Chest pain that occurs during coughing and deep breathing is often thought to be caused by some a lung problem. However, the lung tissue itself does not have pain receptors and therefore do not really feel pain. Still, the pain in the chest that accompanies coughing and deep breathing could arise from respiratory problems localized to the bronchi, pleural covering of the lungs, or the tissues of the chest wall. In fact, chest pain during breathing can occur due to a variety of causes that can be localized not just to the thoracic cavity, but also to the upper abdominal regions and the neck.
Signs and Symptoms
Chest pain is often a nonspecific symptom that does not directly indicate the cause of the problem. In this sense, chest pain is similar to non-specific abdominal pain, which can be caused by a variety of factors. Pain is one of the main symptoms of any inflammatory condition. However, pain could also occur due to non-inflammatory causes.
Due to the non-specific nature of chest pain, it is important to note other accompanying signs and symptoms in order to arrive at the diagnosis of the underlying cause. Signs and symptoms that may accompany chest pain during breathing could include fever, dizziness, abnormal sputum, pain during coughing, and pain during specific phases of respiration.
Read more on sleep chest pain.
Causes of Chest Pain During Breathing
Chest pain during breathing can be caused by a variety of conditions. The following are some of the probable causes of chest pain that may arise or get worse with deep breathing or coughing.
Causes of the chest wall
One of the most frequent causes of chest pain that worsens with breathing is an injury to the chest wall. The type of injury and the injured tissue may vary on a case-to-case basis. Some possible chest wall injuries that can cause chest pain during breathing include muscle strain, soft tissue injury, fracture of the bones of the rib cage (sternum and ribs), and disorders of the cartilages or joints in the rib cage (such as costochondritis). In these cases, the area of the chest wall that is injured shows signs of inflammation such as redness, swelling and tenderness. These signs of injury and inflammation may be clearly visible on the chest wall.
Causes of the respiratory system
Conditions that affect the respiratory pathways, lungs and the pleura can all cause chest pain during breathing. Pleura is a double-layered membranous covering of the lungs. Infections and inflammation of the pleura can cause chest pain (technically referred to as pleuritic pain).
Chest pain that occurs during deep breathing (especially during the inhalation phase of the breathing cycle) can very likely be caused by pleuritis or pleurisy (inflammation of the pleura). Coughing may also occur. Conditions affecting the respiratory pathways, such as bronchitis and pneumonia, can also cause chest wall pain accompanied by a persistent cough. However, chest pain is not significant in these conditions.
A sudden onset of severe chest pain accompanied by difficulty in breathing could be caused by spontaneous pneumothorax (also known as collapsed lung).
Causes of heart and blood vessels
Chest pain during breathing can also be caused by diseases affecting the heart and the blood vessels. The heart is covered by a sac known as the pericardium. Inflammation of this pericardium (technically referred to as pericarditis) is one of the common causes of chest pain that occurs during coughing or deep breathing.
In case of chest pain that occurs suddenly, pulmonary embolism and thoracic aortic dissection should be considered as probable causes. It is important to note that most cardiovascular diseases do not cause chest pain that is affected by deep breathing.
Read more on signs of heart pain.
Causes of the digestive system
Esophagitis refers to an inflammation of the esophagus. One of the most common causes of esophagitis is reflux of gastric acid into the esophageal tube. Under normal circumstances, gastric acid reflux is prevented by the lower esophageal sphincter (also known as the gastroesophageal sphincter) that lies at the junction of the esophagus and the stomach.
Dysfunction of this valve allows backward flow of the highly corrosive stomach acid into the esophageal tube, resulting in an inflammation of the esophageal mucosa. The pain caused by esophagitis is commonly referred to as “heartburn”. Other potential causes of esophagitis include infections (both bacterial and viral), and side effects of certain medications.
A variety of diseases that affect the gallbladder can also cause chest pain during breathing. The gallbladder is a small pouch-like organ that stores the digestive bile synthesized by the liver. Diseases of the gallbladder include inflammation of the gallbladder (technically referred to as cholecystitis), formation of gallstones, gallbladder cancer, and restricted flow of bile from the liver (cholestasis).
Pancreatitis refers to an inflammation of the pancreas, which is a critical organ that lies behind the lower end of the stomach. Inflammation of the pancreas can either occur suddenly or develop over a period of many years. Acute pancreatitis refers to the sudden appearance of pancreatic inflammation. This condition requires immediate medical treatment (and hospitalization), and has high mortality associated with it. Severe upper abdominal pain, nausea and vomiting are characteristic symptoms, which may also be accompanied by respiratory distress.
The thoracic and abdominal cavities are separated by a large sheet of muscle known as the diaphragm. The esophagus in the thoracic cavity joins the stomach in the abdominal cavity through a small opening in the diaphragm. In hiatal hernia, the upper part of the stomach pushes through this small opening in the diaphragm to enter the thoracic cavity. Hiatal hernia, also known as stomach hernia, may remain asymptomatic. In some cases, hiatal hernia may produce abdominal discomfort and heartburn or chest pain.
The majority of abdominal organs are enclosed within a thin membranous tissue known as the peritoneum, which also lines the inner abdominal wall. Inflammation of this peritoneum causes acute pain in the abdomen. The pain in peritonitis may be diffuse and gets worse with coughing. The main cause of peritonitis is infection.