Chest Tightness and Pain

Reviewed by: HU Medical Review Board | Last Reviewed: May 2016.

Chest tightness is a typical asthma symptom, along with cough, wheeze, and shortness of breath. For the most part, chest tightness occurs along with other symptoms. However, a recent study suggested that chest tightness may be the only asthma symptom some patients experience.1

What is it?

Chest tightness is a subjective symptom. This means it is something you feel and describe, but a provider cannot observe or measure it. People describe chest tightness as “band-like,” a “heavyweight” or “feeling really tight.”2 You may feel like it is difficult to breathe deeply. You also may feel chest congestion or generalized chest pain.

Chest pain is less typical than chest tightness for asthma patients. Chest pain is often confused with heart conditions. Patients seen in the emergency department for acute asthma were surveyed about their symptoms. Thirty percent described asthma-related chest pain as dull ache and 28% said it was sharp and stabbing.3

Chest pain vs. chest tightness

Chest tightness and pain are not always signs of asthma. Many heart conditions, digestive problems, and other lung problems cause similar symptoms.

What other conditions can cause chest tightness?

Causes of chest tightness include heart disease, exposure to irritating dusts or fumes, blood disorders, hyperthyroidism, diseases of the nervous system, and muscular disorders.1

Chest pain can be a sign of serious or life-threatening heart disease, lung clots, or pneumonia.4 Less urgent causes of chest discomfort are ulcers, GERD (gastroesophageal reflux disease), chest wall pain, and panic disorder.4

How is it evaluated?

If chest discomfort is your main symptom, the first step is to rule out a life-threatening problem.2 Your provider will focus on questions such as:4

  • When did the pain or discomfort start?
  • How has it changed?
  • Where do you feel the pain?
  • How would you describe the pain?
  • What factors make it better or worse?

Your initial evaluation may include an electrocardiogram and chest x-ray, unless there is an obvious and non-threatening cause of chest discomfort.4 Your provider probably will not even consider asthma until he or she is sure that you do not have an immediately threatening condition.2

How common is chest tightness in people with asthma?

In the emergency department survey of people with asthma, 91% reported feeling chest tightness.3 Chest pain was less common. It occurred in about 76% of people.

Asthma-related chest tightness often occurs during exercise or at night.2 If your history and physical exam suggest that you have asthma, your provider may ask you to do spirometry to confirm the diagnosis. Spirometry is an important lung function test to evaluate how much and how quickly you can exhale air. The test is usually done before and after taking a medication that opens the airways (“bronchodilator”). Asthma is likely if medications are able to open the airways.

How is asthma-related chest tightness treated?

If asthma is the cause of your chest tightness, you probably will be given asthma medications. Asthma treatment usually starts with inhaled corticosteroids.5 Your provider will also talk to you about avoiding asthma triggers.

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