9. Cough, Colds, Flu, Covid, Fever, etc.

Question 1

Pathophysiology of the Common Colds

Answer 1

It’s a VIRUS
* Viral invasion
* Over 200 types of viruses - makes finding a vaccine impossible for the common colds

Question 2

Is there a vaccine for colds?

Answer 2

No!
* There are two many viruses that can cause colds and they mutate too quickly.
* Too many things around to block its pathway
* Not advisable to avoid getting the cold with a vaccine - need to strengthen our adaptive immune response

Question 3

Influenza Vaccines

How are the annual flu shots developed?

Answer 3

Developers do their best to assess what flu strains are likely to be predominate prior to flu season and prepare the body on which subunits of flu might encounter.
* Based on what research indicates are most likely to spread and cause illness among people during the upcoming flu season
* Cannot make those predictions with the common colds.

Question 4

Why is it necessary for us to not be immuned to things like the common cold?

Answer 4

To strengthen our adaptive immune system.
* We need to expose ourselves to viruses here and there to make sure our immune systems are working and make sure they are ready when exposed to similar pathogens in the future.

Question 5

What would happen if we went common cold free?

Answer 5

Be more susceptible to harsher viruses such as RSV, pneumonia, COVID, etc.

Question 6

What are some of the “starting points” in the process of a common Head cold?

Day 1, Day 3, Day 6, etc.

FYI: Everyone is slightly different when it comes to common head cold presentations but somewhere to start.

Answer 6

Day 1: Sore throat (nagging, noticable but usually mild pain), Rhinnorhea (i.e., nasal discharge ), Sneezing.

as the infection continues, inflammatory responses get more involved takes the rhinorrhea more of a nuisance or problematic

Day 3: Nasal congestion (inflammatory responses makes it more difficult to get things out of the nose - less leaking = can’t sleep), Sinus headache (from the fluid build-up causing pain from inefficient draining at the front of the face), Plugged ears

Day 6: Cough

Question 7

Rhinorrhea

Answer 7

Runny Nose – Discharge from the nose.
* Vessel dilation in the nasal mucosa from congestion. Nose starts to leak out to cause a runny nose.

Question 8

Sneezing

Answer 8

Stimulation of the histamine (H1) receptors on the nasal mast cells, particularly on the sensory nerve endings of the nose.

Question 9

Describe some of the symptoms might encounter on Day 1 of a common head cold

FYI: Everyone is slightly different when it comes to common head cold presentations but somewhere to start.

Answer 9

Day 1:
* Sore throat (nagging, noticable but usually mild pain),
* Rhinnorhea (i.e., nasal discharge ),
* Sneezing

Question 10

Describe some of the symptoms might encounter on Day 3 of a common head cold

FYI: Everyone is slightly different when it comes to common head cold presentations but somewhere to start.

Answer 10

Day 3:
* Nasal congestion (inflammatory responses makes it more difficult to get things out of the nose - less leaking = can’t sleep),
* Sinus headache (from the fluid build-up causing pain from inefficient draining at the front of the face),
* Plugged ears

**as the infection continues, inflammatory responses get more involved takes the rhinorrhea more of a nuisance or problematic **

Question 11

Describe some of the symptoms might encounter on Day 6 of the common head cold

FYI: Everyone is slightly different when it comes to common head cold presentations but somewhere to start.

Answer 11

Day 6: Cough

Question 12

What are the symptoms we as pharmacist going to zero-in on when counseling for things like a common head cold?

Answer 12

• Nasal Congestion - can’t sleep, can’t breathe
• Cough - can’t sleep

The most bothersome symptoms

Question 13

Common Chest Colds are also known as ____

Answer 13

(Acute) Bronchitis

Question 14

Bronchitis (i.e., chest cold) affects which respiratory tract(s)

Answer 14

Upper Respiratory Tract (URT)
* Affects the bronchi that causes coughing

• Dry & unproductive cough (i.e., dry, hacking cough) during the first few days before it becomes a congested & productive cough

Question 15

Strep Throat - Viral or Bacterial?

Answer 15

Bacterial Infection
* Sore throat (e.g., pain to swallow anything)
* Red and swollen tonsils
* Fever
* Swollen lymph nodes
* Contageous - Respiratory droplets and Direct contact

Question 16

Respiratory Syncytial Virus (RSV)

Answer 16

A common respiratory viral infection in the lungs and respiratory tract.

• Do not know if infected with RSV until they get tested (and if tests positive).

