What are the treatments for chest pain that occurs upon inhaling?

Treatment for Chest Pain on Inhaling

For chest pain that occurs upon inhaling, bronchodilators are the most effective first-line treatment, particularly inhaled short-acting beta agonists (SABAs) for patients with suspected asthma or reactive airway disease. 1

Initial Assessment and Management

• Perform rapid assessment to determine severity and potential causes of chest pain on inhalation, including evaluation of respiratory rate, oxygen saturation, and use of accessory muscles 1, 2
• Administer supplemental oxygen for patients with cyanosis, respiratory distress, or oxygen saturation <90% 1
• Monitor vital signs and cardiac rhythm continuously for patients with suspected serious causes of chest pain 2

Treatment Algorithm Based on Suspected Etiology

For Asthma/Reactive Airway Disease

• Administer inhaled short-acting beta-agonists (SABAs) via nebulizer or metered-dose inhaler (MDI) with valved holding chamber as first-line treatment 1
• For moderate symptoms: Use inhaled SABA every 60 minutes 1
• For severe symptoms: Use nebulized SABA plus ipratropium, either hourly or continuously 1
• Add oral systemic corticosteroids for patients with no immediate response to initial bronchodilator treatment 1

For Pulmonary Arterial Hypertension

• Consider inhaled prostanoids (treprostinil or iloprost) for patients with pulmonary arterial hypertension experiencing chest pain on inhalation 1
• Sildenafil may be beneficial in attenuating pulmonary artery pressure increases 1

For Pain Management During Procedures

• For procedural pain management that may involve chest discomfort during breathing:
  • NSAIDs administered IV, orally, or rectally may be used as alternatives to opioids 1
  • Avoid NSAID topical gels as they have not shown sufficient efficacy 1
  • Avoid inhaled volatile anesthetics outside operating room settings due to safety concerns 1

Special Considerations

• For patients with severe chest pain on inhalation that suggests acute coronary syndrome:

  • Administer aspirin (250-500 mg, chewable or water-soluble) 1, 2
  • Consider short-acting nitrates if there is no bradycardia or hypotension 2
  • Avoid nitroglycerin within 24 hours of sildenafil use 1

• For patients with suspected pulmonary embolism:

  • Provide oxygen support to maintain SaO2 >90% 1
  • Consider vasodilators administered by inhalation rather than systemically to improve hemodynamic status 1

Monitoring and Follow-up

• Perform serial assessments of symptoms, physical examination, peak expiratory flow (PEF), and oxygen saturation 1
• For patients with asthma exacerbations, schedule follow-up care within 1-4 weeks 1
• Consider discharge when symptoms improve and PEF is ≥70% of predicted or personal best 1

Common Pitfalls to Avoid

• Do not use methylxanthines, antibiotics (unless needed for comorbid conditions), aggressive hydration, chest physical therapy, mucolytics, or sedation for asthma exacerbations 1
• Relief with nitroglycerin should not be used as a diagnostic criterion for myocardial ischemia, as other conditions may show comparable response 2
• Do not delay treatment for patients with severe symptoms; early intervention prevents progression to respiratory failure 1