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.

  • 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?

    • 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.

  • Guera Hortelano

    Hi doctor, my name is angel, its hard for me to breathe, every breathe I take seems to b harder n harder… I ha e liver promblems. Can this be effecting me?…

    • James Hubbard, MD, MPH

      It could be from liver problems, or a lot of other things. The main thing is you need to be checked thoroughly to find the cause and treat it. If it’s getting harder to breathe today, you should be checked out today.

      • Guera Hortelano

        Thank you…

        • James Hubbard, MD, MPH

          You’re welcome

  • Tomika Maxwell

    This article saved my life reading the Pulmonary Emboli section. I immediately jumped out if bed and went to the ER and told them what I read, they performed test and it was exactly blood clots. Grateful for this article.

    • James Hubbard, MD, MPH

      Wow, Tomika. Thanks for sharing that. And I’m glad you’re ok

  • 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.