Causes of Pain With Deep Breathing

Understanding Pleurisy (Pleuritic Chest Pain)

Pain with breathing is always something to see a healthcare provider about. That's whether it comes with regular breathing or when taking a deep breath.

Pain from taking a deep breath is called pleuritic chest pain or pleurisy. The names come from the membranes lining the lungs, called pleura.

The term pleurisy is sometimes used to describe any sharp pain with a deep breath. But it can also be used to describe inflammation of the pleura.

This article looks at pleurisy symptoms, the various possible causes of it, and how it's diagnosed.

Causes of Chest Pain With Deep Breathing

Brianna Gilmartin / Verywell

Symptoms

Pleuritic pain may be triggered by medical conditions or injuries involving the lungs, pleura, or nearby tissues or organs, including:

Symptoms that accompany pleuritic chest pain often point to the underlying cause. They include:

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

Pleuritic pain may occur only with deep breaths. Or it may be present all the time but get worse when you take a deep breath. It tends to be sudden, sharp, stabbing, and intense.

Lung-Related Causes

The lungs don't have pain receptors. Still, medical conditions involving the lungs can cause pain in several ways. That includes irritation of the pleura.

These conditions can be cancerous, infectious, or non-infectious.

Cancer

Cancerous causes of pleurisy include lung cancer, mesothelioma, and malignant pleural effusions.

Lung Cancer

The most common type of lung cancer is lung adenocarcinoma. It tends to grow around the edges of the lung near the pleura.

It's most common in:

  • People who've never smoked
  • People assigned female at birth
  • Young adults

The earliest symptom may be pain from cancer reaching the pleura.

Mesothelioma

Mesothelioma is a type of cancer that arises in the pleura. It's most common in people who've been exposed to asbestos.

You can be exposed to asbestos at work or when remodeling homes built before asbestos was banned.

Malignant Pleural Effusion

Malignant pleural effusions cause fluid to build up in the pleura. The fluid contains cancer cells.

Effusions can occur due to lung cancer, breast cancer, and cancers that spread to the lungs.

Infectious Causes

Infectious causes of pain with breathing include:

Non-Infectious Causes

Non-infectious causes of breathing-related pain include:

  • Pleural effusion: Accumulation of fluid between the layers of the pleura. Can be caused by lung disease, heart disease, and autoimmune disorders.
  • Pneumothorax: Partial or total lung collapse. Can trigger severe chest pain and shortness of breath. This is a complication of emphysema and other lung diseases.
  • Pulmonary embolism: Potentially life-threatening. A blood clot breaks off and travels to the lungs. Risk factors are recent surgery, heart disease, and deep vein thrombosis (DVT).
  • Pulmonary infarction (lung infarction): Occurs when a section of lung tissue dies because its blood supply is cut off.

Studies of pleuritic chest pain have suggested pulmonary embolism is the most common life-threatening cause. It's the source of the pain in between 5% and 21% of cases.

Heart-Related Causes

The heart lies near the lungs and the pleura. So heart conditions may cause pain with breathing.

Some heart-related conditions that cause pleuritic chest pain include:

  • Pericarditis: Inflammation of the membrane lining the heart (pericardium). Causes include infection, lung and breast cancer, kidney disease, and autoimmune diseases like lupus.
  • Myocardial infarction (heart attack): Caused by blocked blood flow to a portion of the heart muscle.
  • Aortic dissection: A medical emergency. A weak aorta (artery) allows blood to spill into its inner lining. It often causes severe, tearing pain in the chest and back.
  • Pulmonary hypertension: High blood pressure in the pulmonary artery. Causes include heart disease, lung disease, connective tissue disorders, and some medications.

Musculoskeletal Causes

Conditions involving bony or soft tissue structures in the chest may cause pain associated with breathing.

Some of these include:

  • Rib fractures: Pain develops suddenly. It may worsen with deep breaths or coughing.
  • Costochondritis: A rare condition caused by inflammation between the ribs and sternum (breastbone). Pain can resemble that of a heart attack.

