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.

  • Brittany Blake

    I have asthma and its been hurting me to breath all morning. Not like a asthma attack but it hurts my chest and when I breath at all. I don’t want to go to the ER bc it could be nothing any ideas?

    • James Hubbard, MD, MPH

      There’s no way I could tell without listening to your lungs. I assume you’ve tried your rescue inhaler. Perhaps you could call your regular doctor’s office or go to an urgent care clinic. Sounds like, minimum, someone needs to listen to your lungs.

  • alyssa

    I don’t know if it’s anything to go to the doctor for but it’s worth a shot getting your input on what has been going on with me. Whenever I take a deep breathe it hurts alot n i’ve Been having it for over a week now. I also had body aches n neck pains really bad to the point where I feel weak. It also hurts when I bend over just a little, like I feel pressure to breathe right at the the bottom of my throat.

    • Kristina

      Did you go to the doctor? This same thing is happening to me

    • James Hubbard, MD, MPH

      Since it’s apparently worrying you and not getting better, I’d go.

  • Dorothy MacMenamin

    I have COPD and am using Advair and Spiriva, This morning I have a pain on my right side of my chest going thru to my back at shoulder blade level. I am on two Pain medications – Endocett – 2 every six hours and Hydromorph 1 – twice daily for severe pain in my legs after having both knees replaced. I took my meds at 9 am and the pain is going away . I am also on anti- biotic for a UTI, Should I worry about his pain?

    • James Hubbard, MD, MPH

      Perhaps check with your doctor, nurse hotline or go to an urgent care.

  • joe rubin

    I have difficulty in breathing its painful when i overdo it and i feel that its connected to my throat. NO COUGH NO BLOOD. WAT IS IT THAT IM FEELING

    • James Hubbard, MD, MPH

      If it’s bothering you a lot, have a doctor check it.

  • norman

    with each deep breath I have a slight pressure in my chest and deep throat and it also hurts with exhale, I am in highschool and scared, it just started an hour ago

    • James Hubbard, MD, MPH

      Have a school nurse check you out.

  • jasmine

    Ugh im gonna see a doctor but everytime i breathe sometimes it hurts in the right side like below my boob . I can take a deep breathe but that pain feelin is there and it’s not so easy to breathe in deeply like usual.

  • Arsinoe

    I have a problem with my breathing. I got it from my father and when i breathe smells like cologne(especially cologne),perfume, or even some kinds of food, i cant breathe from my nose. I will make an operation to fix this but i don’t know if the pain in my lungs is part of this problem, but usually, when i get extremely tired, or even for no reason, i feel pain when i inhale,and because i kind of panic a little bit, i breathe from my mouth which makes me feel dizzy and i think that i’m gonna faint, and i can’t calm down easily except if my best friend tries to calm me down.I don’t know how he can calm me down but it’s kind of hard. I think this is different from my problem with my nose,because I can only breathe from my mouth when i smell something and i can’t breathe. I kind of feel like someone is punching me hard on my chest, but not hitting my rib cage,only my lungs. I searched on the internet for any sickness with my symptoms, and i kind of paniced when i realised that i have 3 out of 6-7 symptoms of lung cancer….tomorrow i’m going with my father at my doctor to check me and i hope for the best.

    • James Hubbard, MD, MPH

      I wish you the best, Arsinoe.

  • For the past 2 weeks it’s been slightly painful to inhale and exhale…. It feels my throat is closed but it becomes more painful at night or when the light is off. It still hurts during the day but less than at night.

    • James Hubbard, MD, MPH

      There are so many possibilities I couldn’t begin to give you an answer without an exam. As far as the symptoms worse at night, that’s pretty common with any problems. Sometimes it can be significant to the diagnosis but, often, it’s because your not as distracted with other things and you become more focused on the pain, itching, whatever.

  • [email protected]

    My husband has severe stage 4 copd, he was a smoker and is 75 yrs old. He is on full time oxygen set on level 3. He stays in bed all day except to get on his walker and come to eat. He also has severe pain in his back, making walking painful and he gets so out of breath. His VA doctor says he is depressed and has put him on depression pills, which hasn’t helped. His muscles in his legs are getting weaker and weaker. I can’t tell if he is depressed as he is easy to get along with. Do you think he needs to be on these pills, because he is on so much medication already?

  • Rachel

    I seem to have chest pain often. Right now I have chest pain when I breathe in, sometimes when I breathe in it hurts around my my sides but it only last for a second. But it is a sharp pain and its been happening in the last week or so. Now my chest just hurst sometimes when I breathe in, sometimes when I just sit and the pain keeps going in and out. It is not constant. I’ve been to the cardiologist and I recently went to my doctor about chest pain. I’m 26 yo and I keep having these problems. I’ve been to the ER before and they can never seem to find anything. They have done EKGs, chest x rays and I have been ‘diagnosed’ with different things such as angina and pleurisy, but these have been at the hospital and I didn’t have doctors at the time to follow up with. Now I am stuck with going to the hospital again or making an appointment to see my doctor in a couple days. My recent doctor said after looking at blood test and all the heart test that I did at the cardiologist (the did an echocardiogram and a stress test) that there was nothing wrong with my heart. Thank God for that, but I am still left with the pain. I’ve also taken antacids but it doesn’t do much. The pains seems to get worst when I get into these episodes. I used to get a feeling like my chest was hollow but it felt like there was pressure on it and now I feel sharp pains. I’m not sure what to do. I took two aspirins. I’m hoping it goes away before I need to go to work tomorrow. Sorry for the long post.

    • James Hubbard, MD, MPH

      There’s no way I can tell you for sure. Has anyone suggest it may be anxiety? Most pain that last for only a second or two is usually nothing really to worry about medically. If I were you I’d try to find a good family doctor, have her/him review all the notes and suggest where to go from here.

      • Rachel

        Yes, I have heard anxiety before but I thought the pain hurt too much to be just that. I have severe anxiety and it got worst in college. I’ve also dealt with depression for years and I think this is a big part of it. I guess the two are linked anyway. I prefer not to take medication for this though. I’ll keep praying my way through. Thanks for responding so quickly and for your sound advice. You’ve been a big help. God bless.