Chest pain with deep breathing and often when coughing may be due to a host of causes related to the thoracic cavity, upper abdomen and even the neck. It is often thought that the pain is only emanating from the lungs but strictly speaking, the lungs do not feel pain as its nerve supply is mainly autonomic.
However, this should not detract from the fact that many respiratory conditions may be associated with pain, either from within the bronchi, pleura or chest wall, all of which are related to respiration. Chest pain, like abdominal pain and pain anywhere else in the body, is non-specific. This means that on its own, pain is not a direct indication of a specific condition. While it is a prominent feature of inflammation, there are many non-inflammatory causes that can elicit pain.
Identifying concomitant signs and symptoms with like sputum, fever, dizziness or aggravating factors like pain upon deep breathing or coughing, provides a better indication of the possible causes. Nevertheless, the list of causes can be quite exhaustive. The causes of chest pain discussed below arises or is exacerbated when breathing in deeply and coughing. This does not mean that a cough will be present in every one of these causes.
Causes of Chest Pain with Deep Breathing
Chest wall pain is one of the more common causes of chest pain with deep breathing and coughing. Soft tissue injury, muscle strain, fractured ribs or sternum and joint/cartilage disorders like costochondritis need to be considered. Usually chest wall causative factors present with tenderness over the inflamed area and swelling or redness may also be visible on the surface.
Airways, Lungs and Pleura
Although conditions isolated to the lung may not cause pain, infection and masses may either inflame or irritate the pleura (pleuritic pain) and should therefore be considered. The most important cause to consider is pleuritis and pleurisy where pain with deep breathing, particularly inhalation, and coughing is a characteristic symptoms. Other conditions like bronchitis and pneumonia may not cause significant chest pain, however, these cases often cause chest wall pain due to persistent coughing. In cases of sudden severe pain, especially where there is difficulty breathing, a spontaneous pneumothorax needs to be considered.
Heart and Blood Vessels
Pericarditis is one of the more common cardiovascular causes of chest pain when breathing in deeply or coughing. Most other cardiovascular causes are not significantly altered by deep breathing. If the pain arises suddenly, then conditions like thoracic aortic dissection and pulmonary embolism also need to be considered.
Other causes of chest pain when breathing deeply or coughing may be related to the gastrointestinal system and abdominal contents. This includes :
- gallbladder and bile duct diseases and gallstones
- acute pancreatitis
- hiatal hernia
- liver disease
- liver, subdiaphragmatic abscess
Chest Pain with Coughing
Chest pain may be accompanied by other signs and symptoms like coughing. The pain may be due to forceful or persistent coughing, or can occur independently of the coughing. Nevertheless it is important to identify if both chest pain and coughing are related and to isolate the possible causes of both. Chest pain with coughing is not always due to respiratory causes since certain gastrointestinal and cardiac (heart) conditions can cause chest pain and also trigger coughing.
Causes of Chest Pain Coughing
Most diseases that affect the respiratory passages may result in coughing and chest pain. This may be due to inflammation of the airway, mucus production or fluid in the lungs. Infections of the respiratory passages are by far the most common cause of chest pain accompanied by a cough. However other pathologies that do not directly affect the respiratory passages may also cause coughing and chest pain.
- Common cold, seasonal flu (influenza), H1N1 swine flu, SARS (sudden acute respiratory syndrome).
- Epiglottitis, tracheitis, acute or chronic bronchitis, pneumonia and croup.
- Tuberculosis (TB).
- Opportunistic infections of the respiratory tract in HIV/AIDS patients.
- Post nasal drip.
- Chronic obstructive pulmonary diseases (COPD) like emphysema.
- Smoke inhalation.
- Foreign body or aspiration.
- Pleurisy which may cause chest pain and coughing upon deep breathing.
- Heart failure.
- Pulmonary embolism.
Some types of the following drugs can cause coughing which may result in chest pain. This side effect may not occur in
- Antihypertensives, particularly ACE inhibitors.
- Certain statins which are used for lowering blood cholesterol.
- Some over-the-counter (OTC) cold and flu medicines.
- Certain weight loss drugs.
- Gastroesophageal reflux disease (GERD).
- After an endoscopy or barium esophagogram.