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.

  • Sydney

    I broke and fractured a few ribs when I was younger and then tore my rib cage about 5 years ago. Since then I feel I’ve torn it again doing yoga. I used to be a smoker, but am no longer and ever since I tore my rib cage I have a stinging pain when I breathe at random. It usually doesn’t last very long, but since becoming pregnant and quitting smoking it has been more frequent. Any ideas on what it could be?

  • Trevor Ristino

    Does this happen to people at least once in their life cause I’m 14 and today while I was outside playing hockey and when my body got cold I noticed that it kinda hurts when I breathed in?

    • James Hubbard, MD, MPH

      Trevor, I don’t think it happens to everyone, but it is common.

      • Trevor Ristino

        Thanks the feeling gone away my doctor said it’s just that I was getting sick

  • Elly Ayon

    The right side, (under my chest) hurts when I breathe . It got to the point where I didn’t want to get up . It went away but it’s back . Is this serious?

    • James Hubbard, MD, MPH

      It should be checked out as soon as you can. There are multiple reasons for such pain, some serious and some not.

      • Elly Ayon

        Is It Okay To Run With It Or Workout?

        • James Hubbard, MD, MPH

          Not until you determine the cause.

  • Faith

    Hi Dr, I have a concern that isn’t listed. I have lung pain sometimes when I inhale, but I know what caused it. I just don’t know if it’s serious.
    I got sick when I was 15 for a long time (almost a whole year) and by the time I recovered, the doctor told me that my lung capacity was lower than normal for my age. He said that I could eventually rebuild my lung capacity by doing exercises. That was 5 years ago. Now I’m living in Europe in the mountains and I’ve been adjusting to the new elevation. I find myself getting short of breath easily and I’m tired of it. A few days ago I got the bright idea that I should “stretch” my lungs. Bad idea. I inhaled as deeply as I could and then some. It seemed harmless at the time – it felt fine. I later learned that it’s something divers do called “lung packing”. Anyway, I didn’t think it was a big deal, but I’ve been having pain on and off for a few days when I inhale. Is this serious or will it go away on its own?

    • James Hubbard, MD, MPH

      As I’m sure you know, altitude alone can make you short of breath. At any rate, it sounds like it’s time for a good medical checkup. To check your oxygen level, blood count, lungs, possible xray, and pulmonary function tests (lung capacity) to make sure nothing needs to be treated.

  • michael pendley

    ive been having chest pains, it hurts when I breathe in….like someones squeezing my heart with every breath, or when I breathe to the left of my heart it hurts really bad when I breathe in, any idea what could be the possible reason why?

    • James Hubbard, MD, MPH

      There are many reasons. Sounds like you should have it checked out.

  • Sean

    The pain that most of you are feeling probably derives from PCD. A non-lethal cramping or compression of tissue near your sternum and or lower rib cage. This compression usually manifests itself as a cramping, sharp pain that occurs when inhaling, but has also been recorded while exhaling. Symptoms and duration vary from patient to patient so accurate times cannot be listed. There is no cure, however drinking water, holding your breath and stretching your chest muscles are ways to decrease pain, but will not work for all. If you are a child or delinquent, it is more common than you would think to have this. For the rest of you, since there is no cure, you are likely stuck with it. Origins of PCS are unknown but many lean towards genetic or natural causes. I hope this helps.

  • sóuqi

    Im a male in my mid twenties , ive been smoking cigarrets/cannabis for a long time but i cut off smoking cigarrets for around 4 months from 1+ pack a day to no more than 5 cigarrets a day and continued smoking cannabis , 2 days ago i smoked a few cigarrets and since then my left lung hurts but it kinda feels like its more concentrated in the middle of my left lung , it hurts when i take a deep breath and i cough a few times , i live in denmark and the tempreture dropped to 4°c from 12°c in around a week , could this be because of the weather or do i need serious help?

    • James Hubbard, MD, MPH

      Sounds like you should have it checked out.

  • Jc38295

    I’m a person in my teens and I have had for the past three days the flu, and just in the middle of the night my left lung developed a sharp pain as I breathed in deeply and even when I move to turn to my side. I’m not sure if I need to go to the hospital but I’m alittle worried. Any thoughts?

    • James Hubbard, MD, MPH

      Check with your parents first, then consider calling your family doctor.

  • Stacey

    My husband is 64 years old. Life long smoker but never had chronic cough or shortness of breath. He developed more of a “smoker’s cough” over the last 3 months and tried to cut back/quit smoking but still is about 1/3 a pack a day. The last 4 weeks he has had daily Pain in his lungs (he says lung pain/chest pain) when he breathes deep and it is worse at night but no difference if sitting up or lying down. The pain is with any deep breath. He is thin, active, and has no swelling in legs/body, no fever, no cold/flu symptoms but the physicians want to treat (symptomatic) as pneumonia without a very thorough exam (I work at the hospital and know that physicians are hesitent to jump to a chest CT without treating conservatively first) especially without shortness-of-breath, low O2 sats, or MI symptoms but with his history doesn’t this warrant a CT or chest X-ray?

    • James Hubbard, MD, MPH

      First, “the physicians” means his regular doctor who directly checked your husband out, then the doctor must have a good reason. Your husband should ask. If it means doctors you or he have just talked to, then your husband should have a direct formal exam. Actually, unless this some unusual circumstance, I always get an x-ray.

  • Luna Laflue

    I don’t understand what is happening, I am not having trouble breathing it just hurts my middle upper back when I do. I have no cough or fever, wth is wrong with me?

    • Guest

      Hey thank you so much, would it be ok for me to wait a couple of days to see if I have just strained my back? I don’t want to go into the doctor all afraid if it is just a back strain. Because I have no shortness of breath, no fever, no cough. Pain when I move my back a certain way and breath in too deep, that doesn’t sound like an embolism or anything, should I be ok to leave it for a few days and see how I get?

      • James Hubbard, MD, MPH

        Sorry. You have to make that decision.

    • James Hubbard, MD, MPH

      Luna, I can’t specifically diagnose. In general muscle pain in the back and chest can cause painful breathing like that. Often the area would be tender to touch. But, there are other more serious problems so, if you have worries, check with a health care provider.

      • Luna Laflue

        Hey thank you so much, would it be ok for me to wait a couple of days to see if I have just strained my back? I don’t want to go into the doctor all afraid if it is just a back strain. Because I have no shortness of breath, no fever, no cough. Pain when I move my back a certain way and breath in too deep, that doesn’t sound like an embolism or anything, should I be ok to leave it for a few days and see how I get? Thank you again, so much help.