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.

  • KatSoph

    I’m 12 and I’ve been getting pain by my lungs but it’s like every time I breath in a deep breath it feels like something is poking me. Idk if it’s a broken rib or something else but I told my parents and they don’t know what it is and they’re gonna take me to the doctor soon but I have to stay still until it goes away. My friend kinda had the same thing but she got checked and it was just a growing rib? Could this be the same thing? I’m so worried about it.

  • Sophfifi

    That happens to me to

  • alex

    is walking in cold weather a cause for mild pain in the chest when breathing deeply, hours after?

    • James Hubbard, MD, MPH

      Cold dry whether can make the lungs burn sometimes but it should go away pretty quickly.

  • Kate

    Having back pain in upper left back below shoulder. The pain has been persistent and worsening since 12/28/15. Now I have persistent pain and a VERY sharp pain when I breath and can barely take a breath while lying on my back. IS THIS ER WORTHY or should I wait until my family physician can see me next Tuesday?

    • James Hubbard, MD, MPH

      Sorry but I’ve been traveling. How are you doing?

  • Kate


  • Miku

    Its been hurting for some time now. But it is slowly getting better. But my leg also hurts for some unknown reason. What should i do doc?

    • James Hubbard, MD, MPH

      see a doctor.

      • Miku

        Even if it stopped hurting?

  • robert

    hi doc , ive been on steroids for 3 weeks with acute bronchitis,i had a very bad cougth and was wheezy,using my inhalers for asthma also,now i have terrible heaviness pain on my chest at right hand side and also when lift my right arm up have dull pain any suggestions ive been using hot albass oil to help and having hot baths but still pain is there.

    • robert

      sorry doc meant to say im 53 years old and am waiting for xray results for my chest problems,do you think this pain is muscular due to my coughing

      • James Hubbard, MD, MPH

        There’s no way I could tell you but clues that it might be muscular pain are pain with movements and tenderness to touch over the area of pain.

        • robert

          thanks doc for your reply,will see my doc wed thanks again for your speedy reply appreciated.

  • 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