What is the treatment for costochondritis caused by a cough?

Treatment of Costochondritis from Cough

For costochondritis caused by coughing, treat with NSAIDs (such as ibuprofen or naproxen) or acetaminophen for pain relief, combined with activity modification to avoid chest muscle overuse, while simultaneously addressing the underlying cough with bronchodilators if bronchospasm is present. 1

Primary Treatment Approach

Pain Management

• NSAIDs are the first-line treatment for costochondritis inflammation and pain, where medically safe and appropriate 1
• Acetaminophen can be used as an alternative analgesic, particularly in patients with contraindications to NSAIDs 1
• The condition is typically self-limited and benign, resolving within several weeks with conservative management 1

Activity Modification

• Advise patients to avoid activities that produce chest muscle overuse or repetitive movements 1
• Physical exertion and severe coughing are primary causes of costochondritis, so reducing these triggers is essential 2

Treating the Underlying Cough

For Acute Bronchitis-Related Cough

• Albuterol (short-acting β-agonist) is first-line treatment to reduce cough duration and severity, with approximately 50% fewer patients reporting cough after 7 days 3
• Antitussives containing dextromethorphan or codeine provide modest effects on cough severity and duration 3
• Avoid routine antibiotics for uncomplicated acute bronchitis, as they provide minimal benefit (reducing cough by only half a day) with potential adverse effects 3

For Chronic Bronchitis-Related Cough

• Short-acting β-agonists should be used to control bronchospasm and may reduce chronic cough 3
• Ipratropium bromide improves cough in stable patients with chronic bronchitis 3

When Conservative Treatment Fails

Physical Therapy Interventions

• If symptoms persist beyond typical self-limited course (several weeks to months), consider referral to physical therapy 4
• Manual therapy directed at the cervicothoracic spine and ribcage, combined with therapeutic exercise, shows clinically meaningful improvement 4
• Rib manipulation and soft tissue mobilization techniques can provide complete resolution in atypical costochondritis cases 5
• Physical therapy typically requires 4-5 sessions to achieve meaningful outcomes 4

Critical Diagnostic Considerations

Rule Out Serious Causes First

• In patients older than 35 years or those with cardiac risk factors, obtain an electrocardiogram and possibly chest radiograph before diagnosing costochondritis 1
• Coronary artery disease is present in 3-6% of adult patients with chest pain and chest wall tenderness to palpation 1
• Any patient with cardiopulmonary symptoms requires cardiac workup regardless of reproducible chest wall tenderness 1

Confirm Diagnosis

• Diagnosis requires reproducible pain by palpation over the costal cartilages 1
• In children, adolescents, and young adults without cardiac risk factors, history and physical examination documenting reproducible palpation tenderness is usually sufficient 1

Common Pitfalls to Avoid

• Do not prescribe antibiotics for uncomplicated acute bronchitis despite patient expectations, as they lack benefit and have potential adverse effects 3
• Do not assume all chest wall pain is benign costochondritis without appropriate cardiac evaluation in at-risk populations 1
• Do not fail to address the underlying cough trigger, as persistent severe coughing perpetuates the costochondritis 2
• Do not overlook bronchodilator therapy when bronchospasm is contributing to the cough 3
• Provide realistic expectations that cough typically lasts 10-14 days, as patient satisfaction depends more on communication than receiving antibiotics 3