Ask the GP: When a cough is a sign of acid reflux

A permanent cough is uncomfortable and irritating - and, during the Covid pandemic, also alarming
Dr Martin Scurr

Q - I was diagnosed with polymyalgia rheumatica in 2016. I have been taking the steroid prednisolone for five years, and have had a chronic cough since. Is the cough a result of the steroid? My doctor says the drug is causing reflux, which Gaviscon combats.


A - A permanent cough is uncomfortable and irritating - more so now, during the Covid pandemic, than ever before.

Polymyalgia rheumatica is a condition that typically affects those over 50 and begins as stiffness and aching in the shoulders, neck and hips.

This pain tends to resolve after two or three years and, as you know, can be controlled by steroid tablets such as prednisolone.

But that's not always the case, and I've seen patients who have experienced symptoms for as long as 10 years.

The coughing you experience is not a known side-effect of steroid medication. But, as you mention, steroids can cause an increase in stomach acid, which might have triggered the coughing.

If the current medication - the alkaline antacid, Gaviscon - isn't stopping this, you can speak to your GP about a proton pump inhibitor such as omeprazole. This will suppress acid secretion entirely and minimise, if not get rid of, the cough.

Alternatively, the cough could be due to the reactivation of latent tuberculosis (TB) - where the bacteria that cause TB are present in the body (usually in the lungs) and reactivated.

This may be the result of the steroids, which can activate the disease. TB causes coughing and possibly eventual symptoms of weight loss and night sweats.

For that reason, speak to your GP about testing for TB, too. This can be done with a chest X-ray and a blood test.

I do hope that one of these two routes of diagnosis may lead you to some relief.


Q - A few times each year I experience an aura, but without the usual headache. Lately I have experienced this four times in two days. A private neurologist once offered me migraine medication. Can you shed some light on it? I am 75.


A - An aura is a common precursor of some types of migraine.

It often starts as a bright or blind spot in your vision, sometimes expanding to geometric shapes or zig-zagging lines with a shimmering effect.

This is caused by a wave of abnormal nerve activity in the brain.

Patients often say these shapes resemble the walls of ancient forts, leading to the name 'fortification spectrum'.

Migraine affects around one in five women and one in 15 men (they are possibly more common in women due to hormones), and around 25 per cent of sufferers experience an aura.

You may be reassured to hear that in one form of the condition, the aura occurs without a subsequent headache.

According to a Japanese study from 2010, this type of migraine is experienced by 3.2 per cent of the general population - around one in 30 people.

Studies have suggested that migraine with aura increases the risk of ischaemic stroke, where an artery that supplies blood to the brain becomes blocked by a blood clot - although why this should be the case is uncertain.

However, you can be reassured that this increased risk is very small. In my entire career as a GP, and with a particular interest in migraine (I suffer them myself, without aura), I have never seen this happen.

Nevertheless, I acknowledge your concern - not least as the experience of aura, particularly with an increasing frequency in recent times, may be alarming.

To prevent any further worries, I would suggest seeing your GP to discuss your risk of stroke.

Most other associated factors, including high blood pressure, excess weight, smoking and lack of regular exercise can be helped with lifestyle changes.

These will minimise the chances of a stroke, which are only increased a tiny amount by the aura you experience.



::New food taxes won't solve our diet problems

By Dr Martin Scurr

LAST week I was asked on a TV news channel for my views on taxing foods containing salt and sugar. I have no doubt it would result in better health across the population, but there are bigger questions here - mainly about ethics.

The policy would hit those who can least afford it the hardest, as the poorest are most likely to choose industrialised, manufactured foods. These inevitably have high levels of salt and sugar.

Yet making sensible food choices can seem difficult for many of us, given the multiplicity of contradictory messages - not least recently, with world-class footballers being interviewed with cans of cola parked in front of them.

Let us hope that the time is coming when healthy ideas about nutrition are taught at school as a core subject.

But in the meantime, for most of us the best instant guide is Michael Pollan's book Food Rules. Its message is simple: "Eat food, not too much, mostly plants", and "Don't eat anything your great-grandmother wouldn't recognise as food". Sound advice indeed.

© Daily Mail

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