Painful Breathing: 4 Causes

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This survival-medicine website provides general information, not individual advice. Most scenarios assume the victim cannot get expert medical help. Please see the disclaimer.

When Every Breath Hurts: What to Do

by James Hubbard, MD, MPH

Breathing is so natural, so automatic. The only time we notice it is if we’re not getting enough oxygen or it’s painful to breathe (or if you start thinking about it, like you are right now).

If breathing is painful, we start holding our breath or breathing less deeply, which makes us want to breathe even more. If this happens to you and you can’t get medical help, you’ll want to know how to stop this cycle.

There are some simple things that can help, but in the end, professional treatment may be the only thing that fixes it. Depending on the cause, you may need quick treatment for more than just painful breathing anyway.

What Causes Painful Breathing

In doctor language, painful breathing is called pleuritic chest pain. If the pain is caused by inflammation of the pleura (the lining of the lung and the lining of the inside of the chest wall), we call it pleurisy. That’s what this post is about—pleurisy.

Normally, every time we breathe, the moist, pleural surfaces glide against each together so smoothly we never even notice. But if something causes them to get inflamed, every breath feels like two sores rubbing against each other.

Now if you can’t get to a doctor and your breathing becomes painful, one thing you’re going to have to do, no matter the cause, is slow down your activity so you don’t have to breathe as hard. A second thing you can do is take an anti-inflammatory such as Advil (ibuprofen) or Aleve (naproxen), or maybe you’re already on one for arthritis.

With pneumonia, if an exam reveals decreased breath sounds in one of the lungs, you have a pneumothorax, or collapsed lung. Fluid—perhaps pus—has gotten into the pleural space.

After that, you’re going to have to go after the source—whatever’s causing the inflammation—such as:

1. Pneumonia. Bacterial and viral infections that cause pneumonia can sometimes cause painful breathing.

Symptoms: Cough, muscle aches, shortness of breath.

Signs: Fever. With a stethoscope or an ear to the chest you may hear rales like I describe in my pneumonia post. If fluid, such pus, gets in the pleural space, the breath sounds may be decreased on that side of the chest.

Treatment: Antibiotics as described in my pneumonia post.

2. Viruses. Even without pneumonia, a viral infection such as the flu, but also many others, can cause inflammation of the lining of the lungs and chest wall.

Symptoms: Muscle aches, sore throat, headaches, runny or stopped up nose, cough.

Signs: Fever. With a stethoscope or an ear on the chest, sometimes you can hear a “rub.” It sounds kind of like two pieces of leather rubbing against each other with each breath.

Treatment: Treat the symptoms, and beef up your immunity as best you can. (Fodder for a future post.)

3. Tuberculosis. Yes, it’s still around. Over ten thousand cases are reported each year in the U.S. Worldwide it’s in the millions.

Symptoms: Similar to pneumonia

Signs: Similar to pneumonia

Treatment: Here’s the big difference. TB has to be treated for several months with medications you’re not likely to have in your medical kit. So, unless you know it’s TB, all you can do is treat it as pneumonia. If it’s TB, it’s not going to get better, and probably will get worse until you get expert help.

4. Pulmonary emboli: Sometimes a blood clot in a leg vein can flick off a smaller piece that travels to the heart. The heart then pumps this small clot (called an embolus) into a lung blood vessel. The blood supply to this area of the lung is cut off. This can cause a chain reaction of dead lung tissue and swelling and is very dangerous.

Symptoms: Besides the painful breathing, you may become very short of breath.

Signs: If you have a sore, swollen calf this could be the source. But, sometimes, there is no warning. Blood clots are very hard to diagnose without specialized testing.

Treatment: Rest and transferring to a medical facility as quickly as possible.

Have you ever had pleurisy? What was the cause? How was it treated?

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Lung-anatomy illustration by Yori Kato on Flickr. Pneumothorax illustration by Petrus Adamus and released under CC BY-SA 3.0.

  • Dawn

    I was diagnosed with Legionnaires Disease last month. I have been home from the hospital for three weeks, off oxygen for almost two and have just developed unbearable pain in my back (where my lungs are) when I take a deep breath. It has caused me to go back on the oxygen. Could this pain be from pleurisy?

    • James Hubbard, MD, MPH

      Could be. You should definitely check with your doctor.

