Pleurisy vs. Bronchitis: Differences and Similarities

What is pleurisy?

Pleurisy is a condition, in which the lining that surrounds the lungs and the interior of the chest cavity is inflamed. Due to the inflammation of the pleura, this condition is also called as pleuritis. The pleural space is the space between the lungs and the chest cavity wall. Normally, pleural fluid fills this space, so that when a person breathes in and out, the membranes can move against each other smoothly. Because of pleurisy, these tissues get inflamed. It results in a sharp distinctive pain in the chest since the pain sensation fibers of the lungs are located in the pleura.

Due to the inflammation, the pleura tends to rub against each other. Thus, when the person breathes in, there is a sharp pain experienced on the inflamed side of the chest. Often, pleurisy is associated with pleural effusion, a condition in which there is excess pleural fluid. Excess pressure is exerted on the pleural space. When a person breathes in, pain is felt due to pressure. An individual may also experience coughing and shortness of breath. 

What is bronchitis?

Bronchitis is a condition in which the larger airways in the lungs get inflamed and causes an ongoing cough. People develop bronchitis when they smoke or when viruses, bacteria, or dust are inhaled. There are two types of bronchitis: acute and chronic.

Acute bronchitis is often due to viral infections such as the common cold or the influenza virus. These conditions usually last for weeks, but many people tend to feel better with time and after taking plenty of rest. 

Chronic bronchitis is associated with smoking that could last for months and may recur after each year. The passage of airflow becomes difficult in bronchitis. An individual with chronic bronchitis is more prone to getting bacterial lung infections, such as pneumonia. 

Risk Factors

• Bacterial and Viral Infections: There are a number of conditions and diseases that can cause pleurisy. It can occur due to diseases, such as pneumonia, flu, and tuberculosis. 

• Autoimmune Diseases: When the immune system of a person attacks its own cells and tissues, it gives rise to autoimmune diseases, such as rheumatoid arthritis and lupus. These diseases are known to be risk factors for pleurisy. 

• Medications: Pleurisy can also be caused by certain medications. They include nitrofurantoin (antibiotic used for urinary tract infections), procainamide (anti-arrhythmic drug), isoniazid (antibiotic treatment for tuberculosis), and methotrexate (chemotherapy agent). 

• Exposure to Toxic Substances: Exposure to toxic substances, such as asbestos, can also increase a person's risk of developing pleurisy.

• Smoking: One of the highest risk factors is smoking. Irreversible damage to the lungs is caused when the mixture of toxic chemicals from cigarettes enters the body. Smoking also damages the inner membrane of the bronchi resulting in excessive mucus production and inflammation. To prevent serious cases of chronic bronchitis, it is highly recommended for smokers to quit smoking. 

• Passive Smoking: Another risk factor is passive smoking. The risk can increase even when small amounts of secondhand smoke are inhaled. A number of chemicals and carcinogens are present in secondhand smoke, and when an individual is exposed to these harmful chemicals, lung damage can result. The risk of bronchitis is especially high in children when they are exposed to secondhand smoke.

• Age: Children who are younger than 5 years old and elderly people who are more 65 years old and above have an increased risk of bronchitis since their immune system is not strong enough. 

• Medical Conditions: Vulnerability also increases due to medical conditions, such as allergies, cysts, asthma, fibrosis, cancer, diabetes, tuberculosis, gastroesophageal reflux disease (GERD), HIV/AIDS, flu, sinusitis, and the common cold. 

• Pollutants: They can be from chemical industries, textile mills, vehicles, and grain storage facilities. They weaken the immune system and increase the risk of bronchitis.

Causes

Several medical conditions are known to cause pleurisy. In some cases, autoimmune diseases and certain medications can indirectly cause pleurisy. Although many cases of pleurisy are diagnosed, pleurisy can also develop without any identifiable cause. The most common cause of pleurisy is an infection, such as viral pneumonia or influenza. Other common causes are bacterial pneumonia and tuberculosis.

Usually, the pleural part of the lung is involved in any type of pneumonia. Less common causes of pleurisy are fungal and parasitic infections. Liver disease, lupus, and rheumatoid arthritis are also known to cause pleurisy.

Lungs may get inflamed due to lymphoma, mesothelioma, and lung cancer. Pleurisy is also associated with conditions such as asbestosis and sarcoidosis, which are inflammatory conditions. Another rare and fatal lung disease that is linked to pleurisy is lymphangioleiomyomatosis (LAM). Certain drugs can also trigger this condition.

Pulmonary embolism is also associated with pleurisy. In this condition, blood clots from the legs travel to the lungs. Thus, the pleura may become inflamed. 

Chest injuries, rib fractures, and heart surgery may also cause pleurisy. Other causes of pleurisy may include medical conditions, such as liver cirrhosis and pancreatitis.

