Why Does My Chest Hurt When I Cough?

An overview of cough and chest pain

Coughing is common to us all and is a natural reaction of our bodies. When the nerves in our throat or airways are irritated, they initiate a message to our brain. This causes the diaphragm to spasm and produce a cough. This is designed to send a forceful wave of air through our lungs and clear our airways of irritants. Usually, this is a good sign and is a protective mechanism. 

Chest pains are more serious than coughs and can indicate a more serious underlying health condition. These pains can be sharp or mild, widespread or localized to a specific area. If a cough is causing severe discomfort, an individual should seek medical attention.

Otherwise, if the cough is mild, non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or paracetamol should relieve the pain. 

We all have coughed at least once in our lives: when we get a cold, when we choke, when we have an allergic reaction or when we inhale irritants. However, a cough can also be a sign of something more serious - especially when accompanied by chest pains. This article will explore various conditions that can cause us to cough and experience chest pains.

Possible causes of chest pain when coughing

There can be various reasons for coughing and chest pains. Some are mild and not of great concern. Others can be quite serious with the need to visit the hospital. In this section, we will explore the various causes of coughing and chest pain.

Pneumonia

Pneumonia is an inflammation of the air sacs of the lungs caused by an infection. The inflammation causes the lungs to fill with fluid or pus, making it difficult to breathe. This infection can be caused by a variety of microorganism such as: bacteria, viruses and fungi. Hence, the treatment is tailored to target the underlying causative agent. For example, bacteria will be treated with antibiotics.¹

This infection can cause chest pains as tissue in the lungs is damaged by inflammation and the body will react to the infection by inducing cough, to disperse the fluid. However, this can result in excessive coughing which can cause more damage to the tissue of your lungs, exacerbating the chest pains. This can favour the infection as it would increase the transmission of the disease. 

Bronchitis

Bronchitis is similar to pneumonia as it is an infection of the lungs but more specifically bronchitis is an infection of the bronchi. These are the airways that connect to the air sacs in the lungs. It also causes chest pains when coughing in the same way as pneumonia.

Bronchitis can actually be split into two conditions: acute bronchitis and chronic bronchitis. Acute bronchitis is defined as a temporary inflammation that can last up to 3 weeks. On the other hand, chronic bronchitis is a persistent inflammation of the lungs that causes coughing. The condition can be described as chronic when the cough lasts at least 3 months of the year and for two years in a row. In addition, chronic bronchitis comes under the umbrella of chronic obstructive pulmonary disease (COPD) which will be explored further in this article.

Pleurisy

Pleurisy is an inflammation of the lungs, like pneumonia and bronchitis, which affects the pleura (the sheet-like tissue which encases the lungs). However, this will cause a sharp chest pain which will be worse when you cough. As there is no excess mucus or fluid in the lungs, the cough will also be a dry cough. In addition, pleurisy can be caused by a bacterial or viral infection. There can also be a build up of fluid in the lungs, known as pleural effusion, but this is likely to be caused by pulmonary embolism (see below).

Flu

We have all had the common cold but the flu is much more serious, especially for children and the elderly. This is an infection caused specifically by influenza virus. Usually, this will get better on its own and, while uncomfortable, is not particularly threatening. In addition, there are a variety of symptoms of the flu, one of which is a dry cough. However, chest pains are very unlikely with the flu. Though in some cases, chest pains can occur but the flu, in this case, is more likely to be masking another illness.²

Chronic obstructive pulmonary disease (COPD)

This article has briefly mentioned COPD in relation to chronic bronchitis, but this term refers to more diseases than just chronic bronchitis. In essence, COPD is an umbrella term for inflammation of the lungs which causes lasting difficulties breathing. Mainly, it refers to emphysema and chronic bronchitis, but it also refers to difficulty breathing from excessive smoking. In addition, coughing is a symptom of COPD but chest pains are not. Specifically, the cough is a chesty cough with phlegm that can often be dismissed as a “smoker’s cough”.

Asthma

Asthma is a condition that is increasingly on the rise due to air pollution.³ It is an inflammation of the airways that causes them to narrow which makes breathing difficult. This is persistent, but there can be an acute exacerbation of symptoms known as an “asthma attack”. Often, asthma presents itself in childhood, but can occur at any age. In addition, the main symptom is difficulty breathing, but coughing can occur. Chest pain specifically is unlikely an asthma, but a feeling of tightness in the chest is common. 

