PMR Cough?

Posted , 7 users are following.

I have had PMR for about 7 years with varing levels of Steriods and manage it quite well.

Except now I have an awful cough.

It makes no difference if I am in or out or at home or abroad.

We have changed all the bedding and carpets etc.

I have seen the specialists and had the xrays and nothing can be found.

But every day at some time I have the attacks.

It is usually worse on a night and I rarely get a full nights sleep having to sit up to help counter the attack.

I am also on inhalers of all kinds,  and really am desperate for help.

We read about non acid reflux and mentioned this to the specialist who grasping at straws prescibed medication. I am already on medication for acid reflux to counter the problem caused by taking Prednisone for so long.

My GP then overruled  giving me it so another failure.

I obviously have tried increasing the Prednisone but no better.

Any help would be appreciated as I am running out of ideas.

thanks

Mo82150

1 like, 10 replies

10 Replies

  • Posted

    This is a long shot, but you could try asking for a decongestant.  I had a similar problem some years ago which was eventually solved in this way and while I am still rather hoarse at times, I know that is caused by acid reflux.

    I haven't been bothered by the cough since then.

  • Posted

    Sorry - what did the GP overrule? I do find it arrogant of a GP to dispute a specialist's advice or attempt to control a situation. Are the inhalers an attempt to control the cough or has the cough arrived since using the inhalers? 

    Did it occur to the specialist to test for non-acid reflux? Is it available in the UK? It is new and probably only available in specialist centres.  Acid and non-acid reflux are different things and the medication used for acid reflux won't alter the non-acid problem. A technique called "multichannel intraluminal impedance monitoring combined with pH monitoring" can be used but how available it is I'm not sure. This is extracted from a 2011 paper:

    "A significant number of patients with typical reflux-indicating symptoms do not respond to PPI treatment; nonacid reflux disease may be underlying in these patients. Nonacid reflux is common and causes symptoms very similar to the classical symptoms of GERD. Combined impedance-pH monitoring helps us to diagnose nonacid reflux disease, and patients with insufficient response to high-dose PPI should undergo impedance-pH monitoring where available. In contrast to pH monitoring alone, the combination of pH monitoring with multichannel impedance testing is a powerful tool to detect acid and nonacid reflux when performed while the patient continues to take a PPI twice daily.

    Current treatment approaches are limited; however, promising clinical trials are underway. The contemporary approach includes intensifying the same lifestyle modifications recommended for GERD. Baclofen (10 mg four times per day) before meals may be tried as suggested by small clinical trials. If both approaches fail and the patient requires a more definite therapy, a surgical approach may be considered. A requirement for surgery is that nonacid reflux be diagnosed with an impedance study because, until previously, failure of PPI treatment was considered to be a negative predictor of symptom improvement following antireflux surgery. It is presently unclear to what extent drug development will add further options in the near future – the clinical trial activity, however, appears promising."

    Was it Baclofen the specialist recommended? On what grounds did the GP say no? The medical literature mentions that about a third of patients do not respond to PPIs - possibly your PPI is simply not working and it is acid reflux after all. Have you tried ranitidine (Zantac) or another non-PPI instead? I understand that fundoplication surgery is a final resort in non-acid reflux. Using google, look for "what is nonacid reflux disease Martin Storr" to get the paper I took that extract from - had you seen that before? 

    Also using google I think you may find life-style change advice that might help if you haven't already tried it - I imagine that includes small meals, identifying trigger foods and so on, raising the head of the bed. I know there are also some experts who believe that reducing carbohydrate intake drastically can also have a dramatic effect on reflux and a small study was done which demonstrated that. 

    And frankly - if your GP is that unhelpful I would seriously consider finding another. You need one who will work with you and your specialist who is doing his best I imagine - not one who is plain obstructive.

