A cough with chest pain: Cause, investigations and treatment

Cough and cold is a common symptom we suffer at least 4-6 times a year. Cough can be of multiple characteristics. Cough is a protective reflex. It protects our respiratory tract when foreign objects invade it. Cough with chest pain has particular significance. It can occur because of multiple causes. Since the treatment of cough with chest pain depends upon the underlying cause we need to find out the cause for this condition.

Why ‘cough with chest pain’?

Cough with chest pain can occur in multiple diseases and conditions. We will first see why there is an occurrence of chest pain while coughing. It is also called as the mechanism of chest pain while coughing.

Cough with chest pain can occur because of following mechanisms:

  • Muscular pain: if you have a cough with multiple spasmodic episodes, the cough may come in bouts of multiple cuffing episodes. Because of this, multiple boats cough like the firing of a machine gun, muscles may hurt while coughing. This condition can cause coughing and chest pain. You can have this problem even in the case of pharyngitis in which you don’t have any problem in your chest and lungs.
  • Problems of chest wall: Your chest wall is mainly made up of muscles, bones and cartilages joining the bones. Problems with any of these components of the chest wall may cause pain. These problems can be because of injury causing fracture of bone of the chest or because of inflammation of cartilages called costochondritis.
  • Lung infections: Your lungs are situated in your chest. If you have lung infections like pneumonia, it may feel the air cavities in your lungs with fluid. It may also cause inflammation of the covering of your lungs called pleura. This information can cause ‘cough and chest pain’. In these conditions you may also have pain while deep breathing.
  • Neurological cause: Your chest muscles are supplied by the nerves that come from your spine. If these nerves are injured and trapped, it may cause back pain in the area that nerve covers. This pain can increase when you move. It may also present as a cough with chest pain.

What are the causes of ‘ Cough with chest pain’?

After knowing the mechanism of the condition now we will see which diseases and conditions cause cough with chest pain.


Tuberculosis is a lung infection caused by Mycobacterium tuberculosis. Tuberculosis can affect any organ of the body. This disease most commonly affects the lung. This disease can cause conditions of the lung like pneumonia, lung abscess, fibrosis, pleural effusion, pleuritis. Additionally patients may suffer from loss of appetite, weight loss and fever. This disease may present as cough with chest pain.


Pneumonia is an infection caused by bacteria, viruses, fungus or parasites. In pneumonia lower respiratory tract and lung tissue and pleura may get affected. This infection induces inflammation and can cause coughing and chest pain. Other symptoms of pneumonia include fever with chills, loss of appetite, difficulty in breathing.


Pharyngitis is caused by inflammation of the pharynx. This condition can be caused by bacterial or viral infection. It may last for a few days to a few weeks. Repeated cough episodes can cause chest pain. Even if there is no pathology in lungs in this condition it may present like cough with chest pain.


Bronchitis is particularly caused by allergy or viral infections. This condition may last for a few weeks to a few months. There are repeated bouts of cough. This repeated bouts of coughing can cause fatigue of the muscles of the chest. It may hurt your chest while coughing. It may present as a cough with chest pain.

Pulmonary embolism

Pulmonary embolism is a condition in which a blood clot is formed in your body and it is carried to your lung. This blood clot gets stuck in the vessels of the lung. It stops the blood supply to the part of the lung and pleura. As the blood supply of the particular area is stopped there is no oxygen supply to the area. This causes necrosis of the tissue in the area. This necrosis is a very painful condition. This pain may occur at rest and may increase when you cough. This condition presents as a cough with chest pain.

Lung cancer

Like any other organ cancer may affect your lungs. Lung cancer is more common in people with the habit of smoking. Lung cancer can present chest pain and difficulty in breathing with cough. Till the long cancel shows symptoms of cough and chest pain it is very advanced cancer.

