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.