Question 17

3 Types of Coughs

List the 3 Types of Coughs

Answer 17

1. Congested/Productive
2. Congesed/Unproductive
3. Dry/Nonproductive

Question 18

What does it mean to have a “congested” cough?

Answer 18

• Chest feels heavy
• Whenever I cough, it hurts and feels like something is coming up [thick mucus] from the bronchi and lungs
• Wheezing and/or crackling when breathing

Question 19

3 Types of Coughs

Why are Congested/Productive Coughs useful to the body?

Answer 19

• Associated with chest congestion and the expectoration of phlegm
• Wet, productive cough to expel the mucus
• Coughing becomes easier as things starts to loosen up.
• More phlegm is being expectorated (compared to nonproductive) with the wet sounded cough
• Would prefer to leave it be whenever possible as the cough is helping get the bad stuff out.

Question 20

3 Types of Coughs

Congested/NONproductive Cough

Answer 20

• Also associated with Chest Congestion
• It will EVENTUALLY be useful for the body…
• Cough has NOT loosened yet… Nothing [no phlegm] is coming out yet.
• Hacking cough
• Would prefer to leave alone whenever possible because of its (future) productive aspects
• Usually occurs before the congested/productive coughs

Question 21

3 Types of Coughs

Dry/NONproductive Cough

Answer 21

• Not useful to the body at all
• No phlegm
• Very dry cough but NOTHING ever comes out
• Raspy cough
• Would be okay to suggest or try something like an antitussive to get rid of it as it has no value

Question 22

In general, what kind of congestion can we have (2)?

Answer 22

• Chest [congestion]
• Nasal [congestion]

However, decongestants should NOT be used for both kinds of congestions. We cannot decongest the chest - we need an expectorant!

Question 23

What are decongestants for?

Answer 23

Nasal congestion, only!

It does not help with chest congestion.

Example: Pseudoephedrine , Phenylephrine

Question 24

Expectorant

Answer 24

Claimed as an agent used to enhance cough effectiveness by clearing the airways and to loosen and let out the thick mucus in lungs and bronchi via phlegm.

Question 25

Guaifenesin

Answer 25

An expectorant that is claims to help let out mucus in the lungs and bronchi.

Question 26

Antitussives

Answer 26

Typically used as a cough suppressant
Examples:
- Dextromethorphan (DM)
- Codeine

Question 27

Dextromethrophan (DM) is what kind of agent?

Answer 27

DM = Antitussive = Cough Suppressant related to respiratory tract infections.

Question 28

Other than being used as an analgesic, what can codeine be used for?

Answer 28

Treat cough associated with a respiratory infection

Question 29

Are antitussives (e.g., codeine, dextromethorphan) effective?

Answer 29

While common to use for cough via respiratory tract infection, there is little evidence to suggest valid efficacy.

However, antitussives are seen to be effective to treat coughs associated to COPD.

Question 30

Antitussives vs. Decongestants vs. Expectorants

Answer 30

Antitussives = Cough
Decongestants = Nasal Congestion
Expectorants = Phlegm (enhancing productive cough efffects)

Question 31

3 Types of Coughs

What do the Congested/Productive & Congested/Nonproductive Coughs **have in common? **

Answer 31

• Both are associated with chest congestion
• Both produce phlegm (BUT in different amounts)
• Because they are useful (or eventually will be useful), it is best to not take any agents whenever possible and let nature take its course.

Question 32

3 Types of Cough

Which kind of cough elicits a wet, girgling cough?

Answer 32

Congested/Productive Cough - due to the loosening of the mucus in the lungs and bronchi which is trying to get expectorated as phlegm.

Question 33

3 Types of Cough

Which cough is described as a “hacking” cough?

Answer 33

Congested/Nonproductive Cough - lungs and bronchi has thick mucus that has not yet loosened resulting in the heavy cough.

Question 34

3 Types of Coughs

Which cough can be associated with a Smoker’s Cough or a “raspy” cough?

Answer 34

Dry/Nonproductive cough - Very dry cough but nothing ever comes out.

Question 35

Head Cold vs. Chest Cold

Answer 35

• Head Cold - Throat, nose, sinuses. Easier to tolerate and nothing to worrisome and mild.
• Chest Cold - Deeper in the lungs and more involvement towards the upper respiratory tract. Between the two, would be a bit more worrisome.
• Bronchitis - Acute/Simple Chest Infection
• Bronchiolitis - Chest Infection hitting the bronchioles.
• Pneumonia - Infection that causes inflammation on one or both of our aveoli. Most worrisome of the three chest colds.