    On a final note: I have just been googling and found a forum for Barret's oesophagus patients talking about a similar problem to yours. Some doctors claimed that swapping from omeprazole to lansoprazole would help - whether it did or not wasn't clear. However one contributor said:

    "I, too had a cough. And sometimes bad bile reflux. 

    Bile reflux in itself can cause a cough! 

    However I have now cured both the cough and the bile reflux, and am still taking Omeprazole! 

    It is certain, from my experiments that Omeprazole is the cause of both. Excess Omeprazole is metabolised in the liver, so it's hardly a surprise that bile production is affected! 

    The cure for both is to minimise the dose: little and often. I have been taking 1/2 of a 10mG capsule every 8 hours: first thing in the morning, about 3 p.m and again before bed."

    Worth a whirl maybe? Do tell me how you get on - your question has led me to info I'd not come across before and which may well be useful in the PMR story. GPs seem totally in love with PPIs - I had never seen before that they don't work in a third of patients, and they do have some unpleasant side effects which I did know as well as causing osteoporosis. I wouldn't take them if you paid me - the local hospital tried to put me on them a couple of years ago and then I discovered they were not covered by the state health system here, I would have to PAY full cost to take them. I'd never taken them before and decided I wasn't taking them now! They didn't appear to make much difference! If I needed anything I'd get some ranitidine (Zantac).

    • Posted

      Hi,

      thanks for your very helpful reply.

      I saw the Specialist  October the 15th then was called to see my GP when I submitted the presription for I think Baclofen but not sure as I never got the presciption back from him.

      The GP said they would not prescibe to over 60's as it could cause heart problems.

      I am now trying to find the name of the professor at Castlehill Hospital East Yorkshire who wrote about nonacid reflux with a view to sending him a letter/email.

      It seems they do lots there with this problem looking at Google.

      Google peptest

      I am going to approach my GP with that to try.

      thanks

      Mo82150

    • Posted

      Having read the full data sheets and other stuff about baclofen there is nothing there to say it causes cardiac problems in the elderly. 

      "Cardiovascular: Hypotension (0 to 9%). Rare instances of dyspnea, palpitation, chest pain, syncope."

      No mention anywhere of age restrictions except that care should be taken titrating the dose up from low to high in older patients as they may take longer to get used to it. It also says quite clearly that they will still probably tolerate the same upper dose, just it may take them longer to get used to it. Amongst the side effects are loss of balance - so yes you would need to be careful with older patients because of the risk of them falling.

      But I would be asking to see the documentation about it not being used for over 60s because of heart problems. Wonder if it is expensive...

    • Posted

      Hi EileenH,

      some further research since I have recovered from a latest cough.

      Have a look at Professor Morice at Castle hill hospital.

      He seems in touch with some of the problems we face.

      The drug I mentioned to my Specialist was not the one we spoke of but actually domperidone which seems to have good results sometimes.I have a post from him to the Daily Mail some time ago which was the reference I used to approach the consultant with.

      Thanks.

      It seems to me we often go into unchartered seas with PMR.

      Mo82150

  • Posted

    This may not be relevant, but I have a CPAP machine, my last cold I turned the humidity up high and slept wonderfully. No coughing at nite. Have you tried a humidifer, more than what's on your furnace? ( I'm making some assumptions)
  • Posted

    I also have a problem with reflux

    I have been taking nexium 40 for a while

    when I started on the prednisone the reflux was really troublesome, so I take nexium 20 morning and night every day and the reflux is under control.

    The systems of my reflux is a cough, no other pain, so maybe it could be part of your problem

    • Posted

      Hi thanks for your reply have a look at my reply to EileenH.

      Non acid reflux sounds possibly a cause.

      Mo82150

  • Posted

    Are you on  medicine for blood pressure/heart? One that is often forgotten is ACE inhibitors like ramipril (anything ending in ....pril ) they are notorious for causing cough.
  • Posted

    just a thought you are not on blood pressure medication? as this gave me a cough, and a few other people I know.

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