Causes of Chest Pain - Pulmonary Problems

Asthma, Bronchitis, Pneumonia, Pleuritis

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Chest pain or discomfort may be associated with a variety of pulmonary problems, including disorders of the airways such as asthma or bronchitis, infection of the lungs themselves (pneumonia), or inflammation of the lining of the lungs (which is called pleuritis or pleurisy).

Fortunately it is usually not too difficult for a doctor to make the correct diagnosis with any of these conditions - so they are not often confused with chest pain due to a myocardial infarction.

However, the heart is not the only critical organ in the chest. Any of these pulmonary conditions are serious medical problems that need a doctor’s attention.

Chest Discomfort From Asthma

Asthma is a chronic disease in which the airways periodically become inflamed and constricted. “Attacks” of asthma can be triggered by exposure to airborne irritants, exposure to cold air, exercise - or nothing in particular. During an attack, the airways become constricted and it becomes difficult to expel air from the lungs. In addition to severe shortness of breath, wheezing and cough, the asthma sufferer may experience significant chest tightness or even chest pain.

This asthma-induced chest tightness is caused by the excessive muscular effort that is needed to expel air, and possibly by the muscle constriction of the airways.

Once the episode of asthma is adequately treated, the chest tightness goes away - though there may remain some residual soreness for a day or two.

These severe asthma attacks can be greatly reduced or eliminated with adequate treatment.

Chest Discomfort From Bronchitis

Bronchitis is also a disorder that produces obstruction of the airways, although with bronchitis the obstruction is due to inflammation and accumulation of mucus rather than muscular constriction.

(People with chronic bronchitis, however, often have a component of asthma.) Bronchitis may be an acute condition (most often associated with an infection), or it may be chronic - a form of chronic obstructive pulmonary disease.

Because it is also disorder of airway obstruction, the chest discomfort associated with bronchitis is very similar to that caused by asthma.

Chest Pain From Pneumonia

Pneumonia, an inflammation (usually caused by an infection) of the lung tissue itself, can also cause chest pain. The pain is usually caused either by muscle strain from excessive coughing, or by an associated inflammation of the outer lining of the lungs (pleurisy).

Chest Pain From Pleurisy

Pleurisy (or pleuritis) is an inflammation of the outer lining of the lungs. It can be caused by a number of conditions including a viral or bacterial infection; autoimmune disorders such as lupus or rheumatoid arthritis; medications including procainamide, hydrazine and isoniazid; pneumothorax; chest surgery; and cancer.

The pain caused by pleurisy is usually quite characteristic. Because the lining of the lungs is irritated, anything that stretches the lung lining causes pain. That “anything” includes breathing. So “pleuritic pain” is chest pain that is caused by taking a breath, coughing, or moving the chest. The pain may be localized to one area of the chest (or shoulder), or it may be generalized.

Pleuritic pain is sometimes quite similar to the pain of pericarditis, and indeed with autoimmune diseases (including Dressler’s syndrome) patients can have both pericarditis and pleurisy.

Once the pleuritic inflammation is treated (depending on the underlying cause), the pleuritic pain resolves.

Summary

Chest pain or discomfort caused by pulmonary problems are generally not confused by doctors with the pain of a heart attack. But any of these lung conditions is itself a significant medical issue that needs to be evaluated and treated by a physician.

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Sources:

Svavarsdóttir AE, Jónasson MR, Gudmundsson GH, Fjeldsted K. Chest pain in family practice. Diagnosis and long-term outcome in a community setting. Can Fam Physician 1996; 42:1122.

Verdon F, Herzig L, Burnand B, et al. Chest pain in daily practice: occurrence, causes and management. Swiss Med Wkly 2008; 138:340.

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