Advice on increasing Pred for breathlessness and persistent cough

[Motida]

My GP told me that breathlessness is a symptom of PMR, so I can't seek her advice on how to manage this cough etc. Some people are saying that Eris Covid is around and it presents as a bad cough which does not show up as positive on home covid testing kits.

I have had a persistent productive cough for 2 weeks but clear phlegm and new breathlessness. Never had it before. I use the preventer inhaler for mild asthma in the mornings and have taken 1000 mg of paracetamol (lemsip) morning and evening. I use Halls strong cough sweets that numb the back of the throat but they are not helping so well now.

I have tapered to 9 m.g from 1 August and will remain there for the month. What I have noticed is that the cough only starts to get persistent around 3 p.m each day and continues throughout the night off and on.

Would you advise me to go back to 12.5 m.g and treat it as a flare up? Or could I take 4.5m.g at breakfast and 4.5mg at around 7 p.m. (supper) Just not sure if breathlessness and coughs are counted as inflammation which pred reduces.

Hope you can advise me as time permits. Thanks

Pronoun (She/her!) 80 uk

[PMRpro Ambassador]

Sorry - not clear why you can't approach your GP - from what you say this is a change. PMR can cause breathlessness, but this is a persistent cough, not the same at all, and you say it is different.

It doesn't sound like a bacterial infection but it does sound a bit as if it is making your asthma worse - night time cough is said to be typical. I think you need to see a doctor, or even a nurse of paramedic at the practice who might be more helpful/

[Motida in reply to PMRpro]

Thank you very much for pointing out the distinction between breathlessness and this cough. I did not want to raise the pred without very good reasons. I will ask for an Asthma review (which is overdue) from one of the nurses who are really helpful. May not be that soon but it will give time, for what is causing the cough, to leave me hopefully.

Really grateful for everything you and DL offer so generously and for all the other tips and information from the wider group.

[SnazzyD]

Any GP worth their salt should be checking you over gladly because it is a new and persistent cough with breathlessness. There could be any number of causes, some of which need prompt attention. If there is inflammation the Pred increase might ease it, but you need to know what the cause of the inflammation might be beyond a bit of a guess. Just assuming it’s a run on from asthma, PMR or Covid is a bit dicey I’d say.

What is the Paracetamol for?

Also, if it IS breathlessness from PMR at this low dose then it might not be under control and your dose might need a rethink. Just saying to you, “oh it is just PMR” and thinking nothing doing is ok is not acceptable either.

Call the GP and stress the breathlessness as well as the cough and ask to be seen.

[PMRnewbie2017]

Are you taking ACE inhibitors for high blood pressure? The data sheet says dry cough but as you have asthma if you have sensitive airways, pollen or dust could be responsible for the mucus production. You do need to have your asthma review and get it looked into.

[Gimme]

Do you keep an eye on the pollen count? And is there any link with that? Despite all the rain we have had, the pollen count has been quite high off and on. I was collecting my pred last week and the lady behind me noticed and asked if it was for asthma and we both agreed that our asthma has been worse lately with a lot of coughing. Though, even if that might be the cause, I do think that you should get it checked out. Persistent coughing can be early indicator for other health issues and it is always wise to get any change in your asthma checked out.

[Motida in reply to Gimme]

Thank you every one for your advice yesterday. Glad to say I got a telephone appointment this morning with a duty GP and she has prescribed antibiotics in case it is a chest infection with an offer to check me over. Also booked an Asthma review next week with the nurse so am grateful for that too.

I had to leave the tube train twice yesterday because of a coughing fit. Even with a mask people look worried of course. Then a neighbour asked if I was Okay because he could hear me coughing above him at night. A gentle nudge about his disturbed night which I felt bad about. What is curious about this cough followed by worse breathlessness is that it starts getting persistent after 3 p.m. when the pred is wearing out perhaps.

My own GP rather assumed that both things were part of the inflammation from the PMR but now I see that they are separate. I hope she will too.

Thank you again.

[PMRpro Ambassador in reply to Motida]

Good - GPs should never assume. And actually, breathlessness with PMR tends to be more associated with exercise - reasonably enough - though everyone is different. But it isn't always a PMR feature by any means.

[darkred]

Has there been a fever at any time? Would be hard to know, maybe, since you are taking a fever reducer. A night cough is exasperating...I know. Hard to get sleep. I found that lactose-free dairy, taken with my bedtime dose of pred, caused mucus, phlegm and cough. (GERD does not help my situation.) I've since switched back to soy milk and avoid any dairy at bedtime, including cheese. I'm not equating my condition with yours, as I don't have asthma.

I am finding that I take more breaths per minute these days, when accomplishing some household chores, but not enough to concern me, as I'm probably just "out of shape," and stressful events may increase my respirations. (Having PMR is a stressor.)

My bad cough preceded a diagnosis of PMR. When talking on the phone, I would have to excuse myself to drink water and get a cough drop. (I use Ricola.) I never had a sore throat before the cough began. I did not take a Covid test and still am skeptical that it was Covid but can't be sure.

Eventually, the cough and phlegm went away. Then came the pronounced left shoulder pain (x-ray showed severe osteoarthritis) followed soon by bilateral shoulder pain. I requested a sed rate (very high) and sought Prednisone treatment.

When there is a "mix" of conditions, it can be hard to figure out the cause. I wonder about the interactions between some conditions, such as how PMR interacts with asthma.