Persistent Cough and Chest Pain: When to Seek Medical Attention?

Q: Persistent Cough and Chest Pain: When to Seek Medical Attention?

Hello Sam： Based on your respiratory history, including a history of pneumothorax, allergic rhinitis, and chest pain (possibly neuropathic pain), if your symptoms are not too severe, you may choose to monitor your condition. <br>It is advisable to drink plenty of warm water and a

Persistent cough and chest pain?

Hello Doctor: I started experiencing persistent coughing every night between 11 PM and 1 AM about a week ago, which is more pronounced when lying down compared to other positions.
I feel an unbearable itch in my throat around the area between my collarbones, but there is no phlegm.
In the past two days, I have also started coughing during the day, and I feel pain in the area about three fingers wide from my right nipple towards the left.
The pain feels somewhat like a bruised injury; it doesn’t hurt when not pressed, but it does hurt when pressed.
However, there are no visible abnormalities at the pain site, and I have no recollection of any external trauma.
I work in information management, and I usually have my computer on during the night until I go to bed, in addition to my daytime work hours.
I do not smoke or drink alcohol, and there are no other smokers in my household.
I drink coffee and take vitamin B supplements, and sometimes I temporarily forget about the urge to cough when I am focused on work, but I occasionally have strong coughing fits.
I am 176 cm tall and weigh 68 kg.
In the past, I underwent surgery for a left-sided pneumothorax at Chang Gung Memorial Hospital in Kaohsiung in 1997, and my follow-up was good.
In June of this year, I visited a local clinic for persistent sneezing and runny nose, and the doctor informed me that it was due to nasal allergies and prescribed treatment for three and a half months, including oral medication and a nasal spray.
However, after three weeks of treatment, in early July, I felt discomfort in my left chest and started coughing, and I stopped the medication on my own without consulting a doctor.
About two weeks later, in mid-July, the discomfort and coughing in my left chest improved.
Recently, I have started coughing again for unknown reasons, and I am unsure if it is related to the previous issues.

Regarding other symptoms, I used to habitually clean my nasal passages while showering every day, possibly due to commuting by motorcycle, which would lead to some nasal discharge.
However, since developing nasal allergies, the amount of nasal discharge has significantly decreased.
Now, I often go three to four days without much nasal discharge, and when there is some, it is white rather than the yellow-green color I used to have.
As a frequent visitor to hospitals, I sometimes feel I should see a doctor, but the answers I receive after a long wait are often, “It looks fine; I’ll just prescribe you some painkillers.” I often feel confused about whether I should seek medical attention or self-medicate with over-the-counter drugs.
Doctor, should I go to the hospital for a consultation, or should I wait until the weather improves or my condition worsens or becomes clearer? If I choose to seek medical attention, which specialist should I consult, or what should I pay attention to? Thank you.

Sam, 30~39 year old female. Ask Date: 2009/08/10

Dr. Yang Wenda reply Pulmonology

Hello Sam: Based on your respiratory history, including a history of pneumothorax, allergic rhinitis, and chest pain (possibly neuropathic pain), if your symptoms are not too severe, you may choose to monitor your condition.
It is advisable to drink plenty of warm water and avoid maintaining one position for too long.
However, if you experience difficulty breathing (concerned about a recurrence of pneumothorax) or if your cough or sneezing symptoms become too severe, you may consider consulting a pulmonologist for follow-up chest X-rays and to prescribe some medications to alleviate your symptoms.
The above suggestions are for your reference.
Best wishes!

Reply Date: 2009/08/10

More Info

Persistent cough and chest pain can be concerning symptoms, especially when they disrupt your daily life and sleep. Given your description, it seems you have been experiencing a cough that worsens at night, accompanied by chest pain localized to the right side. This situation warrants careful consideration and possibly further medical evaluation.

When to Seek Medical Attention
1. Duration and Severity of Symptoms: Since your cough has persisted for over a week and is now accompanied by chest pain, it is advisable to seek medical attention. Coughing that lasts more than a week, especially when associated with pain, can indicate an underlying condition that needs to be addressed.

2. Nature of the Pain: You described the pain as similar to a bruise, which could suggest muscle strain from persistent coughing. However, it is crucial to rule out other causes, such as pleurisy (inflammation of the lining around the lungs), pneumonia, or even a pulmonary embolism, especially given your history of pneumothorax.

3. Associated Symptoms: If you experience additional symptoms such as fever, shortness of breath, or coughing up blood, you should seek immediate medical attention. These symptoms could indicate a more serious condition.

4. Impact on Daily Life: If your symptoms are affecting your ability to work or sleep, it is a sign that you should consult a healthcare provider. Persistent cough and pain can lead to fatigue and decreased quality of life.

Recommended Actions
1. Visit a Healthcare Provider: Given your symptoms, it would be prudent to schedule an appointment with a healthcare provider. They may perform a physical examination, listen to your lungs, and possibly order imaging studies such as a chest X-ray to rule out any serious conditions.

2. Consider a Specialist: Since you have a history of respiratory issues, you might benefit from seeing a pulmonologist. They specialize in lung conditions and can provide a more in-depth evaluation of your symptoms.

3. Monitor Symptoms: Keep a diary of your symptoms, noting when they occur, their severity, and any associated factors (like activities or environmental changes). This information can be valuable for your healthcare provider.

4. Avoid Irritants: Since you work in a computer-based job, ensure that your workspace is well-ventilated and free from irritants. Consider taking breaks to stretch and move around, which can help alleviate some discomfort.

5. Home Care: In the meantime, you can try using a humidifier in your room to ease throat irritation and coughing. Staying hydrated is also essential, as it can help thin mucus and soothe your throat.

Conclusion
In summary, your persistent cough and chest pain warrant further evaluation by a healthcare provider. Given the potential for serious underlying conditions, it is better to err on the side of caution. Seek medical attention sooner rather than later, especially since your symptoms have changed and worsened. A thorough examination and possibly imaging studies will help determine the cause of your symptoms and guide appropriate treatment. Remember, your health is paramount, and addressing these symptoms early can lead to better outcomes.

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