  • Michele Farnum

    K. Thanks for your advice. It is greatly appreciated.

  • Michele Farnum

    Wow, thanks for the fast response. I do have many kidney problems, CKD, etc. Do you think this could be related?

    • James Hubbard, MD, MPH

      If the kidney disease has caused you to develop any fluid on your lung, that could cause pleuritic pain. Otherwise, I don’t know, but you should ask the doctor treating for that.

  • Michele

    Looks like an old thread, but maybe someone’s still checking. I’ve been having problems with upper right chest pain, back only, when breathing for over three years. It started when I was pregnant with my fourth and final child. In the beginning, it was a “spot” in the upper right part of my back, and it bored through to the front. Seeing an OB at the time, he thought it was the baby pressing on something. Sure enough, after delivery it went away to almost nothing. But soon returned with a vengeance. Stayed status quot for a couple of years, so I just tried not to breathe deeply. Quit exercising, etc. Lately, last four or five months, the breathing pain has spiraled. Now, it EVERY breath, deep or not, hurts on both sides although the upper right “spot” is much worse. Almost three in the AM and still cannot sleep. I’m a 32 year old female, so I’ve not been to a doctor yet who thinks this is anything or takes me seriously.

    • James Hubbard, MD, MPH

      Michele, it could be muscle pain or lung pain. You should have both checked out. For the muscle pain, possibly see a physical medicine doctor (physiatrist) or a chiropractor.

  • Kasper

    Thanks this might help me not to feel pain while breathing

  • Stephanie Quinn

    my left side has been hurting for the past four hours every time i take a breath.This happens to me a lot, but will normally stop after a half hour at the longest. Is this normal? Why is it lasting so long this time?

  • Zach

    Hello doc. I’m having VERY sharp pain in my right side every time I take a breath in and extreme pain when I take a deep breath. Please, I know you can’t help me without seeing me, but do you have any ideas?? It doesn’t hurt to push on my side though. This is only happening on the right side of my body right under my ribs is how it feels.

    • James Hubbard, MD, MPH

      You should see a doctor for a checkup and possibly a chest x-ray.

  • Aaron

    in the case i dont have fever, i mean i just feel the pain while breathing, my doctor told me that is due to the temperature changes, i dont know but i am taking pills for the pain and for the inflamation, this is my 3rd day and feel much better , i have to tell you this is a pain in the ass,

    • James Hubbard, MD, MPH

      Glad your better.

  • Kara

    This use To Happenn To Me As A Child On Hot Days When I Was Doing A Lot Of Swimming I Nevet Knew What It was.

    • James Hubbard, MD, MPH

      Interesting, Kara.

  • Alex Freiburg

    How come fungal infection isn’t on this list? Also, can’t lung cancer be the cause of painful breathing?

    • James Hubbard, MD, MPH

      Alex, good possibilities. Thanks. Anything that irritates the lining can cause painful breathing. My list of 4 is nowhere close to inclusive. I mentioned a few of the most common ones that you might be able to differentiate when you can’t get to a doctor. Serious fungal infections are less common, they’d be really hard to try to diagnose in the field, and I doubt you’d have the antifungal medicine available outside a hospital (of course you could argue that about TB also). Lung cancer is going to need an X-ray, or more, to diagnose and is not treatable in the field. Another one I should have probably mentioned is a spontaneous pneumothorax–where a weak spot in your lung lining starts leaking out air into the pleural space.

      • Alex Freiburg

        Wow thanks for the rapid response! Maybe you can help me out. I’ve had pain in my chest for months now that comes and goes along with a dry cough. For the past TWO years I’ve had yellow post nasal drip so my primary doctor thinks the pain is caused by mucus that has drained into my lungs. I’ve been to a pulmonary specialist and she put me on Augmentin for the past month. Unfortunately, the pain has not subsided and seems to get worse when I get up and move around. It’s a sharp stabbing pain in the upper left side of my chest and very rarely on the right side of my chest as well. The specialist looked at my x-ray and saw nothing that looked serious. However, my primary doctor thought she may have seen what looked like enlarged blood vessels converging? I mentioned fungal infection because in December I smoked some cannabis that I thought may have been moldy. I’m starting to worry that this cough/pain will never go away and maybe it’s something scary like an embolism. Anything you can tell me would be greatly appreciated. I have no shortness of breath, fever, chills, or night sweats. Thanks.