Three men, two of them with barrels in their chests

Understanding Barrel Chest with COPD

If you have COPD or care for someone who does, you probably are aware of the four most common symptoms of this condition:1

  • Shortness of breath, especially during activity
  • Chronic cough, often producing a lot of mucus
  • Wheezing
  • Chest tightness

There are other symptoms, such as fatigue, but those are the most common. But have you ever heard of the term, "barrel chest" in relation to COPD? If not, you're probably not alone. It's not always talked about, but it is quite common during the later stages of COPD, or emphysema.

What is a barrel chest?

This is simply a term to describe the shape of the ribs in your chest and thoracic regions. Your ribs form what is called a "cage" of bones that surround your lungs, diaphragm, and heart. The ribs are 12 pairs of curved bones that attach to the spinal column in your back. They circle around to the front of the body where the top 7 pairs attach to the sternum, also called the breastbone. The next 3 pairs attach to a kind of cartilage in the front. The final 2 pairs are attached only to your spine, but "float" in the front.2

In healthy people, the ribs slope downward slightly from back to front. But in people with a barrel chest, the shape of the rib cage tends to round outward and your chest area starts to look as round as a barrel. Think of how your chest expands when you take a deep breath in and hold it.

What causes a barrel chest?

There can be a number of possible causes for a barrel chest, including:3

Bodybuilders with overdeveloped chest muscles may also appear to have a barrel chest. However, this post is concerned with barrel chests that result from chronic respiratory conditions, such as emphysema and severe asthma.

In the form of COPD known as emphysema, there can be many changes in the lungs that make it harder to breathe over time.3 Chronic inflammation leads to swelling and irritation in the airways. The airways and the cells in them also become more rigid and less able to expand and contract as you breathe. Your diaphragm also flattens and weakens, which matters because it's a key muscle for moving air into and out of your lungs.

As a result of all those changes, your lungs tend to stay partially inflated all of the time. And that causes your rib cage to stay expanded too. As some people age, there may also be a forward rounding of the back, making the barrel chest appear to be even more pronounced.4

Your barrel chest can worsen over time as emphysema progresses, making breathing even more difficult.

Should I be concerned about barrel chest?

Worrying is never the answer! However, what you need to understand is that barrel chest with emphysema cannot be treated specifically. But if your treatment plan for emphysema can lessen or improve any of your symptoms, you may find that the barrel chest lessens slightly too.

In other words, the barrel chest itself is not generally treated. The underlying condition, in this case emphysema, is treated. There is no cure for emphysema, though, so it won't be possible to completely reverse barrel chest either, once it develops.

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