It Hurts to Breathe: Causes and When to Worry

Why it hurts to breathe

Breathing moves the ribs, the muscles between them, the cartilage joining ribs to the breastbone, the diaphragm and the two-layered lining around the lungs (the pleura). Pain from any of these structures worsens as they stretch or rub with each breath. The lung tissue itself has few pain nerves, so painful breathing usually means the problem involves the lining or chest wall.

Where the pain is and what makes it worse gives strong clues:

• Tender to press on: points to the chest wall.
• Sharp, catching pain at the end of a deep breath or cough, not tender: points to the pleura.
• Worse lying flat, better sitting forward: points to the sac around the heart.
• Pain on breathing plus breathlessness: points to a lung problem such as a clot, collapse or pneumonia.

Common causes

Chest wall strain

Coughing fits, heavy lifting, twisting or new exercise can strain the intercostal muscles between the ribs. The pain is localized, tender to press, worse on twisting and deep breaths, and improves over 1 to 3 weeks.

Costochondritis

Costochondritis is inflammation where the ribs join the breastbone. It causes sharp or aching pain at the front of the chest, worse with deep breaths, and pressing on the joints reproduces it. It is harmless and often follows a viral illness or exertion.

Rib injury

A bruised or broken rib after a fall or blow causes sharp pain with breathing, coughing and laughing, with a tender spot. Shallow breathing to avoid pain can lead to chest infection, so regular pain relief and deep breaths are important.

Pleurisy

Pleurisy is inflammation of the pleura, most often from a viral infection. It causes a sharp, stabbing pain on breathing in, often in one side or the shoulder tip. A doctor may hear a scratching "rub" through a stethoscope. Pleurisy can also accompany pneumonia, clots, lupus and rheumatoid arthritis.

Serious causes

Pulmonary embolism

A pulmonary embolism is a blood clot in the lung arteries. Typical features are sudden breathlessness, fast heart rate, sharp chest pain on breathing and sometimes coughing blood. Risk factors include recent surgery or hospital stay, long journeys, pregnancy, birth control pills, cancer and a previous clot.

Pneumonia

Pneumonia causes fever, chills, cough with sputum, fast breathing and pleuritic pain over the infected area. Older adults may just be confused or weak.

Collapsed lung

In a pneumothorax, air leaks into the space around the lung. It causes sudden one-sided sharp pain and breathlessness. It occurs spontaneously in tall, thin young adults, especially smokers, and in people with COPD or after chest injury.

Pericarditis

Pericarditis, inflammation of the sac around the heart, causes sharp central chest pain that worsens with breathing in and lying flat and eases on sitting forward. It often follows a viral infection.

Other causes

• Shingles: burning pain in a band around one side of the chest, followed days later by a blistering rash.
• Heart attack: usually pressure rather than pain on breathing, but never assume.
• Upper belly problems such as gallbladder inflammation or a liver abscess can cause pain on deep breaths under the right ribs.

Comparing causes of painful breathing

How doctors find the cause

The doctor asks about onset, injuries, infections, travel and clot risk, then checks pulse, breathing rate, oxygen levels and temperature, presses on the chest wall and listens to the lungs and heart. Tests include:

• ECG to look at the heart and signs of pericarditis or strain from a clot.
• Chest X-ray for pneumonia, collapsed lung, fluid or fractures.
• Blood tests: D-dimer to help rule out a clot in low-risk people, troponin for heart damage, and infection markers.
• CT pulmonary angiogram when a clot is likely.

Treatment and home care

• Chest wall pain and pleurisy: rest, warm or cold packs, and anti-inflammatory pain relief such as ibuprofen, following the label dose. Avoid NSAIDs if you have stomach ulcers, kidney disease or are on blood thinners. Acetaminophen (paracetamol) is an alternative.
• Keep breathing deeply: take a few slow deep breaths every hour, holding a pillow against the sore area when you cough. This prevents chest infection.
• Specific treatment for the cause: antibiotics for bacterial pneumonia, blood thinners for a pulmonary embolism, a chest drain for a large pneumothorax, anti-inflammatory medicines for pericarditis.

Frequently asked questions

Why does it only hurt when I breathe in?

Pain only on breathing in usually comes from structures that stretch with each breath: the chest wall muscles, rib joints or the lining of the lung (pleura). Muscle strain and viral pleurisy are common. If you are also short of breath, have a fever or have clot risk factors, get checked the same day.

Is it serious if it hurts to breathe?

Often it is not, especially if the chest wall is tender and you are otherwise well. It can be serious if it starts suddenly with breathlessness, a fast heartbeat, coughing blood, fever or fainting. These can signal a blood clot, collapsed lung or pneumonia.

Can anxiety make it hurt to breathe?

Anxiety can cause chest tightness, fast breathing and muscle tension that make breathing uncomfortable. It does not usually cause sharp pain that catches with every breath. Do not assume anxiety until a doctor has ruled out physical causes, especially the first time.

How long does pleurisy pain last?

Viral pleurisy usually improves within a few days to 2 weeks with anti-inflammatory pain relief. Pain that lasts longer, keeps returning, or comes with breathlessness or fever needs further tests to look for pneumonia, fluid or other causes.

What helps chest pain when breathing from a pulled muscle?

Rest from heavy lifting and twisting, apply warmth or ice, and use over-the-counter pain relief as directed on the label. Keep taking some deep breaths through the day. Most strains improve within 1 to 3 weeks.