessation should be advised for patients with pleurisy caused by asbestosis.[4] Antimicrobial and antiparasitic agents are selected empirically based on the suspected underlying organism. Decortication is considered in cases of pleuritis associated with refractory pleural effusions resulting from malignancy, chronic renal failure, or rheumatoid pleurisy.Colchicine (1.2 to 2.0 mg orally once per day, or twice per day in a divided dose) is the mainstay of treatment for familial Mediterranean fever.[5]. NSAIDs are first-line therapy for patients with post–cardiac injury syndrome; corticosteroids are reserved for those who are intolerant of or experience no response to NSAIDs.[6].Although oral corticosteroids are recommended for patients with lupus pleuritis, they have not been demonstrated to influence the course of rheumatoid pleuritis.[7].The role of systemic corticosteroids in the treatment of tuberculous pleuritis is controversial. Tuberculous pleuritis is associated with inflammation and fibrosis, and a small number of randomized and quasi-randomized studies with patients who did not have human immunodeficiency virus have assessed the impact of steroids on this process.[8]. Although these studies did show a trend toward benefit (reduction in the number of patients with pleural effusions, thickening, or adhesions), there is insufficient evidence to determine whether steroids are an effective treatment.
References
- ↑ Sacks PV, Kanarek D (1973). "Treatment of acute pleuritic pain. Comparison between indomethacin and a placebo". The American Review of Respiratory Disease. 108 (3): 666–9. PMID 4583171. Unknown parameter
|month=ignored (help);|access-date=requires|url=(help) - ↑ Huggins JT, Sahn SA (2004). "Drug-induced pleural disease". Clinics in Chest Medicine. 25 (1): 141–53. doi:10.1016/S0272-5231(03)00125-4. PMID 15062606. Unknown parameter
|month=ignored (help);|access-date=requires|url=(help) - ↑ Rubin RL (2005). "Drug-induced lupus". Toxicology. 209 (2): 135–47. doi:10.1016/j.tox.2004.12.025. PMID 15767026. Unknown parameter
|month=ignored (help);|access-date=requires|url=(help) - ↑ Nelson HH, Kelsey KT (2002). "The molecular epidemiology of asbestos and tobacco in lung cancer". Oncogene. 21 (48): 7284–8. doi:10.1038/sj.onc.1205804. PMID 12379872. Unknown parameter
|month=ignored (help);|access-date=requires|url=(help) - ↑ Ben-Chetrit E, Levy M (1998). "Familial Mediterranean fever". Lancet. 351 (9103): 659–64. doi:10.1016/S0140-6736(97)09408-7. PMID 9500348. Unknown parameter
|month=ignored (help);|access-date=requires|url=(help) - ↑ Wessman DE, Stafford CM (2006). "The postcardiac injury syndrome: case report and review of the literature". Southern Medical Journal. 99 (3): 309–14. PMID 16553111. Retrieved 2013-04-30. Unknown parameter
|month=ignored (help) - ↑ Aiello M, Chetta A, Marangio E, Zompatori M, Olivieri D (2004). "Pleural involvement in systemic disorders". Current Drug Targets. Inflammation and Allergy. 3 (4): 441–7. PMID 15584892. Retrieved 2013-04-30. Unknown parameter
|month=ignored (help) - ↑ Matchaba PT, Volmink J (2000). "Steroids for treating tuberculous pleurisy". Cochrane Database of Systematic Reviews (Online) (2): CD001876. doi:10.1002/14651858.CD001876. PMID 10796669.
|access-date=requires|url=(help)