Can a chronic cough cause costochondritis?

Can Chronic Cough Cause Costochondritis?

Yes, chronic cough can cause costochondritis as the repetitive mechanical strain from persistent coughing can lead to inflammation of the costochondral junctions in the chest wall.

Mechanism of Costochondritis from Chronic Cough

Costochondritis is an inflammatory condition affecting the cartilage that connects the ribs to the sternum (breastbone). When examining the relationship between chronic cough and costochondritis:

1. Mechanical Factors:

   • Chronic cough creates repetitive strain on the chest wall
   • The forceful contraction of respiratory muscles during coughing puts stress on the costochondral junctions
   • This repeated mechanical stress can lead to inflammation of these junctions 1

2. Risk Factors That Increase Likelihood:

   • Severity and frequency of cough episodes
   • Duration of chronic cough (defined as lasting ≥8 weeks) 2
   • Pre-existing respiratory conditions like chronic bronchitis 2

Clinical Presentation

When costochondritis develops secondary to chronic cough, patients typically present with:

• Localized chest wall pain that worsens with coughing
• Tenderness to palpation over the affected costochondral junctions
• Pain that may be reproduced by certain movements or deep breathing
• Absence of swelling or erythema (distinguishing it from infectious costochondritis) 1

Diagnostic Approach

Diagnosis of costochondritis secondary to chronic cough is primarily clinical:

• History of chronic cough preceding chest wall pain
• Reproducible tenderness over costochondral junctions on physical examination
• Absence of other concerning features (fever, swelling, erythema)

For patients over 35 or with cardiac risk factors, it's important to rule out cardiac causes of chest pain, as coronary artery disease can coexist with chest wall tenderness in 3-6% of adults 1.

Management Strategy

Treatment should address both the underlying chronic cough and the resulting costochondritis:

1. Treat the Underlying Cause of Chronic Cough:

   • For chronic bronchitis: smoking cessation is the most effective intervention 2
   • Consider appropriate bronchodilator therapy for patients with COPD or asthma 2
   • Short-term use of cough suppressants like codeine or dextromethorphan may provide symptomatic relief 2

2. Manage Costochondritis:

   • NSAIDs or acetaminophen for pain and inflammation 1
   • Activity modification to avoid exacerbating movements
   • Local heat application may provide relief
   • Rest from activities that worsen symptoms

Important Distinctions

It's crucial to distinguish between non-infectious costochondritis (caused by mechanical factors like chronic cough) and infectious costochondritis:

• Non-infectious costochondritis is self-limiting and responds to conservative management
• Infectious costochondritis presents with purulent drainage, fever, and requires antibiotics and possibly surgical debridement 3

Clinical Pearls and Pitfalls

• Pearl: Costochondritis from chronic cough typically resolves when the cough is effectively managed
• Pitfall: Dismissing all chest pain as costochondritis without appropriate cardiac evaluation in at-risk patients
• Pearl: Addressing the underlying cause of chronic cough (such as smoking cessation in chronic bronchitis) is more effective than treating symptoms alone 2
• Pitfall: Failing to recognize that persistent cough can cause secondary musculoskeletal issues beyond the respiratory system

By addressing both the chronic cough and resulting costochondritis, most patients will experience significant improvement in their symptoms and quality of life.