Lecture 16 - Minor Ailments & Responding to Symptoms in Community Pharmacy: Coughs & Colds

Respiratory tract infections

Upper respiratory tract

• Cold, cough, flu, tonsillitis, sinusitis and hay fever

Lower respiratory tract

• Bronchitis, pneumonia and influenza

Colds

• Can be caused by over 200 different viruses

• Incubation 1-4 day s and symptomatic 3-4 days

Signs & Symptoms - upper respiratory tract

• Causes inflammation in the lining of the nose

• Nasal congestion

• Rhinorrhoea: runny nose

• Sneezing

• Sore throat & cough

Signs & symptoms - lower respiratory tract

• Cough

• Increased mucous production

• Pain/discomfort 

• Voicr change if larynx involved

• Airflow obstruction: muscular/mucous onstruction

• Haemoptysis (coughing up blood) - serious

Management of Cold

• Anti-tussive: cough suppressant 

• Mild pain killers e.g. paracetamol

• Sore throat sprays - numb the pain, contain anaesthetics

• Antihistamines: as deconhestants or sedation in night preparations

• Steam inhalation: menthol, eucalyptus

Influenza

• Influenza virus A,B or C - A and B most common

• Epidemic nature & incubation phase 1-3 days

• Early symptoms resemble cold

• Distinguished by fever

• May be severe

• In pandemic can be high mortality

• Contagious - first 3 days after symptoms begon

Spread of cold and flu

• With each cough, about 1.5L of air is expelled - contains 3000 saliva droplets

• Travels at speed of about 50mph

• Sneezes can travel up to 100mph and create around 100000 droplets

Classification of cough: duration

Acute - less than 3 weeks

• Dry: pneumonia, cold/flu, asthma

• Chesty: cold and flu

Subacute - 3-8 weeks

• Asthma, post infection airway inflammation, postnasal drip

Chronic - more than 8 weeks

• Dry: medicines, allergy, reflux

• Chesty: infection, asthma, lung cancer, COPD

Coughs: dry vs chesty

Dry:

• Non productive, tickly or tight

• No mucous/ sputum production

Chesty:

• Mucous production

• Clear, yellow/green, blood

Treatment of cough

• Variable ways depending on cause

• Most involves self-care

• If caused by virus can’t be treated with antibiotics

• Cough suppressant

  • Centrally acting - codeine, pholcodine, dextromethrophan

• Expectrorants

  • Hydration, ammonium salts, guafenesin, ipecuanha, citric acid, etc

• Demulcents

  • Honey, glycerin, syrup, coat pharyngeal mucosa

Cough suppressants - dry cough

• Codein is the standard - normal dose 15-30mg

• Dextromethorphan now widely used - dose range in adults 15-30mg

• Demulcent linctuses - act in pharynx to reduce irritation and sensation of sensory receptors

Expectorants - chesty cough

• Increased productivity of the cough

  • Direct stimulant action in respiratory tract

  • Indirect activation of p-sympathetic tone secondary to gastro-intestinal irritation

• Water is an expectorant - hydration of mucous to reduce viscosity

Guaifenesin

• Widely used - readily absorbed from oral dose

• Plasma half life is 1 hour

• Well tolerated and free of major side-effects

• Reported dose 100-200 mg every 2-4 hours

• No clear evidence of efficacy

Best practice in children

• Non-pharmacological interventions - fluids and rest

• Fever and pain - paracetamol, ibuprofen

• Nasal congection - saline nasal drops, vapour rubs, steam inhalation

• Cough - warm clear fluids, lemon and honey drink

• Symptoms persist - referral to GP

Cough preparation for children

• Very little is available or should be used

• Under 6 - don’t use antitussives, expectorants, nasal decongestanats, antihistamines

• Codeine - not to be used in children under 18

OTC supply

• Who? - age important

• What? - determine history & symptoms

• Other factors e.g. environemental 

• What’s the nature?

• How long?

• Has action been taken and is it appropriate?

• Medication?

Lung cancer warning signs

• Cough more than 3 weeks

• Worsening or change in long-standing cough

• Repeated or persistent chest infections

• Blood in phelgm (haemoptysis)

• Unexplained persistent breathlessnes

• Unexplained persistent tiredness or lack of energy

• Unexplained persistent weight loss

• Persistent chest and/or shoulder pain

• Unexplained persistent hoarseness

• Unexplained swelling of the face and neck