Cough and Cold

Question 1

Common Cold

Answer 1

• Mild viral infection of the upper respiratory tract that is usually self-limiting
• Viruses (>200), including: rhinoviruses, coronaviruses, adenoviruses
• Modes of viral transmission: hand contact with infected person or contaminated environmental surface, droplets via sneezing or coughing

Question 2

Clinical Presentation

Answer 2

• Sore throat (1st)
• Nasal symptoms (2nd-3rd day): rhinorrhea, congestion, sneezing, nasal secretions clear, thin/watery for first 2 days, then become thicker and color may change to yellow or green
• Cough (4th-5th day): acute and non-productive
• Fever: low-grade (rarely >101°F)
• Aches and pains

Question 3

Common Cold vs. Influenza

Answer 3

-Onset:
• Common cold has gradual onset of symptoms (within 1-3 days after contact with virus)
• Influenza has abrupt onset of symptoms
-Fever:
• Low-grade fever (rarely >101°F) occasionally occurs
with common cold
• Fever >101-102°F is common with influenza

Question 4

Cold: Complications

Answer 4

• Sinusitis
• Acute otitis media
• Exacerbations of asthma or COPD
• Bronchitis
• Pneumonia

Question 5

Cold: Exclusions for Self-Treatment

Answer 5

-Fever: Oral temperature ≥103°F
• May refer for lower temperature
-Chest pain
-Shortness of breath
-Worsening of symptoms or development of additional symptoms during self-treatment
-Concurrent underlying chronic cardiopulmonary diseases (e.g., asthma, COPD, heart failure)
-AIDS or chronic immunosuppressant therapy
-Frail patients of advanced age
-Infants ≤3 months of age
-Severe sore throat
-Hypersensitivity to recommended OTC medications

Question 6

OTC Cough and Cold Medications in Children

Answer 6

-Age cutoffs for OTC cough and cold medications:
• In 2008, FDA began recommending against use in children <2 years
• In 2011, CHPA issued warning against use in children <4 years, leading to product labeling changes

Question 7

Treatment of Sore Throat in Common Cold

Answer 7

Non-Pharmacologic Therapy Options
-Warm salt water gargles 
-Tea with honey or lemon 
-Hard candy
Pharmacologic Therapy Options
-Lozenges
-Throat sprays

Question 8

Lozenges

Answer 8

• Onset: within seconds
• Adverse Effects: localized stinging or burning (benzocaine: methemoglobinemia)
• Contra: children <5, allergic to ‘caine’
• Drug Interactions: minimal
• Patient Ed: allow slow dissolve every 2 hours as needed, choking hazard, do not use for >2 days

Question 9

Throat Sprays

Answer 9

• Onset: within seconds
• Adverse Effects: minimal
• Contra: children < 3
• Drug Interactions: N/A
• Patient Ed: Apply to affected area (1 spray), allow to remain in place for at least 15 seconds, spit out. May use every 2 hours. Children <12 years should be supervised. Do not use for >2 days.

Question 10

Cough: Exclusions for Self-Treatment

Answer 10

-Cough with thick yellow, tan, or green sputum
-Children <4 years
-Cough with fever:
• A/C: >3 months: ≥103°F
• Infants ≤3 months: ≥100.4°F
-Cough with one or more of the following:
• Shortness of breath, chest pain, unintended weight loss, nighttime sweats, hemoptysis, chills, etc
-History or symptoms of chronic underlying disease associated with cough
-Cough associated with foreign object aspiration
-Suspected drug-associated cough
-Cough for >7 days, or frequent recurrences
-Cough that worsens during self-treatment
-Development of new symptoms during self-treatment

Question 11

Oral Antitussives

Answer 11

Dextromethorphan (Delsym®)

• Mech: act centrally on respiratory center in medulla to increase cough threshold
• Efficacy: Acute, non-productive cough
• Onset: 15-30 minutes
• Adverse Effects: CNS: dizziness, drowsiness, fatigue. GI: nausea, vomiting, discomfort
• Contra: children < 4
• Drug Interactions: not with MAOI
• Patient Ed: avoid activities using mental alertness, if >7 see PCP

Question 12

Topical Antitussives

Answer 12

Camphor, eucalyptus, and menthol: Vicks® VapoRub®

• Mech: Stimulate sensory nerve endings within nose and mucosa, creating local anesthetic sensation and sense of improved airflow
• Efficacy: acute, non-productive cough
• Onset: within minutes
• Adverse Effects: burning sensation of skin
• Contra: children < 2
• Drug Interactions: minimal
• Patient Ed: apply thick layer, repeat up to 3 times per day, topical use only, avoid eyes and mucous membranes, do not apply to broken skin, wash hands immediately after application, if >7 days see PCP

Question 13

Expectorants

Answer 13

Guaifenesin: Mucinex®, Robitussin®

• Mech: Loosen and thin respiratory tract secretions
• Efficacy: acute, productive cough
• Onset: 30 min
• Adverse Effects: well-tolerated, CNS: dizziness, drowsiness. GI: nausea, vomiting
• Contra: children < 12
• Drug Interactions: none
• Patient Ed: take with water / do not crush, break, or chew extended-release tablets / if >7 days see PCP