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What is Pleural Effusion?

The pleural space is a thin layer of fluid between the inner wall of the chest cavity and the outer wall of the lungs. The layer of fluid acts as a lubricant between the two surfaces as the move up and down in relation to one another. The negative pressure from the sealed space between the pleural layers helps pull the lungs up and out as the chest wall moves up. This is a necessary feature to maximise lung expansion as part of normal respiratory movement.

Pleural effusion occurs when excess fluid builds up within the pleural space. This either results from increase production of fluid or an inability to properly drain it. The net effect is an increased separation of the pleural layers reducing the effectiveness of the chest wall mechanical ventilation. Depending on severity it can result in partial collapse of some lower airways, reducing the available lung space for gas exchange. This cumulates to lower your respiratory efficiency leaving you tired and breathless with increased risk of developing further infections, either in the retained pleural fluid or within chest secretions that will be harder to clear.

Improving lung function and exercise tolerance with supervision from a physiotherapistAbove: Improving lung function and exercise tolerance with supervision from a physiotherapist

What causes Pleural Effusion?

The small amount of fluid that is maintained within the pleural space is passively regulated by a process of hydrostatic pressure and normal lymphatic drainage. Because it takes a disturbance of this normal balance to cause pleural effusion there is always an underlying condition that incites the change in fluid levels.

There are broadly two main types of fluid retention that contribute to pleural effusion and you can have one or both causes at the same time. These are caused by either Transudates or Exudates and work as follows;

Transudates describes fluids that have migrated from other parts of the body usually due to unusual hydrostatic or oncotic pressures. They may even result from misguided catheters or nasogastric feeding tubes. Some medical conditions that can lead to transudates include;

  • Atelectasis
  • Cirrhosis
  • Congestive Heart Failure
  • Peritoneal dialysis

Exudates describe fluids that have been produced by a process of inflammation. Not only will excess fluids be drawn to the area, tissue permeability will be altered and lymphatic drainage is impaired. Some conditions that can lead to exudates building up in the pleural space include;

  • Pulmonary Embolism
  • Some types of cancer
  • Tuberculosis
  • Physical trauma

What are the symptoms of Pleural Effusion?

Pleural Effusion has several symptoms but can be easily mistaken for other conditions, including the underlying condition that has caused the effusion to begin with. Some of the most common symptoms of pleural effusion include;

  • Sharp chest pain that is worse with deep breaths due to inflamed pleural surfaces rubbing together.
  • Laboured breathing due to the impairment of lung volume and mechanical lung movement.
  • Dry coughing from lung irritation.
  • Diminished chest expansion on the side of the effusion with deep breaths.
  • With a stethoscope breath sounds may sound louder due to resonance with the fluid, you may also hear the rubbing of the pleural layers.

The variety and severity of symptoms experienced will vary with the size of each pleural effusion. Many smaller effusions will have no obvious outward signs and may only be detected whilst investigating other conditions. These may quickly resolve when the underlying condition is addressed.

How is Pleural Effusion Diagnosed?

A doctor can confirm a diagnosis of pleural effusion following a detailed investigation of your symptoms, medical history and using specific tests to rule out other possible conditions. If you suspect you have a pleural effusion you should seek an assessment with your doctor. Once diagnosed we can assess your current level of lung function and target treatments accordingly.

For more information on how physiotherapy can help treat Pleural Effusion, or to book yourself an assessment, please contact us via email at or ring us on 0330 088 7800.

What would a physiotherapy assessment for Pleural Effusion involve?

At, we want to gain as much information as possible about your condition to ensure we give you the best treatment. In your first appointment with us, our physiotherapists will carry out an assessment which has two parts:


A discussion between you and our physiotherapist to find out what symptoms you are experiencing, and how your condition is affecting you and your lifestyle.


An assessment to discern the presence of any pain, your current breathing pattern, respiration rate, lung volume and a series of special tests to identify the presence of any mucus retention and lung function impairment.

There can be great variation in the symptoms displayed, depending on the progression of the condition and any complicating factors. The assessment process will be important in identifying your current symptoms and needs, so that treatments can be targeted and effective.

What would physiotherapy treatment for Pleural Effusion involve?

The principle treatment approach with pleural effusion is to treat the underlying cause, which is usually more serious and will prevent further effusion. If the cause is not yet known and the fluid retention severe then a doctor can arrange to have it drained.

Treatment of your underlying condition and fluid drainage through a chest tube will be your primary sources of treatment for pleural effusion. Physiotherapy has an important role in stabilising and controlling your breathing, aiding in chest fluid drainage and clearing chest secretions. People whom receive respiratory physiotherapy as part of their treatment will tend to achieve a quicker recovery with fewer complications. Some of treatment techniques physiotherapy provides include;

  • Secretion clearance:
    • Effective / productive coughing techniques.
    • Postural drainage in sitting and lying.
    • Manual assistance, including percussion, vibrations and shaking.
  • Breathing technique retraining:
    • Controlling respiratory rate
    • Diaphragmatic breathing
    • Controlling / reducing breath volume
    • Relaxation breathing exercises
  • Education and Advice:
    • Illness cause and progression.
    • Effects of environmental and allergen factors.
    • Medication management

At you will experience personalised treatment sessions. Each appointment will be aimed at returning to your everyday activities and what you enjoy.

How can I arrange a physiotherapy assessment for Pleural Effusion?

If you have been diagnosed by your doctor as having Pleural Effusion and are suffering from symptoms affecting your breathing and lung clearance, you would benefit from an assessment with one of our experienced respiratory physiotherapists.

You can contact us directly to arrange an assessment and we can advise you if further treatment is recommended, and give you advice on self-management techniques if appropriate. To arrange an appointment please email or call 0330 088 7800.


At, our respiratory physiotherapists can provide specialist assessment and treatment for people with Pleural Effusion. We can apply a range of therapy techniques and advice to manage your symptoms and maintain the best possible level of lung function and comfort. We can also advise on activity modification to make daily living easier. Along with advice for you and your family on appropriate self-management techniques to maximise your functional ability between therapy sessions.

For more information on how physiotherapy can help treat Pleural Effusion, or to book yourself an assessment, please contact us via email at or ring us on 0330 088 7800.

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