Fractured rib cage bone

Your rib cage bone can get fractured in chest injuries like road traffic accidents. The fractured part of bone may get inflamed. Also the fracture part of the bone may get depressed and press on the covering of the lungs while breathing and coughing. When it gets rubbed on the pleura of your lung, it causes a pain sensation that is very severe. This condition may cause a cough with chest pain.

Foreign body aspiration

Foreign body aspiration is inhaling the edible food and other objects while breathing. This condition can occur accidentally in children and adults. It presents with a sudden bout of coughing while eating. This condition can gives rise to pneumonia and chest pain with cough. It may present as a cough with chest pain.


Asthma is a reversible constriction of airways in the lungs. This construction and inflammation of the airway reduces the diameter of the airways of the lungs. Reduced diameter produces increased resistance while breathing. So patients may seem like they are working hard to breathe. This condition also causes chest pain and cough.


Smokers have an increased tendency of various lung diseases. Smoking can enhance the chances of bronchitis, asthma, pneumonia and lung cancer. All these conditions can cause coughing and chest pain.

Gastric reflux

Gastric reflux is a condition in which acidic content of the stomach comes in the esophagus. The gastric content may come further up into the mouth and pharynx. Because of this acid there may be irritation and ulcer formation in the esophagus. Whenever this acid in the esophagus and pharynx it induces coughing. There is chest pain. So it may present as a cough with chest pain.


Flu is a viral infection of the upper respiratory tract. It may progress to involve the lower respiratory tract causing pneumonia or bronchitis. It induces the inflammation in the small airways and pleura. It may cause chest pain while coughing.


The world is suffering from the pandemic of the covid-19. Moderate to severe disease can present as fever with chills, difficulty in breathing and a cough with chest pain.

What are the tests needed in coughs with chest pain?

For the treatment of the condition, finding out the underlying cause is an important thing. The diagnosis can be clinically done or may need some tests. Depending upon associated clinical symptoms and physical findings, your doctor may suggest you to do some tests.

The following are the tests needed for the diagnosis: 

  • X ray chest: This test is needed to diagnose various conditions of the lungs like pneumonia. It may also be needed to diagnose conditions like tuberculosis and lung cancer, bone fractures. Chest X-ray may be needed to exclude the other causes of difficulty in breathing in cases of asthma and bronchitis.
  • HRCT chest: This is high resolution computed tomography of the chest. This test is needed to find out the foreign bodies in the airway. It also detects the presence of conditions like pneumonia and lung cancer, tuberculosis, bone fractures. If diagnosis of the covid-19 is doubtful, HRCT chest is the test that is sensitive enough to detect covid-19 pneumonia.
  • MRI chest: Some patients may need MRI for the diagnosis.
  • Sputum examination: If the cough with chest is suspected to be because of tuberculosis sputum examination may be needed for diagnosis. The sample is taken in the morning after sleep and examined under a microscope with ZN staining. Sputum culture is done to detect the Mycobacterium tuberculosis, but it takes time of weeks for diagnosis.  Genexpert is more rapid and sensitive and gives results in a few hours.
  • ESR: Erythrocyte sedimentation rate is the test that detects chronic infection. If ESR is raised chronic inflammation or infection may be detected and helps in diagnosis of chronic problems like autoimmune disease or tuberculosis.
  • Pleural tap: This test is needed in case of pleural effusion. The pleural fluid is taken with a needle and examined under microscope and its biochemistry is tested in this test. It may give the idea of an underlying cause like infection, tuberculosis or cancer. Pleural tap can be sonography guided tap.
  • Other blood tests like HBCBC may be needed depending upon the underlying suspected cause. To start the treatment further tests to know renal function and liver function may be needed as some drugs may not be tolerated in liver or kidney dysfunction.

What treatment is needed for a cough with chest pain?

As we discussed cough with chest pain can be because of various conditions from infection to lung cancer, the treatment involves management of underlying illness. Some causes like bronchitis need just symptomatic treatment and diseases like tuberculosis need treatment with anti tuberculosis antibiotics. 

The knowledge of the underlying cause helps immensely in deciding the treatment.

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