Samansara Asked :
I stopped smoking seven months ago after 40 years. I had a chronic smoker’s cough. I am still coughing but it seems worse to me. My doctor keeps telling me it is my sinus and has given me steroids, antibiotics, benzonatate to help with the cough, nasonex…….and the list goes on.
Now I have a stabbing pain in the sternum from all the coughing I am doing. My doctor assures me that all of this will pass with time but I feel as though I will never see an end and want to just give up. Should I see another doctor?
This question was posted under the Causes of Breastbone Sternum Pain article.
Any response by the Health Hype team does not constitute a medical consultation and the advice should be viewed purely as a guide. Always consult with your doctor before making any changes to your current treatment program. The information provided in this article is not an authoritative resource on the subject matter and solely intends to guide the reader based on the questions asked and information provided.
Dr. Chris Answered :
Chest pain with coughing even months after smoking is a frequent complaint. It is common to experience an aggravation of your sinusitis or allergic rhinitis (‘hay fever’) after you quit smoking. This can cause mucus to ‘drip’ to the back of the throat and trigger a cough (post nasal drip) or proceed further down the respiratory tract where it will cause a productive ‘wet’ cough. In this regard you doctor is correct and the medication he has put you on is to offer symptomatic relief, reduce the mucus production and treat or prevent bacterial infections.
However, given your age and the worsening cough, it is important to exclude any cardiac conditions as well. Firstly an ECG is necessary to ensure that this stabbing pain is not related to angina. Secondly an x-ray or CT scan will confirm or exclude any enlargement of the heart which can also be linked to heart failure. The latter is not often painful to this extent but can lead to a persistent cough, which may be mistaken for chronic bronchitis (smoker’s cough). Refer to the article on Heart Chest Pain.
Chronic bronchitis will not necessarily resolve completely now that you have stopped smoking. It can take a long period of time for the inflammation to ease and you should also confirm that your lung capacity is not reduced and there are no other signs of other chronic obstructive pulmonary disease (COPD) like emphysema. The pain itself may be related to the lungs or airways (refer to the article on Lung Chest Pain). The damage from years of smoking will not resolve immediately and a ex-smoker is at significant risk of the same diseases as a smoker up to two years after quitting smoking.
Persistent coughing often does lead to pain in the sternum as you describe and could have caused inflammation of the joints where the ribs meet the sternum (costochondritis). Remember that a cough is quite a violent action and with persistent coughing like what you describe, it is putting lot of pressure on your chest wall, so this pain could also be linked to muscular causes. Refer to the articles on Muscle Chest Pain and Bone Chest Pain.
The decision to seek a second opinion is your choice. If you are uncertain about any aspect of your treatment or management, then you should seek a second opinion and allay any fears that you may have. In your case, it would be a good idea to consult with a pulmonologist who specializes in respiratory conditions. It is also important to remember that the drugs that you are currently using can have a host of side effects, the most common of which is acid reflux. The rising acid can often produce the stabbing chest pains that you describe. Refer to the article on Gastric Chest Pain. Speak to your doctor about it.