Other Causes

Other common conditions that cause pain with breathing usually cause other symptoms, as well. These conditions include:

  • Hemothorax: Accumulation of blood in the pleural space, usually due to an injury.
  • Shingles (herpes zoster): Reactivation of the chickenpox virus. May cause pleuritic pain if it affects the chest. Pain is followed after a few days by a painful rash.
  • Gastroesophageal reflux disease (GERD): Can cause severe acid reflux, heartburn, and sometimes a chronic cough with pleuritic pain.

Diagnosis

Depending on your symptoms, your healthcare provider may order several tests. These include imaging, bloodwork, and other tests.

Imaging

Imaging studies include:

  • Chest X-ray: May show some problems but is often of limited use. Chest X-rays are negative in up to 25% of people with lung cancer.
  • Computed tomography (CT): A type of X-ray using multiple images to create three-dimensional pictures.
  • Magnetic resonance imaging (MRI): An imaging test that can show details of the body's soft tissue.
  • CT lung angiography: Checks for pulmonary embolisms or arteriovenous malformations (abnormal veins) in the lungs.
  • CT heart: Examines the structure of the heart.
  • Echocardiogram: This is an ultrasound test of your heart that can visualize the heart while it's in motion.
  • Bronchoscopy: During 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).

Bloodwork

Blood tests your provider may order include:

These look for markers of inflammation. They can help identify autoimmune diseases and other inflammatory conditions.

Other Tests

You may also be sent for:

  • Electrocardiogram (EKG): Used to check for heart rhythm abnormalities.
  • Thoracentesis: A needle is used to extract fluid from the pleural cavity to diagnose (and treat) pleural effusion.
  • Lung tissue biopsy: A tissue sample is taken and examined by a pathologist. Often used to diagnose cancer.
  • Oximetry: A non-invasive test to measure blood oxygen levels.
  • Pulmonary function tests: These measure lung capacity and performance.

Treatments

The treatment options for painful breathing depend on the specific cause. Early diagnosis is typically associated with greater treatment success.

When to Call a Healthcare Provider

  • If pain is severe or persists for more than a couple of days
  • When the symptoms develop suddenly and profoundly
  • When pain interferes with breathing
  • If you feel lightheaded, dizzy, or like you're going to faint
  • If you cough up any blood, however light
  • If you have a high fever (over 100.4 degrees Fahrenheit) and/or chills
  • If you have rapid or irregular heartbeats

Summary

Many things can cause pleurisy. That includes several lung conditions, heart conditions, infections, and musculoskeletal problems.

Breathing-related pain can be diagnosed using a wide array of imaging studies, bloodwork, and other tests.

You should always treat breathing-related problems as a medical emergency and get immediate help.

A Word From Verywell

Pain with breathing can be scary. You should always pay attention to this symptom and get medical attention.

Most causes of pleurisy aren't life-threatening. But enough of them are to warrant a proactive approach. Getting an early diagnosis and treatment can mean a faster recovery.

Frequently Asked Questions

  • Are chest pain and trouble breathing signs of COVID?

    Chest pain can be a symptom of COVID-19. Up to about 18% of people with it have some chest pain. These may be due to cardiac complications or infection of the pleura.

    Chest pain in COVID may or may not be accompanied by difficulty breathing. Get medical attention if you've tested positive for the coronavirus or suspect you’ve been exposed.

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

    Chest pain and trouble breathing are not considered "normal." They may be signs of a serious condition like heart disease.

    That said, exercise-induced bronchospasm (EIB) is not always something to worry about. It causes your airways to narrow during physical exercise.

    You can avoid or manage episodes by adjusting your workout routine or treating underlying conditions such as allergies, which put you at risk for EIB.

  • What is pleurisy?

    Pleurisy is an inflammation of the pleurae—the tissue that lines the lungs. The term pleurisy has been around since about 5 B.C. and has historically been used to describe pain upon taking a deep breath. Pleurisy is also known as pleuritic chest pain.


  • Can pleurisy go away on its own?

    It depends. If a viral infection causes pleurisy (e.g., the flu), it most often resolves without treatment.

    If it's due to a bacterial infection, you may need an antibiotic. Fungal or parasitic causes may require medication, as well.

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6 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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