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.

  • Mike Bogucci

    Hello…mild upper chest pain when i took deep breaths started around mid day. Nine hours later, pretty constant pain, hurts to breathe deep and very uncomfortable to lie down. ???

    • James Hubbard, MD, MPH

      Sorry, but I can’t diagnose individually without an exam. I suggest you see your doctor.

      • Mike Bogucci

        Thanks for the reply. Apparently it was inflammation of the sac around the heart…..(?). I should have just ignored it!

  • Dave

    Hi Doc,

    One night when I was sitting in front of my computer, I started getting upper-center chest pains (the type that’s hard to pin point and hard to describe: not really tightness or squeezing, but not sharp either – somewhere in between rather). After 2 days, I still have it, but it’s much better now and I hardly feel it.

    Anyways, this pain worsens when I take a deep breath – I don’t normally feel it with just a normal breath. I read online that this means it’s not heart related, but how true is this? Also on the first day, the pain was constant, just made worse by breathing in. Now, I only feel the pain with deep breaths. It seems the pain is also relieved if I lie down on the right side.

    From what I’ve read online it doesn’t sound like a heart issue, but I’ve had chest pains from exercising before and I’m kinda worried.

  • amanda

    I’ve been having this issues for days I went to the walk in clinic and then couldn’t find what was wrong it hurts do bad

  • Jen

    Its been painful to breathe for the past 3 days but will hurt more when I take deep breaths. Today is going on the 4th. I will feel pain through my back here and there. I was thinking about waiting for a week to see if the pain will go away to seek medical attention, what can it be…?

    • James Hubbard, MD, MPH

      Muscle pain, bone pain, lung pain, take your pick. You can generally suspect bone or muscle if pressing on an area brings on the same pain you’re feeling.

  • Elizabeth Calvert

    I have been hurting for two days now and it’s my right side on my back and it also hurts when I breath . Every time I breath it hurts . Can anyone tell me what can I do to calm this down .

    • James Hubbard, MD, MPH

      Sorry, I’ve been out of town. If it’s a muscle a little heat and ibuprofen or acetaminophen might help. But if has continued, you should have it checked.

  • elizabeth

    Hi. I’ve been having chest pain but it’s not regular like right now as I’m typing I have the pain like a burning & pressure on my chest and I also feel some pain on my right arm between my chest and shoulder. Should I worry? :/

    • James Hubbard, MD, MPH

      Sounds like you should have it checked. If you’re an adult, consider going to an urgent care today. If you’re in your 50s or more, or the pain is severe, and if it has only been going a day or two, consider going to the ER.

      • elizabeth

        I’m only 25 :/ but there are days that I feel fine and all of a sudden it hurts when I take a deep breath.

  • hankee

    hi doc. I’m in 21,a male smoker.I’m having slight pain in my left chest region, like just below sternum and behind lower left ribs. it only pains while deep inspiration. when I’m too full from eating it often happens that, what is the cause ? for that.

    • James Hubbard, MD, MPH

      Sorry, but I couldn’t say for sure. Pleurisy? Costochondritis. And please, please stop smoking. If you don’t you’ll so regret it in a few years. Guaranteed.

  • Sivapriya

    What about bronchitis? I experience painful breathing with bronchitis. Depending on the severity, it can feel like my lungs are burning or sharp pains when I breathe and more. The burning sensation can be felt both in the chest and in the back. I really hoped the Dr would give me an albuterol inhaler, since in the past I would use primatene mist (which is no longer available) and it always helped me to heal quicker and I’ve used the albuterol before with the same results. She gave me antibiotics and some cough suppressant. The cough suppressant doesn’t work, An hour later, I’m still hacking up a lung. ugh It’s been weeks now and my lungs still burn sometimes.

  • 5yoyo5

    Can you please help me I am a 12 year old girl, and this happens to me all the time!! I don’t understand what’s happening to me, and it is scaring me so much! It hurts on my right side, and I have to take little bitty breaths until it goes away. Please help me!!

    • annoyingpink$(pinkinpants)

      when people grow that happens silly its normal, just rest

    • James Hubbard, MD, MPH

      you should tell your parents. Maybe they can tell you what it is and what to do or see if you need to have it checked out by a doctor.

  • William Braddock

    I have had a plumary emboli before but did not have chest pain at all, i have a severe injury to my calf 9 months ago, still healing from it. The pain has stopped after i tool some anti-inflameatories. Should I be overly concerned or go to ER