Pleural disease encompasses a wide range of pathological processes, many of which are common and increasing in incidence. Patients with pleural disease are encountered by both respiratory specialists and general physicians, and a systematic approach to their management helps in targeting investigation and optimizing patient care. Research has led to recent advances in diagnostic strategies and therapeutic techniques in these patients. This review focuses on the clinical assessment, diagnosis and management of patients with pleural effusions, malignant pleural disease, pleural infection and pneumothorax, and provides practical suggestions regarding investigation and management.