Cough and Cold

Learning Objectives

• Cold Management
  • Assess self-care candidacy for patients with a cold.
  • Recommend therapeutic options, both pharmacologic and non-pharmacologic.
• Cough Management
  • Accurately assess the type of cough present.
  • Determine self-care candidacy for cough patients.
  • Suggest appropriate treatment regimens.

Common Cold

• Definition: Viral infection primarily affecting the upper respiratory tract including the pharynx, nasopharynx, nose, and paranasal sinuses.
• Mechanisms:
  • Histamine & bradykinin cause sneezing.
  • Cholinergic & sympathetic pathways lead to congestion.
• Viral Agent: Rhinovirus, with peak concentrations occurring 2-4 days post-inoculation, persisting for about 16-18 days.
• Transmission Modes:
  • Self-inoculation.
  • Aerosol transmission.

Clinical Presentation

• Common symptoms include:
  • Red throat, postnasal drainage
  • Nasal obstruction and tender sinuses
  • Nasal secretions and possible low-grade fever (<100F)
• Symptoms typically appear 1-3 days post-infection: sore throat, nasal symptoms, cough.

Evaluation of Patient Case

• Case Study: JT
  • 56-year-old female with dry cough lasting 2-3 days.
  • History of uncontrolled hypertension & hypothyroidism.
  • Consider self-care options, possibly avoiding certain medicines due to hypertension.

Treatment Approaches

• General Guidelines:
  • Antibiotics ineffective for viral infections.
  • Single-entity products preferred over combination.
  • No cure, focus on symptom reduction and preventing transmission.
  • FDA advises against using nonprescription cough/cold medications in infants <2 years; similar guidelines for children <4 years.

Non-Pharmacologic Therapy

• Recommendations:
  • Increase fluid intake, get adequate rest, maintain a nutritious diet.
  • Use increased humidity via vaporizer/humidifier, steamy showers.
  • Nasal saline and salt gargles for symptomatic relief.
  • Special considerations for children (e.g., upright positioning, bulb syringe for mucus relief).

Complementary Therapies

• Zinc: Inhibits rhinovirus adhesion and replication; effectiveness of products is questionable.
• Vitamin C: Effective as a prophylactic agent.
• Herbal Options:
  • Ma huang (ephedra): Associated with serious cardiovascular side effects.
  • Goldenseal: Potentially toxic.

Preventing/Reducing Transmission

• Hygiene Practices:
  • Frequent hand cleaning with effective agents (isopropanol ethanol preferred).
  • Consider antiviral tissues or lysol spray to eliminate rhinoviruses from surfaces.

Pharmacologic Therapy

• Decongestants:
  • Variety of systemic and nasal products available; affect congestion differently (direct, indirect, mixed).
  • Caution with side effects: cardiovascular and CNS issues are more pronounced in extremes of age.
  • Duration of use generally should be limited to 7-14 days to prevent rebound congestion.

Types of Decongestants

• Direct-acting:
  • Phenylephrine, Oxymetazoline (short and long-acting respectively).
• Indirect-acting:
  • Ephedrine, displaces norepinephrine for alpha-and beta-stimulation.
• Mixed-acting:
  • Pseudoephedrine, combines effects of direct and indirect mechanisms.

Antihistamines

• Limited efficacy in cold treatment; better when combined with decongestants.

Local Anesthetics

• Temporary sore throat relief (e.g., Benzocaine, Dyclonine).

Antitussives & Expectorants

• General Considerations:
  • Inefficacy of traditional cough medications in colds; discuss risk factors and side effects of common products.
  • Guaifenesin can help with productive coughs by thinning mucus.
• Codeine & Dextromethorphan: Shell out specific cautions regarding their use given varied efficacy and specific needs of patient populations.

Special Populations

• Pregnancy, Lactation, Older Adults: Carefully weigh risks vs. benefits.
• Cough and Cold Management in Children: Natural products like honey (for ages >1), due to the risks of OTC cough medications.

Cough Management

Types of Cough

• Productive Cough: Aimed to expel secretions; expectorants (e.g., guaifenesin) can provide symptomatic relief.
  • Goals: Prevent ventilation impairment & infection.
• Nonproductive Cough: Dry cough often associated with irritants; focus on antitussives to mitigate annoyance without treating productive outcomes.

Treatment Goals for Cough

1. Reduce number and severity of cough episodes.
2. Prevent complications.

Cough Treatment Algorithm

• Assess and categorize cough (productivity, acute vs chronic, underlying causes).
• Determine self-treatment eligibility; use non-drug measures & monitor patient improvement.
• Exclusions for self-treatment identified—consider medical referral based on severity and duration.

Herbal/Natural Options for Kids

• Caution in OTC meds for young children; honey effective for ages >1; helps ease nighttime coughs and promotes better sleep.

Conclusion

• Careful assessment and management of cough and cold symptoms ensure proper treatment and support patient recovery while considering unique individual needs and population characteristics.