An Overview of Chest Tightness in COPD

Senior patient complaining of chest pain
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If you have chronic obstructive pulmonary disease (COPD), you may experience a feeling of chest tightness from time to time. This is a common effect of COPD, but chest tightness can also be a sign of other medical conditions—including an asthma attack, heart failure, or a life-threatening heart attack.

The structural lung changes in COPD cause that sensation of chest and lung tightness. If you experience this your medical team will likely order some diagnostic tests for you so that the exact cause can be identified. This will help in planning the right treatment to relieve your chest tightness.

Symptoms

Chest tightness can manifest with a number of associated symptoms, and it can worsen when your COPD acts up. While COPD is often characterized by shortness of breath, especially with exertion, chest tightness can occur even when you are at rest.

When you have chest tightness with COPD, you may feel:

  • It is a struggle to breathe
  • You can't take a deep breath
  • As if something is wrapped around your chest
  • You can also experience severe wheezing

These symptoms are common in COPD, but an asthma attack or a heart attack can cause sudden chest tightness. It is important that you recognize the symptoms of these emergency situations rather than assuming that your chest tightness is related to your COPD.

An asthma attack can make you feel like you can't breathe or that you are choking. Asthma and COPD often coexist.

Recognizing Heart Failure in COPD

Since COPD and heart failure share many of the same symptoms, it may be especially difficult for people with COPD to recognize the signs of heart failure or a heart attack. Heart failure often causes low energy, dizziness, and swelling of the legs.

Signs of a heart attack include:

  • Chest pain or discomfort that feels like pressure, squeezing, or fullness
  • Pain or discomfort in one or both of your arms, back, stomach, jaw, or neck
  • Shortness of breath, with or without chest discomfort
  • Cold sweat, nausea, or lightheadedness
  • Nausea, vomiting

Seek emergency medical care right away if you are having severe, sudden, or unusual tightness in your chest.

Causes

Chest tightness in COPD is often associated with lung infections, such as bronchitis or pneumonia. When you have COPD, you are at increased risk for developing lung infections and you also can experience severe and prolonged effects.

COPD affects the lungs in a number of different ways, making it difficult to breathe and resulting in a sensation of chest tightness.

  • Excess mucus production is common in COPD. The mucus (also often described as phlegm) can build up in the bronchi (airways) and alveoli (air sacs), preventing air from efficiently getting in and out when you breathe. In general, mucus buildup is common in COPD, but it worsens when you have an infection.
  • Narrowing of the airways can occur due to the spasm of the bronchi. This is typically more severe when you have a lung infection.
  • Chronic inflammation causes persistent thickening and narrowing of the airways, which results in a sensation of chest constriction.
  • Pulmonary hypertension is a chronic process in which the blood vessels in the lungs become narrow and blocked. It is associated with a combination of heart failure and COPD, and it adds to the sensation of chronic chest pressure.

Typically, COPD is characterized by all of these effects, but you can experience some of them more than others, and they can fluctuate from time to time.

Diagnosis

The key to diagnosing chest tightness in COPD lies in determining whether it is caused by the progression of the disease, a COPD exacerbation, or another problem—such as heart disease or heart failure. You may need several diagnostic tests to help your medical team identify the cause of your chest tightness.

Diagnostic tests used to assess chest tightness include:

Electrocardiogram (EKG): If there is a concern that you could be having a heart attack, this test will be done urgently. An EKG is a rapid test that can identify an ongoing or past heart attack. It involves the placement of metal leads on your chest to detect your heart activity.

Pulse oximeter: A noninvasive test that can approximate oxygen levels in the blood can be used to determine whether you need to use supplemental oxygen, either urgently, or for the long term.

Arterial blood gas (ABGs): A blood sample from an artery (usually in the wrist) can be used to accurately measure the oxygen level in your blood. If there is a concern that your oxygen level was low or borderline based on your pulse oximeter reading, this test can help better assess your blood gas levels (including carbon dioxide, bicarbonate, and blood pH).

Chest x-ray or chest computerized tomography (CT): Shortness of breath can be associated with an infection or with serious lung damage in COPD. Chest imaging studies can be used to identify structural changes that require medical and/or surgical treatment.

Pulmonary function tests (PFTs): These tests require your cooperation as you breathe in and out of a device that measures the air volume. They are used to assess how well your lungs are functioning.

Echocardiogram: An echocardiogram is an imaging test that looks at the movements of your heart as it is beating. It can help identify many heart conditions, including heart failure and heart valve disease.

Treatment

When chest tightness is caused by COPD, you need to use a treatment that can help alleviate the sensation. Therapies can include medications that reduce inflammation, widen the airways, and/or decrease the mucus in your lungs.

  • Treatments for pulmonary hypertension include oxygen therapy, diuretics (water pills to reduce fluid build-up), and medications that improve heart function.
  • Anti-inflammatory medications, such as steroid treatments, can also be used to help reduce the inflammation that is usually associated with COPD. And you may feel relief by using a mucolytic, such as Mucinex, which can help break up the mucus in your lungs so that you can cough it out.
  • Airway narrowing can often be relieved with bronchodilators, which are medications that help open the airways. These are often used as inhaled aerosol therapy, such as an Albuterol inhaler. Albuterol is a quick-relief medication that is often used for the treatment of asthma attacks. Inhalers will not cure the chest tightness that's associated with your COPD, but they can give you temporary relief.

In general, surgery is not a common approach in the treatment of COPD. However, in some cases, surgical treatment of a collapsed lung or another structural issue may be necessary to relieve chronic chest tightness.

If your chest tightness is caused by a heart attack or asthma attack, you may need urgent treatment.

A Word From Verywell

Chest tightness is very common in COPD. It can also occur with several other medical conditions, some of which are emergencies. If you experience gradually worsening chest tightness or sudden chest tightness, you need to get medical attention.

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