Causes of Pain With Deep Breathing

If you are having pain with breathing, whether normal breathing or when taking a deep breath, you’re likely feeling worried. Doctors describe the kind of pain that occurs with taking a deep breath as either pleuritic chest pain or pleurisy. The name is derived from the membranes lining the lungs known as pleura.

The term pleurisy is sometimes used to describe any sharp pain that occurs with a deep breath, but can also be used to describe inflammation of the pleura. Pleuritic pain may be triggered by any number of disorders, diseases, or injuries involving the lungs, pleura, or associated tissues or organs, including:

• Ligaments, muscles, and soft tissues of the chest
• The thoracic spine
• The heart and pericardium (lining of the heart)
• The esophagus
• The breast

Symptoms

There are a number of symptoms which may occur alongside with painful breathing, depending on the underlying cause, including:

• Coughing
• Shortness of breath
• Hoarseness
• Wheezing
• Pain spreading the back or shoulder
• Fever and/or body chills

Lung-Related Causes

While the lungs themselves do not have pain receptors, medical conditions involving the lungs can cause pain in several ways, including those that cause irritation of the pleura. Some of these include:

• Pneumonia is an infection in the lungs that may be bacterial, viral, or fungal.
• Viral infections can often cause pleuritic pain. These include the Coxsackie virus, respiratory syncytial virus (RSV), influenza, parainfluenza, the novel coronavirus (COVID-19), mumps, adenovirus, cytomegalovirus (CMV), and the Epstein Barr virus (EBV).
• Lung cancer is commonly accompanied by pleuritic pain. The most common type, lung adenocarcinoma, tends to grow in the periphery of the lung near the pleura and is most common in people who have never smoked, women, and young adults with lung cancer. Sometimes these cancers first cause symptoms when they extend to the pleura and cause pain.
• Pleural effusion is the accumulation of fluid between the layers of the pleura and may be caused by any number of diseases, including lung disease, heart disease, and autoimmune disorders (like rheumatoid arthritis). Malignant pleural effusions are pleural effusions containing cancer cells that are associated with lung cancer, breast cancer, and metastatic cancers that has spread to the lungs.
• Pneumothorax is a collapse of part or all of a lung which can trigger severe chest pain and shortness of breath. Pneumothorax is a common complication of emphysema and other lungs diseases.
• Pulmonary embolism is a potentially life-threatening condition in which a clot in a vein will break off and travel to the lungs. Risk factors for pulmonary embolism include recent surgery, heart disease, and deep vein thrombosis (DVT).
• Pulmonary infarction, also called lung infarction, occurs when a section of lung tissue dies because its blood supply has become blocked.
• Mesothelioma is a type of cancer that arises in the pleura and is most common in people who have been exposed to asbestos. Asbestos exposure can occur at work, or in people who remodel homes built before asbestos was banned for this use.
• Tuberculosis (TB) is a relatively uncommon cause of pleuritic pain in the United States but a very common cause worldwide. That said, it appears that tuberculosis is increasing in the United States, and anyone who has traveled should be tested if they are coping with lung pain.

Heart-Related Causes

Since the heart lies near the lungs (and pleura) and moves with respiration, heart conditions may cause pain with breathing. Some heart-related conditions which cause pleuritic chest pain include:

• Pericarditis is the inflammation of the membranes lining the heart (pericardium). Pericarditis has many causes including infections, cancer (most commonly lung cancer and breast cancer), autoimmune conditions such as lupus, and kidney disease.
• Myocardial infarction (heart attack) is caused by a blockage of blood flow to a portion of the heart muscle.
• Aortic dissection is a medical emergency in which a weakening in the aorta allows blood to spill into the inner lining of the aorta. It often causes a severe, tearing type of pain that may be felt in the chest and the back.
• Pulmonary hypertension is a serious condition in which the blood pressure in the pulmonary artery is elevated. Pulmonary hypertension can be caused by any number of conditions including heart disease, lung disease, connective tissue disorders, and even some medications.