Acid reflux

Acid reflux is when the opening to the stomach opens at the wrong time, allowing stomach acid to release into the esophagus (throat). This will cause heartburn and a sour taste in your mouth. In addition, acid reflux can cause coughing as the body reacts to the acid. However, it is unlikely to cause chest pains aside from the feeling of heartburn. 

Pulmonary embolism

This is when an artery to the lung is blocked by a blood clot. This is very serious and can be life-threatening if not treated. It causes the tissue in the lungs to die off, which may permanently affect your ability to breathe. In addition, this condition will definitely cause chest pains and coughing. The cough may also include blood, as this is damaged lung tissue being coughed up.

Lung cancer

Tumors can grow anywhere in the body, including the lungs. This damages the tissues of the lung, and like any cancer, is serious and should be treated. The main symptom of this is coughing, as well as breathlessness and chest pains. The coughing can also be bloody due to damage to the lung. Famously in Breaking Bad, the main character has lung cancer which initiates the events of the show.

Lupus

This is an autoimmune disease that affects the whole body, not just the lungs. The immune system attacks its own cells and the disease can often present with a butterfly blush on the face. The symptoms can include chest pains and coughing if the lungs are affected. In addition, lupus can cause a variety of complications such as an increased risk of cancer.⁴

Is chest pain common with dry cough?

A chest pain with a dry cough is only common with excessive coughing. As there is no mucus to expel in dry coughing, it can be quite abrasive. Therefore, excessive coughing can cause damage to our lungs and our throats which leads to chest pains. For example, rib fractures can be caused by coughing.⁵

How do I know if my chest pain is serious?

There are several signs that your chest pain may be serious:

• Spreading to other areas in the body such as the left arm and jaw
• Lasting more than 5 minutes
• Doesn’t go away after taking medication 

If you experience any of the signs above, seek medical attention immediately.

Diagnosis 

A doctor can diagnose a patient using a variety of examination procedures and with coughing or chest pains - this would be no different. One of the main ways might be a chest x-ray. With pneumonia, darker areas might occur in the lungs which indicate that they are filled with fluid or pus.⁶ In addition, with chest pains, an ECG might take place to determine if there is any cardiovascular association.

Treatment for cough and chest pain

There are many over-the-counter treatments or prescriptions for coughing and chest pains. For coughing, cough syrups can be commonly bought from shops or pharmacies. Cough sweets can also be purchased which will soothe the throat. For chest pains, painkillers can be bought at a store or stronger painkillers can be prescribed. However, both coughing and chest pains are symptoms of diseases. Therefore, treatment for the underlying disorder should be sought by consulting with your doctor.

Home remedies

Often for treating coughing or chest pains, there are a variety of home remedies which vary by culture. Honey can be used and is documented to have antibacterial effects.⁷ Another remedy is onion syrup where a peeled onion is cooked in boiling water and the water is drunk afterwards.

Complications

Coughing can cause complications such as fractured ribs if it is excessive, as previously mentioned. However, this is in rare circumstances and coughing does not usually cause complications. In addition, chest pain is a complication by itself and is caused by an underlying condition.

Prevention

Prevention of coughing and chest pains depends on the condition. With the common cold, steps to prevent it are similar to that of steps to prevent Covid as they are both caused by viral agents. Washing your hands and avoiding contact with people who are ill will prevent the transmission. For chest pains, it will very much depend on the conditions but good general advice is to adapt a healthy lifestyle.

When to see a doctor

A doctor should be consulted when coughing or when chest pains become uncomfortable. For coughing, a COVID-19 test should be taken to eliminate the possibility. After which, a doctor should be seen for medicine. For chest pain, it is generally good advice to see a doctor if the pain lasts longer, even if it is mild. When both symptoms present together, then a doctor should be seen as soon as possible to receive treatment or to detect if there is underlying cause.

Summary

There are a variety of causes for coughing and chest pains. These range from pneumonia to common acid reflux. When addressing “Why does my chest hurt when I cough?”, we need to look at the circumstance of the patient and assess whether there are any other conditions present. You should always consult a doctor if your chest hurts when you cough.