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.
Bill Hepke, Yorkshire.
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 ten 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.
A permanent cough is uncomfortable and irritating — more so now, during the Covid pandemic, than ever before
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.
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.
Susan Lawrence, St Albans, Herts.
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
