Boswellia

Boswellia (Indian frankincense, Boswellia serrata) has well-documented anti-inflammatory actions (notably via boswellic acids such as AKBA inhibiting 5-lipoxygenase / leukotriene pathways) and clinical evidence in inflammatory/respiratory conditions (asthma) and inflammatory bowel/joint disease — but there are no high-quality clinical trials showing Boswellia as a proven treatment for pleurisy specifically. That means it may be biologically plausible to help pleurisy (an inflammatory condition of the pleura), but it must not replace standard medical evaluation and treatment (eg antibiotics, drainage, steroids, NSAIDs) when indicated.

Pleurisy is inflammation of the pleural layers (usually from infection, autoimmune disease, PE, malignancy etc.) and is treated mainly by treating the cause and reducing inflammation/pain (NSAIDs, sometimes corticosteroids). Mayo Clinic

Boswellia’s active constituents (boswellic acids, especially AKBA / acetyl-11-keto-β-boswellic acid) inhibit enzymes involved in leukotriene production (notably 5-lipoxygenase) and reduce inflammatory mediators in vitro and in vivo — a mechanism directly relevant to inflammatory lung conditions where leukotrienes and inflammatory cells play a role. This is the primary pharmacologic rationale for using Boswellia where inflammation and leukotriene pathways are important. ScienceDirect

Animal / in-vitro and human evidence shows Boswellia reduces airway inflammation and improves symptoms in some respiratory inflammatory diseases (eg asthma); that respiratory anti-inflammatory activity makes it biologically plausible it could reduce pleural inflammation, but plausibility ≠ proven effectiveness for pleurisy. Alternative Medicine Review

Important: these are protocols used in trials for inflammatory conditions (osteoarthritis, asthma, ulcerative colitis) — there are no standard, evidence-based dosing guidelines for pleurisy. If you are considering Boswellia as an adjunct, tell your treating clinician first.

• Typical trial doses (oral extracts): many clinical trials used ~300–350 mg of a standardized Boswellia extract taken three times daily (i.e. ~900–1,050 mg/day) or similar regimens (some supplements use 100–500 mg two-three times daily). Trials in asthma and ulcerative colitis commonly used 300–350 mg TID for ~4–6 weeks. Use of a standardized extract (with measured boswellic acid / AKBA content) is important — raw resin or unspecified supplements vary in potency. Alternative Medicine Review
• Formulations: look for standardized Boswellia serrata extracts with specified boswellic acid/AKBA content; some commercial extracts (eg 5-Loxin®, Aflapin®, others) enrich AKBA. Clinical trials often used these standardized extracts. BioMed Central
• How to take: oral capsules/tablets with food (improves absorption and reduces GI upset) are typical. Follow manufacturer instructions and the dose used in any supporting clinical trial for the same condition if applicable. Health Jade
• Duration used in studies: most short-term trials ran 4–6 weeks (some longer for chronic conditions). Clinical response, safety and interaction monitoring should guide continuing use. Alternative Medicine Review

Crucial clinical caveat for pleurisy: pleurisy can be caused by infection (bacterial, TB), malignancy, pulmonary embolus, autoimmune disease, etc. If the pleurisy cause is infectious or requires drainage, Boswellia alone is inadequate — you need standard care (antibiotics, thoracentesis, chest tube, targeted therapy). See clinical guidance for pleurisy management. Mayo Clinic

Mechanistic / pharmacology

• Early mechanistic paper showing AKBA inhibition of 5-lipoxygenase (key inflammatory/leukotriene enzyme). ScienceDirect

Systematic reviews / scoping overviews

• A systematic/scoping review of Boswellia in vitro, in vivo and clinical research (large capture of studies across many conditions). This is useful to see where clinical evidence exists and where gaps are (no large trials for pleural disease reported). ORCA
• BMJ systematic review of Boswellia serrata clinical trials (evaluates RCTs across conditions). Good for summarizing trial quality and which conditions have trial support. BMJ

Clinical trials showing benefit in related conditions

• Asthma: double-blind, placebo-controlled clinical study (Gupta et al., European Journal of Medical Research, 1998) — ~300 mg TID for 6 weeks; ~70% of treated patients showed clinical improvement versus ~27% placebo in that small trial. (This is an older small RCT — encouraging but limited.) Sciepub
• Ulcerative colitis / IBD: randomized trial comparing Boswellia (350 mg TID) vs sulfasalazine showed comparable remission rates in a small trial (1990s). This supports anti-inflammatory activity in mucosal inflammation. Alternative Medicine Review
• Osteoarthritis / musculoskeletal inflammation: randomized trials of standardized extracts (for example 5-Loxin® enriched in AKBA) showed benefit for pain/function vs placebo in knee OA. These are often cited as the strongest, higher-quality RCTs for Boswellia in humans. BioMed Central

What these mean for pleurisy: the assembled evidence shows Boswellia can reduce inflammatory mediators and has produced clinical benefit in some inflammatory diseases including asthma (airway inflammation) — which makes it plausible as an adjunctive anti-inflammatory for pleural inflammation.