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Mayo Clinic Health Letter, December 2011 Highlights: Finding the Cause of Chronic Cough; When Chest Pain is Not a Heart Attack; Treating Polymyalgia Rheumatica.

ROCHESTER, Minn. -- Here are highlights from the December issue of Mayo Clinic Health Letter. You may cite this publication as often as you wish. Reprinting is allowed for a fee. Mayo Clinic Health Letter attribution is required. Include the following subscription information as your editorial policies permit: Visit www.HealthLetter.MayoClinic.com or call toll-free for subscription information, 1-800-333-9037, extension 9771.

First, Find the Cause of Chronic Cough

ROCHESTER, Minn. -- Coughing is normal. It's how the body expels mucus and other irritants in the throat and airway. But a cough that lasts longer than six to eight weeks may be the sign of an underlying problem or disease.

The December issue of Mayo Clinic Health Letter covers chronic coughs and the sometimes time-consuming process of determining the cause. Finding the cause and determining treatment are important. A long-lasting cough can cause physical problems such as damage to the vocal cords, rupture of small blood vessels in the airway, fainting spells, hernias, or even broken ribs. A chronic cough also can interfere with quality of life, interrupting sleep and making social activities difficult.

To determine the cause of a long-term cough, doctors systematically consider and eliminate the most likely culprits. In about 90 percent of cases, the underlying cause is postnasal drip, asthma or gastroesophageal reflux disease, where stomach acid backs up (refluxes) into the esophagus. Less likely causes are whooping cough (pertussis); lung disorders including chronic bronchitis or lung cancer; and the use of angiotensin-converting enzyme (ACE) inhibitors, medications prescribed to lower blood pressure.

Usually, chronic cough can be stopped by treating the underlying cause. Sometimes, multiple causes need to be addressed. Treatment may include:

* Antihistamine allergy medications and decongestants for postnasal drip

* Inhaled asthma medication to reduce inflammation and widen airways

* Drugs to suppress stomach acid

* Antibiotics, if the cough is suspected to be caused by a bacterial or lung infection

Doctors also advise patients not to smoke and to avoid secondhand smoke. In addition to causing chronic bronchitis, smoking irritates the lungs and can worsen coughs caused by other conditions.

Chest Wall Pain: It's Not a Heart Attack

ROCHESTER, Minn. -- Chest wall pain -- called costochondritis -- has nothing to do with the heart. Yet, the sharp pain, which can come on suddenly or gradually, can seem similar to the pain associated with a heart attack.

The December issue of Mayo Clinic Health Letter provides an overview of this usually short-lived condition. Costochondritis is due to inflammation in the rubbery cartilage that connects ribs to the breastbone. It can afflict anyone, including children, and is most common in women and people over age 40. Costochondritis may cause a specific area of pain and tenderness, usually on one side of the breastbone in one or more places where the ribs attach to the breastbone. Pain is usually sharp, although it may be dull or gnawing. In addition, pain may occur with deep breaths and coughing and may intensify when arms are raised.

Generally, costochondritis can't be seen on chest X-rays or other imaging tests that may be done to rule out other possible causes.

Costochondritis usually goes away on its own. Treatment focuses on managing pain while the tenderness improves over time. In some patients, pain lingers for several months. For mild symptoms, nonprescription painkillers may offer adequate relief. For lingering symptoms, physicians might prescribe antidepressants or pain medications.

The Mayo Clinic Health Letter reminds patients to always seek emergency care for new or unexplained chest pain or pressure that lasts more than a few moments. For pain that is less alarming, or tenderness in the breastbone that doesn't improve, it's reasonable to make an appointment with a physician to determine the cause.

Polymyalgia Rheumatica: Treatment Provides Dramatic Relief for this Inflammatory Disorder

ROCHESTER, Minn. -- The sudden and deep aches in the shoulders caused by polymyalgia rheumatica can make it difficult to comb hair or put on a jacket. Stiffness in the hips and upper legs from this illness can make getting out of bed a painful ordeal.

The December issue of Mayo Clinic Health Letter covers the symptoms and treatments for polymyalgia rheumatica (pol-ee-my-Al-juh roo-MA-tih-kah). Fortunately, proper treatment can often improve symptoms in a matter of days or even overnight. But keeping the disorder in check usually involves careful medication management for one to two years.

Polymyalgia rheumatica is a disorder where inflammation occurs in the body for no apparent reason. The pain and stiffness result from inflammatory cells and proteins that are part of the body's normal disease-fighting immune system. In addition to muscle and joint aches and pain, other symptoms may include fatigue, a low-grade fever at the onset, anemia, loss of appetite and depression.

Most people who develop polymyalgia rheumatica are older than 65. It's most common in women and rare in people under age 50. Blood tests are helpful in making the diagnosis.

Oral corticosteroids, such as prednisone, are the primary treatment. This treatment usually provides relief from pain and stiffness in the first two or three days.

Typically, corticosteroid treatment will be needed for one to two years. Patients will need to see a physician for frequent follow-ups to manage the condition, adjust the medication to the lowest dose that is effective, and monitor for side effects from the medication. Osteoporosis and loss of bone density are possible side effects. Other possible side effects from long-term corticosteroid use are high blood pressure, diabetes, cataracts and depression.

Mayo Clinic Health Letter is an eight-page monthly newsletter of reliable, accurate and practical information on today's health and medical news. To subscribe, please call 1-800-333-9037 (toll-free), extension 9771, or visit www.HealthLetter.MayoClinic.com .

About Mayo Clinic Mayo Clinic is a nonprofit worldwide leader in medical care, research and education for people from all walks of life. For more information, visit http://www.mayoclinic.org and www.mayoclinic.org/news .
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