Just as infection causes pleurisy, viral infections can also cause acute bronchitis. Acute bronchitis may occur along with a cold or any other respiratory infection. Pleurisy is non-contagious, unlike bronchitis, which can spread. Acute bronchitis can spread when a person with the condition sneezes, coughs, or talks. Other people can also catch the disease by touching contaminated objects or shaking contaminated hands of an infected person.

Other irritants that cause pleurisy can also cause bronchitis. Irritants include smoking and being exposed to secondhand smoke, chemical fumes, or air pollutants. All of these irritants can increase the risk of chronic bronchitis. Asthma is indicated if some people have bronchitis along with wheezing, coughing, and shortness of breath.

Signs and Symptoms

The most common symptom experienced by people with pleurisy is chest pain, and only because of this pain, the person will visit the doctor. People with pleurisy may experience a sharp, stabbing pain in the chest. This pain tends to worsen when they laugh, breathe deeply, cough, or move. 

The pain can be dull or continuous. Even though the pain may extend to the neck, back, shoulders, or abdomen, the pain is usually limited to the chest region. There are also many complaints about shortness of breath, which is medically called as dyspnea. Shortness of breath may also occur due to an underlying condition or due to chest pain.

Sometimes, when excess fluid is accumulated in the pleura, breathing becomes harder. In some cases, coughing may be present. It can be a productive cough that may generate mucus or a dry cough. Sometimes, people may cough up blood. If the cause is pneumonia or tuberculosis, then pleurisy can also cause a cough.

Other symptoms occur depending on the medical cause. Some may even experience dizziness, sore throat, fever, chills, poor appetite, weight loss, and tiredness. Pleurisy may sometimes indicate the presence of an infection.

Coughing is one of the common symptoms of bronchitis. In most cases, a person with acute bronchitis gets a dry annoying cough. When the lining of the bronchial tubes is inflamed, this triggers a cough.

Other symptoms of bronchitis are similar to pleurisy symptoms, which include headache, cough with greenish phlegm, or yellow mucus, chills, feeling ill, shortness of breath, chest tightness, and wheezing. Bronchitis and pleurisy are very common in smokers.

On most days of the months or years, a person with chronic bronchitis will show symptoms similar to that of acute bronchitis, except that there is no chills and fever, and there is a chronic productive cough. Recovery in such people is usually longer. They experience daily shortness of breath, wheezing, and coughing, and if the condition is left untreated, these symptoms can get worse.

Bouts of bronchitis may suddenly appear in people with asthma, and episodes of shortness of breath, chest tightness, wheezing, and difficulty breathing, are triggered. If asthmatic bronchitis is severe, breathing becomes difficult because of the narrowed airways. 

Complications

Once the underlying cause is treated, then there would be no long-term problems associated with pleurisy. However, some people may develop complications. They can also have recurring symptoms, depending on the cause. 

Excess accumulation of fluid in the pleural space gives rise to pleural effusion, which is a complication of pleurisy. Sometimes, the inflamed pleura is cushioned by the fluid and the pain is decreased. However, the pressure that builds up may cause cyanosis due to less oxygen, coughing, and difficulty breathing. Another complication is a collapsed lung. It happens when the buildup of air increases lung pressure, causing the lung to collapse. 

Pleural fibrosis is another rare complication of pleurisy. In this condition, the pleura is thickened, which causes scarring of the pleura and impaired function. This complication may also further increase a person's risk of other health problems and even death.

Both bronchitis and pleurisy can develop secondary infections leading to pneumonia. In the case of bronchitis, even though it is primarily caused by a viral infection, a bacterial infection or pneumonia may also develop. The alveoli are specifically affected by this condition. The risk of pneumonia increases in smokers, patients with heart or lung disease, and those with weakened immunity. If the condition is mild, then it can be treated at home, but if it is severe, then it can only be treated in the hospital.

Long-term COPD may result due to chronic bronchitis. In this condition, the lung reserves progressively diminish along with having a difficulty in breathing. The risk of occasional flare-ups also increases as well as the frequency of chest infections.

Prevention

It is possible to prevent pleurisy when there is quick management or early detection of the underlying condition. For example, when infections are early diagnosed and treated, fluid buildup can be prevented in the pleural cavity, minimizing inflammation. However, pleurisy can also be difficult to diagnose since it can be confused with other types of diseases. Consuming a healthy diet and getting plenty of rest can help prevent complications, such as pleurisy while being treated for any health condition. 

Acute or chronic bronchitis cannot always be prevented. However, there are steps that you can take to lower your risk of developing both conditions. The most important step is to stop smoking or not start smoking. 

Other lung irritants, such as dust, vapors, fumes, secondhand smoke, and air pollution must also be avoided. To help protect your lungs, you can wear a mask over your nose and mouth, especially when using substances that have strong fumes, such as varnish, paint, and paint removers. 

You also need to develop good handwashing habits to limit your exposure to harmful microorganisms. Your healthcare provider may also recommend an annual flu shot or a pneumonia vaccine to help fight lung problems.