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.

  • 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.

    • http://thesurvivaldoctor.com/ 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.

    • http://thesurvivaldoctor.com/ 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.

    • http://thesurvivaldoctor.com/ 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.

  • Sydney

    Hello,
    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?

    • http://thesurvivaldoctor.com/ 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?

    • http://thesurvivaldoctor.com/ 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?

        • http://thesurvivaldoctor.com/ 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?

    • http://thesurvivaldoctor.com/ 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?

    • http://thesurvivaldoctor.com/ 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.