I have asthma and my chest hurts: what should I know?

Chest pain with asthma should be assessed by its character, breathing symptoms and response to your action plan. Tightness during a flare can accompany wheezing, cough and breathlessness, but new, severe or unusual pain should not automatically be attributed to asthma.

Asthma can narrow the airways and make the chest feel tight or sore, especially after repeated coughing or strenuous breathing. Allergic rhinitis and house dust mite allergy may trigger airway symptoms. Chronic cough can strain chest muscles. Chest tightness, wheezing and cough often occur together during airway narrowing, yet chest pain can also arise from heart, lung, muscle or digestive problems, which require clinical assessment.

Stop exertion and sit upright. Follow your prescribed asthma action plan, including the reliever dose and timing it gives you. Move away from smoke, dust or another known trigger. Avoid lying flat if breathing feels difficult. Note whether the pain is pressure, sharp pain or soreness with movement, and record wheezing, cough, fever, dizziness and how your reliever affects symptoms. Do not delay help to test whether it settles.

Call emergency services for crushing or heavy chest pain, pain spreading to the arm, jaw or back, severe breathlessness, blue lips, fainting, confusion or inability to speak normally. Seek urgent care when chest pain is sudden, persistent, worsening, linked with coughing blood, or does not improve as your asthma plan expects. Arrange a review after a flare or when symptoms are waking you, limiting activity or needing reliever medicine more often.

Does this pain fit airway tightness, muscle strain or another cause? Is my inhaler technique correct? Should my action plan change? Do I need breathing tests, an ECG or other assessment? When would nebuliser treatment be appropriate?