Chest pain when breathing in: causes, red flags and when to get it checked

The lungs themselves have no pain-sensing nerves, but the lining that covers them (the pleura) and the chest wall do. When breathing in stretches an inflamed or injured surface, you feel a sharp, catching pain. The clues are what else is happening: cough and fever, a calf swelling, a recent injury or long journey.

• Muscle strain or rib and cartilage inflammation (costochondritis): tender when pressed on the chest wall, worse with movement, twisting or a deep breath.

• Viral respiratory infection or pleurisy: sharp pain with a recent cold or flu.

• Pneumonia: chest pain with fever, productive cough and breathlessness.

• Pericarditis: sharp central chest pain, eased by leaning forward, worse lying flat, often after a viral illness.

• Pulmonary embolism: sudden sharp pain with breathlessness, sometimes coughing blood, in people with a recent operation, long travel, leg swelling or cancer.

• Pneumothorax (collapsed lung): sudden pain and breathlessness, more common in tall young men and smokers.

• Rib fracture after injury, and shingles before the rash appears.

• Lung cancer or an autoimmune condition such as lupus, which are less common causes.

Sudden onset, breathlessness at rest, a fast pulse, coughing blood, fainting, a swollen painful calf, fever with rigors, pain after a long flight or surgery, a history of cancer or clots, and oxygen levels or blood pressure that are low are warning signs.

• Call 999: severe chest pain, pain with severe breathlessness, collapse, coughing blood, blue lips, or chest pain with pressure, sweating or radiation to the arm or jaw.

• A&E or NHS 111 today: sharp chest pain with breathlessness of recent onset, or fever with rapid breathing.

• GP same day or within a day or two: pain on breathing following a cold, or after a minor strain.

• Routine GP: reproducible chest wall tenderness that is improving.

The clinician asks when it began, what makes it better or worse, breathlessness, cough, fever, recent travel, surgery, injury, leg swelling, smoking, hormones and past clots. They check pulse, blood pressure, temperature, oxygen saturation, listen to the heart and lungs, press the chest wall and examine the legs.

• ECG and troponin blood test: to exclude a heart cause.

• Chest X-ray: to look for pneumothorax, pneumonia or fluid.

• D-dimer and CT pulmonary angiogram: if pulmonary embolism is possible.

• Blood tests and inflammatory markers: for infection or pericarditis.

• Echocardiogram: if the pericardium or heart function is in question.

For a confirmed chest wall or viral cause, simple painkillers such as paracetamol or an anti-inflammatory (if suitable for you), warmth and gentle movement help. Deep breathing exercises reduce the risk of chest infection. Do not take painkillers to mask pain that is severe, sudden or accompanied by breathlessness.

On the NHS, severe or sudden pain should go to A&E; otherwise a GP can arrange tests. Private hospitals can offer same-day chest X-ray, ECG and CT, but emergencies still require 999.