Barrel chest is a condition in which the chest appears to be partially inflated all the time, with the rib cage broadened as if in the middle of a deep breath. The person may find it hard to breathe normally.
While people sometimes give the description “barrel-chested” to people with large chest muscles, a barrel chest in a medical sense may be the result of arthritis or chronic obstructive pulmonary disease (COPD), a group of diseases that cause serious respiratory problems.
While the condition does not always require medical treatment, when a barrel chest is the result of COPD it may become necessary to manage breathing symptoms.
Around 16 million people in the United States have COPD. This article explores the causes of barrel chest and discusses how to prevent the onset of factors that can lead to barrel chest.
Osteoarthritis (OA) is a disease that causes the cartilage at the ends of bones to break down.
People sometimes describe OA as the “wear and tear” type of arthritis, because it usually develops slowly and most often occurs in older adults.
A barrel chest can develop if OA develops where the ribs meet the spine. Stiffness occurs and the joints in the ribs lose their flexibility. Eventually, the ribs might appear to be stuck outwards.
The condition most often occurs in the spine, hands, hips, and knees. Stiffness and swelling are two of the most common symptoms.
Barrel chest often results from COPD, a respiratory disease that includes emphysema and chronic bronchitis. It is a serious condition that gets worse over time. A person with COPD may not be able to achieve full function without on-going care once the condition reaches its end stage.
The National Heart, Lung, and Blood Institute (NHLBI) notes that COPD is the third-leading cause of death in the United States.
Individuals with COPD find it harder to breathe as time progresses. This is because COPD damages the lungs in four different ways:
- The different parts of the lungs become less able to stretch or to expand and contract.
- Damage occurs in the walls of the air sacs, or alveoli, where the exchange of oxygen and carbon dioxide takes place.
- The airways or passageways through the lungs become irritated and swollen.
- Extra mucus is produced and clogs the airways.
The chest area may change shape to resemble a barrel, and the shape of the diaphragm, a key muscle for moving air and an out of the lungs, will also change. It loses some of its length and thickness and weakens.
If the lungs do not have full function, it can be difficult for someone to inhale or exhale completely. The lungs remain partially inflated most of the time, and the rib cage stays expanded.
This state of hyperinflated lungs can result in a barrel chest, normally during the later stages of COPD.
Individuals with a barrel chest from COPD may appear as if they are about to take a very deep breath, even though that this is often a difficult action to complete for people with the condition.
Emphysema is another of the diseases within COPD that might also lead to a barrel chest.
The lungs stay constantly inflated with air, giving the characteristic barrel chest appearance.
A chronic cough and shortness of breath after physical activity are two of the most common signs and symptoms of emphysema.
Other symptoms include:
- difficulty inhaling
- higher rates of oxygen being used, even when at rest
- high levels of carbon dioxide in the blood
- limited ability to exercise
- severe breathlessness
No cure is available for either emphysema or COPD, but treatments and lifestyle changes can help.
The following steps can help a person with emphysema regain quality of life:
- quitting smoking
- using supplemental oxygen
- regularly using inhalers
- adopting healthy exercise
- a balanced, nutritious diet
Researchers require more evidence before deciding whether the extent of a barrel chest reflects the severity of accompanying symptoms of emphysema or COPD.
In children, a barrel chest may be a symptom of cystic fibrosis (CF).
This is a genetic condition during which mucus builds up in organs throughout the body. In 75 percent of children with CF, diagnosis occurs before the age of 2 years.
Mucus in the lungs can lead to frequent infections and lung damage, sometimes resulting in a barrel chest.
Studies of children with severe cases of asthma also suggest a strong link between hyperinflated lungs and the development of a barrel chest. Children with a barrel chest may also experience slower growth rates.
As many presentations of barrel chest are the result of lung damage and conditions, treatment revolves around managing the effects of whichever condition has led to the damage.
There are no remedies or interventions currently available to fully cure COPD, emphysema, or CF. Treatment is, therefore, about making breathing as easy as possible and reducing inflammation.
People often use bronchodilator medications and steroids to treat the effects of COPD and emphysema that cause the expansion and swelling of lung tissue, including breathing difficulties.
Barrel chest that occurs due to OA is harder to control, but people use non-steroidal anti-inflammatory drugs (NSAIDs) to reduce the size of swollen tissue.
People with CF will use physical therapy techniques on the chest and back that help to loosen mucus on the lungs alongside many of the above medications.
However, even people who use treatment methods to restore quality of life after the development of barrel chest will not be able to reverse the symptom. The underlying diseases are progressive and symptoms very often do not improve.
Taking steps to reduce the risk of the diseases in COPD and osteoarthritis is crucial to preventing the restrictive effects of barrel chest.
Measures that focus on preserving lung health can keep COPD at bay, including
- People who smoke tobacco should stop immediately.
- Maintain a smoke-free home to reduce exposure to second-hand smoke.
- Wear the appropriate protective gear when spending time around chemicals and pollutants, for example when in the workplace or at home.
The maintenance of an active lifestyle and healthy body weight plays a key role in strengthening the cartilage and reducing the risk of OA. Excess body weight can place strain on the joints and tendons.
Measures to achieve this include:
- moderating sugar intake to keep blood glucose within normal limits, because sugars contain certain molecules that stiffen cartilage
- taking measures to avoid injury or physically risky situations where possible, as fractures and damaged cartilage drastically increase the risk of OA
- carry out 30 minutes of physical activity five times a week to stabilize the knees and hips
Preventing cystic fibrosis
As a genetic condition, no method is currently available to prevent the onset of CF, and barrel chest can develop early on in the condition.
However, the following steps can help reduce the severity of mucus build-up and the risk of damaging infections that can make the condition worse:
- Regular fluid intake can help thin the mucus.
- Exercise can help loosen mucus in the lungs.
- Avoiding irritants, such as cigarette smoke and industrial fumes, is important for reducing the buildup of mucus.
Barrel chest is a visible symptom of COPD, emphysema, osteoarthritis, and CF.
The lungs fill with air and are unable to fully breathe out. This gives the chest a pronounced barrel shape.
The treatment of barrel chest focuses on managing symptoms of the underlying condition and limiting the extent of lung damage.
As COPD, emphysema, and osteoarthritis are progressive conditions with no cure, live a smoke-free, active lifestyle is important for reducing the risk of these conditions.
People with CF have the condition from birth, so management involves reducing the build-up of mucus and the risk of dangerous infections.
Barrel chest is not often painful but serves as a sign of severe lung or inflammatory disease.
Does the physical change that occurs in barrel chest cause pain and, if so, what is the best way to manage it?
Typically, barrel chest does not lead to pain. However, some of the conditions that lead to barrel chest can also result in pain.
For example, osteoarthritis can lead to joint pain with movement. COPD can increase the risk of infections, which might cause pain when breathing deeply.
Manage joint pain with anti-inflammatory medications, and treat infections with antibiotics. Discuss the possible reasons for chest wall pain and the best treatments with your doctor.Daniel Murrell, MD Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.