Chest Tightness in Asthma: Symptoms, Causes, Treatment

If you have asthma, you may experience a feeling of chest tightness from time to time. These episodes are usually accompanied by wheezing, shortness of breath, and a chronic cough. Chest tightness can be anxiety-provoking, and it is often a sign of worsening asthma control and/or an impending asthma attack.

This article will explain the symptoms and causes of chest tightness in asthma and how it is treated. It will also explain when chest tightness requires emergency treatment.

Symptoms of Chest Tightness in Asthma

When you have chest tightness due to your asthma, you may feel like you can't easily push air in and out of your chest. With asthma, mild chest tightness can be present all or most of the time, but it may worsen in response to asthma triggers and in the hours or minutes before an asthma exacerbation.

Symptoms of chest tightness include:

• A feeling that your chest is constricted, as if there's a band around it
• A sense that you're trying to push against your chest from the inside as you breathe
• A struggle to fully exhale (breathe out)
• Difficulty inhaling (breathing in)

Not all people who have asthma experience chest tightness. But there is a type of asthma described as chest tightness variant asthma (CTVA) in which this symptom is especially frequent.

Causes of Chest Tightness in Asthma

Chest tightness occurs as a result of several asthma-induced physical changes.

When asthma acts up, your bronchi constrict (narrow), and your lungs become inflamed and produce excess mucus. This makes it hard for air to pass through, even as you put all your effort into breathing.

A number of triggers can lead to worsened chest tightness when you have asthma, including:

How to Treat Chest Tightness

There are several different types of medications that can help control asthma symptoms, including chest tightness.

Medications commonly used to treat asthma symptoms include:

Bronchodilators: Bronchodilators relax muscles around the airways, reducing chest tightness and making it easier to breathe. Short-acting bronchodilator inhalers (also called "rescue inhalors") like albuterol work right away to provide immediate relief from symptoms. Long-acting bronchodilators like Spiriva (tiotropium bromide) are used long-term and are not intended for quick relief.

Corticosteroids: Inhaled corticosteroids, such as Pulmicort (budesonide) are available to reduce swelling in the airways and make it easier to breathe. In some cases, oral versions are recommended.

Anticholinergics: Anticholinergenics (given via an inhaler or nebulizer) prevent muscle bands from tightening around the airways to relieve chest tightness among other symptoms. This type of medicine is typically used in combination with an inhaled corticosteroid and taken daily.

Sometimes chest tightness in asthma is relieved with bronchodilators, but some people with asthma experience improvement of chest tightness only with other asthma treatments.

Asthma with chest tightness that is relieved with the use of asthma drugs except bronchodilators (CTRAEB) might differ from asthma with chest tightness relieved with bronchodilator use (CTRB). The latter is associated with inflammation and bronchoconstriction, while the former is only associated with inflammation.

Avoiding things that trigger your asthma can also keep asthma attacks at bay, as can reducing stress, a known asthma trigger.

Complications and Risk Factors Associated with Chest Tightness

Recurrent episodes of chest tightness may indicate that your asthma isn't well-controlled. When you have sudden chest tightness with asthma, it can be a sign that your symptoms are on the way to escalating into an asthma attack if you do not follow your asthma action plan.

Chest tightness and pain can also be a sign of serious conditions such as heart disease or pulmonary embolism (PE).

Are There Tests to Diagnose the Cause of Chest Tightness?

Several different types of tests may be used to help diagnose the cause of your chest tightness and whether asthma or another condition is to blame.

Common diagnostic tests include:

• Lung function tests, including spirometry, to test how well your lungs work
• Peak expiratory flow (PEF) tests to measure how fast you can blow air out using maximum effort
• Fractional exhaled nitric oxide (FeNO) tests to measure levels of nitric oxide in your breath when you breathe out. High levels of nitric oxide may mean that your lungs are inflamed
• Chest X-ray or computerized tomography (CT) scan

Your healthcare provider may also want to do tests to rule out other causes of chest tightness.
The list of chronic conditions that can cause chest tightness along with other symptoms similar to those of asthma is long and includes chronic obstructive pulmonary disease (COPD), lung cancer, and pulmonary sarcoidosis.

If you seem to be in distress, your medical team will rapidly assess you to determine if you are experiencing a medical emergency, such as a heart attack or a lung emergency (like a PE or a pneumothorax). Often, people who have chest tightness due to these and other emergencies are visibly short of breath.

Your medical team will check your pulse, respiratory rate, and blood pressure. Depending on your symptoms, you may have an electrocardiogram (EKG) to check your heart rhythm and pulse oximetry to check your oxygen saturation as well.

When to See a Healthcare Provider

Whether you have been diagnosed with asthma or not, it is important that you get medical help for your chest tightness.

Call your healthcare provider's office for an appointment if:

• You experience mild chest tightness at the same time every day or when your asthma medicine is wearing off.
• You only experience chest tightness along with your other asthma symptoms.
• You started having occasional chest tightness when you had a change in your asthma medication.
• Your chest tightness improves when you use your asthma rescue treatment, but is recurrent.

Summary

Chest tightness is a common symptom in people with asthma and may be accompanied by wheezing, shortness of breath, and coughing. Chest tightness may be a sign that an asthma attack is coming on or that your asthma is worsening. In some cases, it may be a sign of serious heart and lung problems.

A Word From Verywell

Chest tightness is an especially distressing and anxiety-provoking symptom in asthma. If you tend to experience recurrent chest tightness as part of your asthma, it's important that you learn to recognize the need for rescue treatment and that you seek medical attention if your chest tightness seems worse or is accompanied by unfamiliar symptoms.