Causes of Chest Pain—Pulmonary Problems

Asthma, Bronchitis, Pneumonia, Pleuritis

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Among the many non-cardiac problems that can produce chest pain are a variety of disorders associated with the lungs. Several pulmonary problems can produce—in addition to other symptoms—significant chest pain. These include disorders of the airways such as asthma or bronchitis, infection or inflammation of the lungs themselves (pneumonia), or inflammation of the lining of the lungs (which is called pleuritis or pleurisy).

Fortunately, when chest pain is the result of a pulmonary condition, there are various ways a physician can explore its causes, which may lead to diagnosis and treatment. This kind of chest pain is not easily confused with chest pain due to angina or a myocardial infarction.

It is worth keeping in mind that the heart is not the only critical organ in the chest. Any of these pulmonary conditions are serious medical problems that need a doctor’s attention.

Chest Discomfort From Asthma

Asthma is a chronic disease in which the airways periodically become inflamed or irritated, causing the muscles of the airways to constrict and leading to airway obstruction. “Attacks” of asthma can be triggered by exposure to airborne irritants, exposure to cold air, to exercise — or often, to nothing in particular that can be identified. During an attack, the airways become narrowed, and it becomes difficult to expel air from the lungs. In addition to severe shortness of breath, wheezing, and cough, the asthma sufferer may experience significant chest tightness or chest pain.

This asthma-induced chest tightness is caused by the excessive muscular effort that is needed to expel air through the constricted airways, which may lead to muscle fatigue and strain. Just as with any other skeletal muscles, the chest muscles hurt when they are overused. Doctors can usually diagnose asthma quickly by taking a medical history, doing a physical exam, and doing a spirometry test, which is an easy, painless way to assess your lung function.

Once the episode of asthma is adequately treated, the chest tightness goes away—though there may remain some residual soreness for a day or two.

Asthma is not only distressing, it can be dangerous. It is important for anyone with chronic asthma to be on adequate therapy, and for anyone with an acute asthma attack to get treatment right away. Those with asthma should also receive regular medical check-ups, preferably with a pulmonologist, and be aware of what their triggers are (which may include pets, dust, cockroaches, and pollen).

Chest Discomfort From Bronchitis

Like asthma, bronchitis is also a condition characterized by obstruction of the airways, although with bronchitis the obstruction is due to inflammation and swelling of the lining of the airways and an accumulation of mucus, rather than to muscular constriction.

Bronchitis may be an acute condition (most often associated with an infection), or it may be chronic—a form of chronic obstructive pulmonary disease.

Because it is also a disorder of airway obstruction, the chest discomfort associated with bronchitis is very similar to that caused by asthma.

Chest Pain From Pneumonia

Pneumonia, an inflammation of the lung tissue itself, is usually caused by a bacterial or viral infection. Pneumonia can also produce chest pain. The pain is usually caused either by muscle strain from excessive coughing or by an associated inflammation of the lining of the lungs (pleurisy).

Chest Pain From Pleurisy

Pleurisy (or pleuritis) is an inflammation of the lining of the lungs. It can be caused by a number of conditions, including a viral or bacterial infection; autoimmune disorders such as lupus or rheumatoid arthritis; medications including procainamide, hydrazine, and isoniazid; pneumothorax; chest surgery; pulmonary embolus, and cancer.

The pain caused by pleurisy is usually quite characteristic. Because the lining of the lungs is irritated, anything that stretches the lung lining causes pain. That “anything” includes breathing.

So “pleuritic pain” is chest pain that is caused by taking a breath, coughing, or moving the chest. The pain may be localized to one area of the chest (or shoulder), or it may be generalized.

Pleuritic pain is sometimes quite similar to the pain of pericarditis, and indeed with autoimmune diseases (including Dressler’s syndrome), people can develop both pericarditis and pleurisy (a condition called pleuropericarditis).

Once the pleuritic inflammation is adequately treated, the pleuritic pain resolves.

Chest Pain From Pneumothorax

A pneumothorax is a collection of air in the pleural space — the space between the lungs and the chest wall. Because of this accumulation of air, the lung on the affected side partially collapses, and breathing difficulties ensue. 

Pneumothorax is often caused by trauma to the chest wall, but it can also occur with emphysema, lung tumors, and cystic fibrosis. It can also occur spontaneously, without any apparent underlying cause.

In addition to dyspnea, pneumothorax also commonly produces chest pain. The pain associated with this condition is typically sudden in onset, localized to one side of the chest (the side with the air collection), and usually quite sharp and stabbing in quality. A chest x-ray will reveal the problem.

A small pneumothorax will often resolve on its own, but if breathing difficulties are severe, the air pocket can be treated by inserting a needle and withdrawing the air collection into a syringe.

A Word From Verywell

A number of lung-related problems can produce chest pain or chest discomfort, and may initially be confused with a heart problem. However, the chest pain or discomfort caused by pulmonary problems is generally characteristic enough not to be confused by doctors with the pain of a heart attack. 

However, any episode of chest pain is a potential problem, and is significant enough that it is always important to have it evaluated by a physician. While it may not always be necessary to head to an emergency room, be sure to at least call your doctor's office. Your physician can take a careful history and determine the pain's cause and potential severity, whether over the phone or in an office visit, which may have importance implications for your treatment and next steps.

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Article Sources
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  1. Smith HR, Irvin CG, Cherniack RM. The utility of spirometry in the diagnosis of reversible airways obstruction. Chest 1992; 101:1577. DOI:10.1378/chest.101.6.1577

  2. Sahn SA, Heffner JE. Spontaneous pneumothorax. N Engl J Med 2000; 342:868. DOI:10.1056/NEJM200003233421207

Additional Reading
  • Bösner S, Becker A, Haasenritter J, et al. Chest Pain In Primary Care: Epidemiology And Pre-Work-Up Probabilities. Eur J Gen Pract 2009; 15:141.
  • Global Strategy For The Diagnosis, Management, And Prevention Of Chronic Obstructive Pulmonary Disease: Revised 2011. Global Initiative for Chronic Obstructive Lung Disease (GOLD).
  • National Asthma Education and Prevention Program: Expert Panel Report Iii: Guidelines for the Diagnosis and Management of Asthma. Bethesda, MD: National Heart, Lung, and Blood Institute, 2007. (NIH publication no. 08-4051)
  • Verdon F, Herzig L, Burnand B, et al. Chest Pain In Daily Practice: Occurrence, Causes And Management. Swiss Med Wkly 2008; 138:340.