Left sided chest pain


Am just wondering whether or not I need to speak to resp nurse. I've had no cold but have got a productive cough and am on oabs, pred, nebs etc. I have really bad pain in the left side of my chest (round the back) which eases a bit with paracetamol and ibuprofen but when I cough it hurts so much that it catches my breath. The pain is dull stabbing.

Obviously if it is just pleuritic pain I will self treat, I know it's not a pulled muscle but I just wonder if it could be something else.

Any suggestions??

10 Replies

  • Hi there,

    It does sound like pleuritic pain, but that is just a symptom, not a diagnosis. Pleuritic pain can potentially be due to pneumonia or a pulmonary embolus, as well as simpler things like intercostal muscle spasm, and less serious infections.

    The likelihood is that it is secondary to an infection, as you have a productive cough, but if it is a new symptom for you then please do get it checked out with your GP or respiratory nurse; it's impossible to exclude the dangerous stuff without actually seeing you.

    Hope this helps

    Em H

  • Thanks Em

    I went to Gp and I've got pleurisy - feel better knowing that I'm not heading for a chest drain!!

  • You have my sympathy, pleurisy can be very painful - but as you say, at least it's nothing more serious!


  • Asthmatics are advised to avoid ibuprofen and aspirin as as both are known to exacerbate the condition and may be contra-indicative with certain asthma medications.

  • Hi,

    Liz's GP has put ibuprofen on Liz's repeat prescriptions because she gets very bad headaches due to her epilepsy. We were warned of the possibility of it upsetting her asthma and she only uses it as a last resort.

    No problems yet, fortunately

    Michael (Liz's husband)

  • Hi,

    Around 10% of asthmatics are sensitive to aspirin and non-steroidal anti-inflammatory drugs (eg ibuprofen, diclofenac, mefenamic acid) - this minority of asthmatics can react with anything from very mild symptoms to, very occasionally, potentially life-threatening symptoms. You are more likely to be sensitive to aspirin and NSAIDs if you have rhinitis and nasal polyps as well as asthma.

    If you have had aspirin or NSAIDs before, and have not reacted, you are probably fine with them - but if in doubt, or if you have severe asthma, it is always best to check with your GP first. It's worth noting that occasional reactions to topical NSAIDs such as ibuprofen gel have been noted in sensitive asthmatics, although this is a lot less likely than reaction to the tablets. Deep Heat cream also contains methyl salicylate, an aspirin derivative, and may provoke a reaction in a small minority of asthmatics.

    The only potential interaction between aspirin and NSAIDs and asthma medication is that if you are on long term steroids, there may be an increased risk of gastrointestinal problems such as ulcers and bleeding. This will be largely counteracted if you are also on a medication to reduce acid secretion, such as lansoprazole or omeprazole, as many asthmatics are. There is also a minor interaction between aspirin and NSAIDs and methotrexate and ciclosporin, which a small minority of asthmatics may be on - in the case of methotrexate, NSAIDs may slightly increase the plasma levels of methotrexate, making toxicity more of a risk; in the case of ciclosporin, NSAIDs may slightly increase the risk of kidney problems. Neither of these should be too much of a problem if you are having your regular monitoring blood tests (which everyone who is on methotrexate or ciclosporin should be having) but if you are on one of these drugs, you should consult your GP before using these analgesics.

    The risk of taking aspirin and NSAIDs with asthma is often overstated; many junior doctors believe that no asthmatic should have these drugs, whereas in fact it is only the minority (10%) that are affected. If in doubt, though, do talk to your GP.


  • Yep indeedy - the ""myth"" of the risk is very much overstated. Many people will have taken ibuprofen as a matter of course without even thinking about it - and will have suffered no ill effects.

    Personally I have no problems with ibuprofen, aspirin or diclofenac upsetting my asthma control.

  • I have taken diclofenac four or five years ago for a hip problem, and thought that perhaps it made me very slightly more wheezy after several days, although that could have been just natural variation in the level of my symptoms. Certainly, as a teenager, I used to take mefenamic acid (Ponstan) for dysmenorrhea with no ill effects at all.

    I probably wouldn't risk taking it again unless I was under medical supervision and there were very compelling reasons to do so, like severe pain that wasn't being controlled by any other class of pain-killer. I only take this cautious attitude because my asthma tends to be fairly severe anyway; I have never noticed a dramatic effect.

    This despite being warned by several junior doctors and nurses that brittle asthmatics should *never* take NSAIDs and that the consequences would be devastating - not so!

  • That sounds like the pain i had when i got pnumenonia, i never had chest pain like that in my life, it started with my whole back kinda like muscle cramps, then it progrssed to under my breast bone, shoulder and right side back, and it hurt as i was breathing, they told me the pain was associated with coufing so much with my bronchitis that my muscles were overworked, aslo related to pnumoneia

  • You are right, amandana, the pain associated with pneumonia does tend to be typical pleuritic type chest pain - stabbing in nature, and worse on taking a deep breath and coughing.

    It's usually due to having a bit of pleurisy (inflammation of the pleura - the linings of the lung) in association with the inflammation of the lung tissue itself that you get with infections like pneumonia. If you can take them without worsening of your asthma, NSAIDs such as ibuprofen are particularly good for this, as they have an anti-inflammatory effect as well as a painkilling effect.

    As you say, though, it can also be due to your respiratory muscles having to work harder than they are accustomed to because of the infection - that tends to be why a lot of asthmatics get these sorts of pains, especially during and after attacks. If the intercostal muscles (the ones in between the ribs) have to work too hard, they can go into spasm, which can be extremely uncomfortable.

    It's always best, though, if you get this sort of pain, especially if it's new to you, to get it checked out with your doctor, just because there is a long list of potential causes. Obviously, if it is muscle fatigue and spasm, there's not much that can be done except general measures like painkillers and heat, and of course treating the asthma symptoms causing the overworked muscles. However, there is always the possibility that it is being caused by something potentially dangerous that needs more specific treatment, such as pneumonia, a pulmonary embolus (blood clot in the lung) or a pneumothorax (collapsed lung).


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