Aromatic inhalations, cough preparations and systemic nasal decongestants

Question 1

Why are aromatic inhalations beneficial in bronchitis?

Answer 1

They encourage deliberate inspiration of warm moist air which is often comforting in bronchitis

Inhalations containing volatile substances such as eucalyptus oil are traditionally used and although the vapour may contain little of the additive it encourages deliberate inspiration of warm moist air which is often comforting in bronchitis

Question 2

Name 3 conditions in which aromatic inhalations are used in adults?

Answer 2

Bronchitis
Acute rhinitis
Sinusitis

In bronchitis, the warm moist air is comforting
In acute rhinitis and sinusitis, inhalations are used for relief of nasal obstruction

Question 3

Why are aromatic inhalations used in the treatment of acute rhinitis and sinusitis?

Answer 3

Relief of nasal obstruction

Question 4

Prior to prescribing cough suppressants what conditions potentially causing the cough must you rule out first? (4)

Answer 4

Asthma
GORD
Rhinitis
Drug side-effect (e.g. ACE inhibitor) 
Smoking or environmental pollutants

Question 5

What side effect of cough suppressants may be harmful in patients with chronic bronchitis and bronchiectasis?

Answer 5

Sputum retention

Question 6

Name 4 drugs that can be used as cough suppressants (not including drugs used in palliative care)

Answer 6

Codeine phosphate
Dextromethorphan
Pholcodine
Sedating antihistamines

Question 7

Cough suppressants:

Codeine phosphate is also constipating and can cause dependence; (?) and (?) have fewer side-effects.

Answer 7

dextromethorphan

pholcodine

Question 8

What is the preferred drug used to control distressing cough in terminal lung cancer?

Answer 8

Morphine

Others:

• Diamorphine hydrochloride
• Methadone hydrochloride (but avoid due to long duration of action and accumulation)

Question 9

Why is morphine only used to control distressing cough in terminal lung cancer (palliative care)?

Answer 9

Induces sputum retention and ventilatory failure

Also causes opioid dependence

Question 10

Demulcent cough preparations contain soothing substances such as syrup or glycerol and some patients believe that such preparations relieve a (?)

Answer 10

dry irritating cough

Question 11

Expectorants are claimed to promote expulsion of (?), but there is no evidence that any drug can specifically facilitate expectoration.

Answer 11

bronchial secretions

Question 12

An over-the-counter cough medicine containing the expectorant (?) may be used for acute cough; there is some evidence to suggest it may reduce symptoms.

Answer 12

guaifenesin

Question 13

Compound preparations are on sale to the public for the treatment of cough and colds but should not be used in children under (?) years

Answer 13

6 years

Question 14

Nasal decongestants for administration by mouth may not be as effective as preparations for local application but they do not give rise to (?) on withdrawal.

Answer 14

rebound nasal congestion

Question 15

Name a nasal decongestant administered by mouth that is available over the counter?

Answer 15

Pseudoephedrine hydrochloride

Question 16

The use of strong aromatic decongestants (applied as rubs or to pillows) is not advised for infants under the age of (?).

Answer 16

3 months

Question 17

How should young infants with nasal obstruction with mucus be treated? (2)

Answer 17

1. Sodium chloride 0.9% as nasal drops

2. Suction aspiration (carers can be taught)

Question 18

The use of over-the-counter cough suppressants containing codeine phosphate should be avoided in children under (?) years and in children of any age known to be CYP2D6 ultra-rapid metabolisers.

Answer 18

12 years

Question 19

The use of over-the-counter cough suppressants containing codeine phosphate should be avoided in children under 12 years and in children of any age known to be (?).

Answer 19

CYP2D6 ultra-rapid metabolisers