Pleural Effusion: When Your Lungs Throw a Pool Party You Didn't Sign Up For

Imagine suffering a sharp, searing pain each time you inhale, as if a weight is pressing down on your chest. This is the daily reality for those living with pleural effusion, a condition that is common in India and transforms something as simple as breathing into a painful challenge.

Pleural effusion happens when there is a build-up of excess fluid in the tiny gap (pleural space) between the layers of the pleura — the thin membranes that cover the lungs. Normally, there’s a small amount of fluid that helps the lungs move smoothly, but too much fluid can lead to serious breathing problems.

"When the doctor told me my breathing issues were due to fluid around my lungs, I was shocked — I thought it was just a bad cough from the flu," recalls 34-year-old Nivisha*, who recently recovered from pleural effusion. 

At first, pleural effusion can be tricky to identify because it may mimic a respiratory infection - a slight fever or a cough that you can’t seem to shake off. However, as the fluid increases, symptoms of pleural effusion become more noticeable. These include: 

• Sharp chest pain: Especially when you take deep breaths or cough
• Shortness of breath: Even when resting, it can feel like you are gasping to breathe or out of breath
• Inability to breathe lying down: This is called orthopnea, where you need to sit upright to breathe comfortably
• Dry cough
• Persistent fatigue or feeling weak
• Fever (common in cases of infection)
• Unexplained weight loss (especially in cases of malignancy) or even tuberculosis
• General discomfort or feeling of heaviness in the chest
• Rapid breathing
• Reduced movement or expansion on the affected side of the chest

"It started with a stabbing pain every time I tried to breathe deeply. I couldn’t even lie down without feeling like I was suffocating,"  Nivisha says. These symptoms can vary depending on the underlying cause of the pleural effusion.

Certain conditions make you more susceptible to pleural effusion. There are two types of pleural effusion:

This type happens when fluid leaks into the pleural space due to imbalances in pressure or protein levels in the blood vessels. Common causes include:

• Heart failure: Fluid may be forced into the pleural space as the heart struggles to pump blood effectively and increases pressure in the lungs.
• Cirrhosis: Severe liver disease lowers protein levels and raises pressure in blood vessels, which may cause fluid to build up in the abdomen and around the lungs.
• Nephrotic syndrome (kidney disease): The kidneys lose proteins through urine, reducing protein levels in the blood, which leads to fluid accumulation in the pleural space.

This type develops when inflammation or damage to the pleura allows high-protein fluid to enter the pleural space. Common causes include:

• Pneumonia: An infection in the lungs inflames lung tissue, causing fluid to collect around the lungs. This can be a bacterial infection or viral infection like COVID-19.
• Cancer: Cancers like lung, breast, or lymphoma spread or block lymphatic drainage, leading to fluid buildup.
• Post-surgical complications: Surgeries, especially in the chest, can disrupt normal fluid drainage, leading to pleural effusion due to inflammation or infection.
• Tuberculosis: In India, Tuberculosis is one of the top causes of pleural effusion.

Other risk factors of pleural effusion include:

• Smoking: It increases the risk of lung diseases
• Asbestos exposure: This can lead to conditions like mesothelioma (a rare and aggressive cancer that affects the lining of the lungs, abdomen, or heart), often causing an abnormal buildup of fluid around the lungs 
• Recent surgeries or chest trauma
  "I had no idea my flu could turn into pneumonia and that it would lead to fluid buildup in my lungs," Nivisha explains.

Pleural effusion is a significant health issue in India, particularly driven by tuberculosis. Studies show that tuberculosis is the leading cause of pleural effusion, accounting for around 70% of cases in various regions. The age group most affected by pleural effusion is adults aged 31-40.

When you visit your doctor with breathing difficulties, they will take your medical history and listen to your lungs. If they suspect pleural effusion, they may order tests to confirm the diagnosis. “Almost always, it is recommended to have the effusion drained to try and get at the cause,” says Dr Belani

• A doctor might start by using an imaging technique that provides a general view of the chest to check for fluid buildup. 
• If they need more detailed images, a more advanced imaging method can be used to examine the lungs and surrounding tissues more closely.
• A noninvasive technique using sound waves can be employed. This gives clear visuals of the affected area, allowing the quantity and location of the fluid to be determined. 
• If fluid is detected, a procedure may be performed to carefully extract some of it for analysis, allowing the doctor to test for infections or cancerous cells.

"When they told me they’d need to use a needle to drain fluid from my lungs for testing, I was nervous, but it wasn’t as bad as I thought," Nivisha remembers.

Once pleural effusion is diagnosed, the goal is to successfully eliminate the fluid and address the underlying cause. Here are the common treatments:

• Draining the fluid can provide immediate relief. "After the fluid was drained, I could finally take a full breath again," Nivisha shares.
• If pleural effusion is caused by infection or heart failure, medications are prescribed. 
• For recurring effusions, a chemical is introduced to create scarring in the pleura, which helps prevent future fluid buildup.
• In more severe cases, surgery may be needed to remove infected or cancerous tissue.

Living with pleural effusion may mean regular monitoring and treatment for the underlying condition that caused it. While not always preventable, you can reduce your risk by:

• Quitting smoking to prevent lung damage.
• Managing chronic conditions like heart disease, kidney disease, or cirrhosis.
• Following your doctor's advice on medications like diuretics or fluid restrictions.

Pleural effusion can be a scary diagnosis, but with the right treatment, it is manageable. If you or someone you know is dealing with this condition, it’s important to stay informed, listen to what your body has to say and take action according to your doctor's advice. 

Whether it’s caused by something as common as heart failure or a more serious condition like cancer, addressing it early can make all the difference.