Musculoskeletal Causes

Conditions involving any of the bony or soft tissue structures in the chest may cause pain which occurs or gets worse with breathing. Some of these include:

• Rib fractures often cause pain that develops gradually and worsens with a deep breath and with coughing.
• Costochondritis is the inflammation of the junction of the ribs, often evidenced pain while breathing and swelling around the sternum. Costochondritis is often mistaken for a heart attack.

Other Possible Causes

There are also causes that may not be initially obvious.

• Hemothorax is the accumulation of blood in the pleural space, usually as a result of an injury.
• Shingles (herpes zoster) is the reactivation of chickenpox virus which may cause pleuritic pain if it occurs in one of the dermatome (nerve groups) of the chest. Shingles is most common in older people, with the risk increasing the older one gets. While shingles is usually associated with a rash, pain often precedes the rash by a few days, making the initial diagnosis challenging at times.
• Gastroesophageal reflux disease (GERD) can cause severe acid reflux and trigger symptoms, often in the middle of the night, that are mistaken for a heart attack. Pain with breathing is sometimes experienced. GERD can also cause a chronic cough and other symptoms easily attributed to the lungs.

Diagnosis

Depending on your symptoms, there are a number of different tests your physician may recommend. These include:

• Chest X-ray: A chest X-ray may be helpful if it shows a problem, but a negative X-ray cannot rule out many of the potential causes of pleuritic chest pain. For example, chest X-rays are negative in up to 25% of people with lung cancer.
• Computed tomography (CT): This is a type of X-ray in which multiple images create "slices" of internal organs or body parts.
• Magnetic resonance imaging (MRI): An MRI is better at imaging soft tissue.
• CT angiography: This is used to check for heart disorders.
• Electrocardiogram (EKG): Used to check for heart rhythm abnormalities.
• Echocardiogram: This is an ultrasound test of your heart.
• Thoracentesis: This procedure is used to extract fluid from the pleural cavity with a needle and syringe.
• Bronchoscopy: In this test, a flexible tube is inserted through the mouth and threaded down into the large airways of the lungs (the bronchi).
• Thoracoscopy: A scope is inserted into the chest cavity to directly visualize the lung (usually to diagnose lung cancer).
• Lung tissue biopsy: A tissue sample is obtained and examined by a pathologist.
• Oximetry: This measures blood oxygen level.
• Blood tests: These include erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) both of which detect generalized inflammation.
• Pulmonary function tests: These measure lung capacity and performance.
• D-dimer test: This is used to detect blood clots (pulmonary emboli).

Treatment

The treatment options for painful breathing will depend on the specific cause. The outcome of treatment depends on the severity of the underlying disease. As with any disease, early diagnosis is typically associated with greater treatment success.

Frequently Asked Questions

Are chest pain and trouble breathing signs of COVID?

Chest pain can be a symptom of COVID-19 with between 1.6% and 17.7% of patients experiencing it to some degree. It may or may not be accompanied by difficulty breathing. While it’s unclear whether the chest pain results from heart-related complications or an infection of the pleura, it’s considered a mark of severe COVID-19. If you've tested positive for the coronavirus or suspect you’ve been exposed, discuss your symptoms with your doctor.

Is it normal to have chest pain and trouble breathing when you work out?

Exercise-induced bronchospasm (EIB) is a somewhat common problem that can cause chest pain while working out. With this condition, the airways in your lungs narrow during physical exercise. About 5% of people suffer from EIB, but it’s much more common among serious athletes. Luckily, you can take steps to avoid or manage episodes by adjusting your workout routine or treating underlying conditions such as allergies, which put you at risk for these bronchospasms.

Can pleurisy go away on its own?

If pleurisy is caused by a viral infection such as the flu, it will most often run its course and resolve on its own without any treatment. Although, you may need a pain reliever or other treatment to help you manage chest pain and related symptoms. In instances where pleurisy is the result of a bacterial infection, your doctor will usually prescribe an antibiotic. An antifungal or antiparasitic medication may be required to treat other forms of pleurisy.

A Word From Verywell

Pleuritic pain can mean something serious or something that is relatively mild and readily treatable. As such, it is important that you neither ignore the pain nor mask it with pain medication. In the end, pain while breathing can never be considered normal or readily dismissed.