An Overview of Barrel Chest

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Barrel chest is a generalized description of what you likely imagine—a rounded, bulging chest that is similar in shape to a barrel. While not technically a medical term, "barrel chest" is often used by doctors to describe a physical characteristic consistent with cases of late-stage emphysema, a disease under the umbrella of chronic obstructive pulmonary disease (COPD), in which the chest may become fixed in an outward position.

Symptoms

Barrel chest occurs when the lungs become chronically overinflated (hyperinflated) with air, forcing the rib cage to stay expanded for long periods of time.

Over time, the distention of the rib cage will not only affect the anterior (forward-facing) chest wall but the posterior (back-facing) wall as well. As muscle wasting develops (often seen in later-stage emphysema), the loss of external support will further promote the deformity.

Barrel chest itself is not usually painful but may serve as a sign of severe underlying lung disease or damage.

Symptoms may include

  • Difficulty breathing
  • Shortness of breath
  • Stiffness
  • Reduced oxygen saturation level
  • High levels of carbon dioxide in the bloodstream
  • Limited ability to exercise

Causes

Lung damage and lung disease are the typical causes of barrel chest in adults, but there are also genetic, atmospheric, and aging-related factors, too, many of which are not fully reversible. In children, barrel chest is usually a result of cystic fibrosis or severe asthma and may be somewhat reversible. Here are six possible causes, both typical and unusual:

Emphysema

Emphysema is one of the two diseases that comprise COPD. It is typically accompanied by chronic bronchitis, an inflammatory condition characterized by the narrowing of the airways and the excessive production of mucus.

Emphysema specifically refers to the destruction of the air sacs of the lung, called alveoli. These are the tiny organs at the end of the air passages through which oxygen is transferred to the blood and carbon dioxide is extracted.

With fewer and fewer alveoli available to facilitate gas exchange, the lungs have to work harder with deeper and longer inhalations. As the condition progresses, the lungs will tend to remain in a hyperinflated state, leaving the rib cage expanded.

With emphysema, the depth-to-width proportion of the chest will typically increase from 1:2 (normal size) to 1:1 (barrel chest). Moreover, as the posterior bulging progresses, the spine will be pushed back as the shoulders roll forward, creating a stooped posture.

Osteoarthritis

Osteoarthritis, also known as "wear-and-tear arthritis," typically affects the hands, neck, lower back, knees, and hips, and it can also cause progressive damage to the middle back and thorax.

The condition, referred to as thoracic arthritis, is caused by the degeneration of the cartilage and bone of the middle spine. As the joint bones start to compress and rub against each other, the ensuing inflammation can trigger the overproduction of bone tissue and the gradual malformation of the spine.

As muscle loss further weakens the external support, the rib cage can develop a splayed, barrel-like appearance that can eventually become permanent as the joint bones fuse. Low calcium levels can further accelerate the problem, causing deformity of the sternum and a condition known as dorsal kyphosis in which the back becomes rounded and hunched.

Cystic Fibrosis

Cystic fibrosis can often cause a barrel chest in children and younger adults affected by the disease. The inheritable genetic disorder triggers the overproduction of mucus, clogging the alveoli and restricting the amount of air entering the lungs.

Over time, the exertion needed to fill the lungs can cause air to become trapped, leaving the chest in a partially inflated position. As a chronic, irreversible condition, cystic fibrosis requires constant surveillance to help clear the lungs and prevent hyperinflation.

Severe Asthma

Severe asthma is a common cause of barrel chest in children. As opposed to cystic fibrosis in which the air passages become clogged, asthma causes the passages to constrict and narrow.

When asthma symptoms are severe, the passages are in a persistently narrowed state (in some cases, even after bronchodilators are used). As the air in the lungs becomes trapped and unable to escape, the child's chest can take on a barrel-like appearance (in part, because the cartilage of the rib cage is still so flexible).

Genetic Disorders

While some people are born with larger rib cages, there are rare genetic disorders for which barrel chests are characteristic.

One such example is Dyggve-Melchior-Clause (DMC) syndrome, a rare, progressive condition characterized by short stature, skeletal deformity, and microcephaly (an abnormally small head). So rare is DMC syndrome that only around 100 cases have been reported.

Sialidosis, also known as mucolipidosis type 2, is another rare disorder characterized by the abnormal accumulation of toxic substances in the body. Symptoms usually develop during infancy or later childhood and may include short stature, barrel chest, mild cognitive impairment, and cherry-red spots in the eyes.

Spondyloepiphyseal dysplasia tarda is a rare, hereditary disorder that only affects males. Symptoms tend to appear between the age of 6 and 10 and include short stature, spinal deformity, barrel chest, and premature osteoarthritis.

Any skeletal malformations resulting from these disorders are considered permanent.

Extreme Altitudes

Because the air is thinner in extremely high altitudes, the lungs have to work harder to maintain the exchange of oxygen and carbon dioxide. As such, people who live in areas higher than 16,500 feet (5,000 meters) will almost invariably have evidence of a barrel chest.

While there are only a handful of formal communities that meet this criterion—among them, La Rinconada in Peru (16,830 feet) and Tuiwa in Tibet (16,630 feet)—there are informal settlements that are situated ever higher.

While visiting high altitudes will not cause barrel chest, the thorax may appear larger as you expand the chest to take in deeper breaths.

Diagnosis

Barrel chest is a visible symptom, so your doctor should be able to visually evaluate your condition. They may also perform other specific tests to assess your lung function through pulmonary function tests such as spirometry, in addition to bloodwork such as a complete blood count and arterial blood gases.

Treatment

Because barrel chest is not a disease in itself, the underlying condition must be treated to prevent further progression. The main goal then becomes symptom management, with the aim of reducing the inflammation leading to inefficient breathing.

In the case of emphysema and osteoarthritis, the control of symptoms through diet and gentle exercise, medication and pulmonary rehabilitation may lessen the appearance of a barrel chest, but these therapies cannot erase it. As COPD is a progressive disease, any damage sustained by the lungs, rib cage, or sternum cannot be reversed.

Cystic fibrosis also affects lung development, due in part to the recurrent bouts of bacterial infection. As lung capacity decreases, the development of barrel chest is enhanced and is unable to be reversed. This is especially true in adults with cystic fibrosis, who have an average lifespan of around 37 years.

Barrel chest in children with severe asthma will generally reverse once the symptoms are brought under control. The greater concern is that, if left untreated, severe asthma may lead to impaired growth.

A Word From Verywell

Barrel chest may be caused by several different factors, but is ultimately a visual sign of something bigger going on underneath the surface. Barrel chest usually appears in the later stages of certain conditions like emphysema and osteoarthritis and should be taken as a warning of severe lung damage. While the condition itself is not usually reversible, work with your healthcare team to find ways to manage your symptoms and hopefully make breathing a little bit easier.

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