Why Does an Asthma Attack Cause Chest Pain and Tightness?

Chest pain, or chest pressure, is a common symptom before, during, and after asthma attacks. So, why do asthmatics experience chest pain during asthma attacks? What does it mean, and what can you do about it?

Disclaimer: Chest pain is a generic symptom; it can range from a tickling or burning sensation to pressure, tightness, or pain in your chest. It can be caused by asthma, allergies, anxiety, gastrointestinal reflux, and it can also be cardiac-related. According to the Mayo Clinic, if you experience unexplained chest pain lasting more than two minutes, it is better to seek medical help than to try to figure out the cause on your own.

Chest pain prior to asthma attacks

When this happens, it is considered an early warning sign of asthma. It means an asthma attack is imminent if you don't take action right away.

Here, I would like to use myself as an example. I have a severe allergy to dust mites. I take Advair 500 to make my airways less sensitive to them. Still, it's not enough to keep my airways from getting twitchy when I'm exposed to dust mites.

As a kid, back in the 1980s, I collected baseball cards. Freshly removed from packs, they smelled like Bazooka bubble gum. I spent many hours sorting them or admiring them. This was something I could do, even when my asthma was acting up.

Fast-forward 30 years, and they smell like old, musty cardboard. When I sort through them for any length of time, the chest pressure begins. Why does this happen? Dust mite feces get into the air I inhale, and my immune system recognizes them as harmful and launches a full-on onslaught.

This worsens airway inflammation, causing a tickling feeling in my chest. So, dust mite exposure causes airway twitchiness, which leads to airway itchiness. This can become chest tightness and even shortness of breath if I don't take action.

How to treat pre-attack chest pain

The treatment is to follow your asthma action plan. My plan calls for me to remove myself from whatever is causing the symptoms—in this case, the baseball cards. If needed, I can use my rescue inhaler. If needed, I can take Benadryl. In most cases, my chest pressure gradually dissipates simply by finding something else to do.

Asthma attack chest pain: A sign of acute asthma

So, say I don't pull myself away from those cards. In fact, let's use another example. I have a lot of boxes in my basement. So, say I decide to go through those boxes in order to clean out the basement. Lord knows this has happened before. I become passionate about the project. I am finding some old things I haven't seen in 30 years. I am having a lot of fun.

Now I notice the tickling, then the chest pressure, but I don't pull myself away. I continue sorting things out. I find a pile of old pay stubs and decide to see how much I made back in 1988 (it was $1.25).

So now it's been over an hour, and my chest is tight. I ignore this. After a while, my chin starts to itch (another common early warning symptom of asthma for me). I am rapt in the project and having fun, so I delay and delay and delay. I want to get the project done. Then the anxiety/panic hits. That is when I start to break things or rip important papers, like the cover of my yearbook from Madison Elementary in 1976. When this happens, it is the cue that I have cleaned too long and must finish the project later or let someone else do it.

As I get up to go upstairs, I realize that I am in a full-fledged allergy and asthma attack. My asthma-attack chest pain is scorching, but so are the itchy chin, itchy face, itchy scalp, and shortness of breath. I might also be sneezing, have itchy eyes, etc. I can now take in only about half a breath at a time. My shoulders are hunched, and I'm using accessory muscles to breathe. Yes, now I realize I should have heeded the early warning symptoms and signs of asthma. But now it's too late.

How to treat early asthma chest tightness

The treatment, again, is following your asthma action plan. For me, that means getting away from dust mites, using albuterol, and probably taking Benadryl. Then I wait until my breath comes back, which it usually does in an hour or so.

Managing chest soreness after an asthma attack

So, it's 24 hours later. My breathing is normal, but my chest is sore and stiff. This kind of lingering asthma attack chest pain is normal, especially if it was bad enough that your accessory muscles were utilized to help you inhale. They hurt because they normally aren't used, and when they are, small muscle fibers can tear, causing pain and stiffness the next day.

This is no different than the pain and soreness you feel after a good, strong workout—the kind of workout you do to make your muscles bigger and stronger. Of course, in our case, we don't want our accessory muscles getting bigger and stronger. Still, because I used them yesterday, they hurt today.

How to treat post-attack chest soreness

As with the pain and soreness from any other workout, this pain and soreness will go away in a day or two. If you want to take Tylenol or something, that is up to you and your doctor to determine. As for me, I just wait it out. Actually, I don't let myself get this bad anymore. Of course, if you are as familiar with this thing we call asthma as I am, you know sometimes it happens even when we don't plan on it. So that's why we take our daily asthma controller medicines, have asthma action plans, and avoid our asthma triggers the best we can.

Key takeaways about asthma attack chest pain

Chest pain, however you want to describe it, is a common early warning sign of asthma. While it may cause discomfort, pain is actually a good thing: it's your body telling you to heed the warning and take action. Sore, stiff muscles the day after an attack are normal and usually go away in a day or two. If you continue to have concerns about any chest discomfort you feel, consult your healthcare provider immediately.

So, I’ve shared my experience with asthma attack chest pain. For me, it is a common early warning sign. Every asthmatic is different. So, do you ever experience it? Let us know in the comments below!