A multivitamin or mineral preparation can help to bridge the dietary gaps in the UK.

Coughs and colds are usually caused by viral upper respiratory tract infections (URTIs). They are nearly always self-limiting and do not generally require treatment with antibiotics. There is increasing concern about the overprescribing of antibiotics and advice and support from the pharmacy team with self-management of symptoms is often the best option.

Questions

There are many OTC cold and cough remedies and careful attention must be paid to the age of the person requiring treatment. OTC cough and cold remedies containing pholcodine and dextromethorphan, guaifenesin and ipecacuanha, nasal decongestants and antihistamines should not be sold for children under 6 years.

Children aged 6-12 years can take these products but with advice to limit treatment to five days or less. Simple cough remedies such those containing glycerin, honey or lemon are licensed for use in children under 6 and are also considered safe for pregnant women and for all adults. Remember that all aspirin-containing products (including oral salicylate gels) are contraindicated for youngsters under the age of 16.

Ask about symptoms, and duration of symptoms, including sneezing and coughing and type of cough (and whether the cough could be caused by medication such as an ACE inhibitor), whether the nose is runny or blocked, aches and pains, including muscular aches and pains which may indicate flu and pain above or below the eyes which may indicate sinusitis, high temperature and fever which may indicate flu rather than a cold and whether the person has a sore throat or earache, which is a common complication of colds in children.

Consider the possibility of asthma in anyone presenting with a cough, particularly a dry cough which is worse at night and ensure that asthma sufferers understand the importance of managing their usual medication to prevent asthma attacks, which can be triggered by URTIs. It is also important to take a medication history.

Recommendations

Steam inhalations (with or without menthol, eucalyptus or a proprietary inhalant) can be useful and comforting for nasal congestion although it is unclear how effective they are and they should not be used in young children because of the risk of scalding.

Sympathomimetics (e.g., pseudophedrine) can be effective in reducing symptoms of nasal congestion. They can be given orally (tablets or syrup) and topically (nasal sprays and drops). If a topical product is recommended it should be used for no more than 7 days due to the risk rebound congestion.

A combination topical product containing ipratropium and xylometazoline is available for the symptomatic treatment of nasal congestion and runny nose in adults aged 18 years and above. Treatment should not exceed 7 days.

Remember that sympathomimetics can increase blood pressure and blood glucose and should be used with caution in people with diabetes, heart disease, hypertension and hyperthyroidism Consider the possibility of interactions with other medications (e.g., beta-blockers, MAOIs and moclobemide, tricyclic antidepressants).

Antihistamines can reduce the symptoms or runny nose and sneezing associated with a cold, but are not so effective at reducing nasal congestion. The older sedative antihistamines are more effective than the newer non-sedative drugs but also have the most pronounced anticholinergic actions (e.g. dry mouth, blurred vision, constipation, urinary retention).

Consider also the possibility of interactions (e.g., with sedatives, hypnotics, betahistine, anticholinergics) and that antihistamines should be avoided in people with closed-angle glaucoma, men with prostatic or urinary flow problems and in epilepsy.

Cough suppressants (codeine, pholcodine, dextromethorphan) are useful for coughs with no identifiable cause. Dextromethorphan has the lowest risk of side effects and, like pholcodine, is less liable to be misused than codeine, which many pharmacists choose not to recommend. Expectorants such as guaifenesin may facilitate expectoration and, for guaifenesin, a product containing a dose of 100- 200mg is required to produce expectoration.

Prevention

Pharmacists should encourage at risk-groups to have an annual flu vaccination and everyone with a URTI should practice hygiene (e.g., routine thorough handwashing with soap and water, use of tissues to cover the mouth and nose when coughing or sneezing and tissues put straight into the bin) to reduce transmission of URTIs.

Also, make sure that customers are topped up with vitamins and minerals as many nutrients support immune function. Evidence exists that vitamin C (high dose) and zinc can reduce the duration of colds. UK dietary surveys show nutrient gaps across the population and a multivitamin/ mineral preparation can help to bridge the dietary gaps.

The whole population is recommended to take a vitamin D supplement throughout the autumn and winter. Low vitamin D status is common in the winter and has been associated susceptibility to respiratory tract infections.

This article also appears in the September issue of Pharmacy Business.


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