Cough, tight chest and shortness of breath

Cough with a tight chest and shortness of breath needs attention because breathing symptoms can worsen quickly. The combination may occur with airway irritation, infection, asthma, chronic lung disease, anaemia, angina or an allergic reaction. The pattern, speed of onset and accompanying symptoms help determine the safest response.

Acute bronchitis can cause cough and chest discomfort as the airways become inflamed. Asthma may cause episodes of chest tightness, cough and breathlessness, sometimes after exercise, cold air or an irritant. COPD and bronchiectasis can produce ongoing cough with breathing difficulty. Anaemia may make you breathless during activity because less oxygen is carried in the blood. Angina can feel like pressure or tightness with exertion. Anaphylaxis can begin suddenly with breathing difficulty, throat or tongue swelling, hives or dizziness.

Stop exertion and sit upright in a comfortable position. Move away from smoke, dust or a known trigger. Use a prescribed reliever inhaler exactly as your clinician directed; do not use someone else’s medicine. Note when the symptoms began, whether the cough is dry or produces phlegm, and whether fever, pain, palpitations or swelling is present. Arrange medical advice promptly if symptoms are new, recurring or limiting normal activity.

Call emergency services immediately for severe or rapidly worsening breathlessness, blue or grey lips, confusion, fainting, inability to speak in full sentences, sudden throat swelling or severe chest pressure. Urgent assessment is also needed for coughing blood, new breathlessness at rest, or chest tightness with sweating, nausea or pain spreading to the arm, back or jaw. Do not drive yourself if breathing is severely difficult.

Could this be an airway problem, infection, heart-related symptom or allergic reaction? Do I need a breathing test, chest examination or blood test? Which warning signs mean I should seek emergency help? If an inhaler is prescribed, how should I use it and when should I review the plan?