Coughs

Question 1

What are the types of coughs (2)

Answer 1

1. Productive or chesty if the customer is coughing up phlegm
2. Unproductive (dry) if it is an irritating bark or tickle with no phlegm.

Question 2

What questions do you ask about coughs (6)

Answer 2

1. WWHAM questions.
2. You will have to establish whether the cough is a productive or dry cough.
3. It is important to get as much information as possible about the customer’s cough, as it can be an early symptom of serious conditions such as asthma, tuberculosis (TB) or lung cancer.
4. If there is anything the customer describes that sounds unusual to you, always refer them to the pharmacist.
5. If a cough is productive, it is important to ask if the phlegm is coloured as this may indicate a bacterial infection.
6. Find out if the patient is taking any other medication because some medicines can cause cough as a side effect. In this case, the pharmacist may refer the customer to their doctor to review their medication.

Question 3

When do you refer someone with a cough (10)

Answer 3

1. Cough lasting three weeks or more or a recurrent cough
2. Chest pain or pain on breathing
3. Wheezing and shortness of breath
4. A child with a persistent night time cough
5. Whooping cough or croup
6. Failed medication
7. Yellow, green, brown or blood stained phlegm/sputum
8. People with persistent hoarseness of the voice
9. Accompanied unexplained weight loss
10. General tiredness, persistent fever or sweats

Question 4

How do cough suppressants work (6)

Answer 4

1. Cough suppressants fordry (unproductive)coughs
2. dextromethorphan
3. codeine
4. Pholcodinecontaining products were used for dry coughs, however, these were withdrawn from the UK market in March 2023. Customers who are due to have surgery and have taken pholcodine in the last 12 months should inform their anaesthetist.
5. Codeine can cause drowsiness and is not to be used by those under 18 years of age.
6. The MHRA has reclassified codeine linctus oral solutions from a pharmacy-only-medicine to a prescription-only medicine (POM).

Question 5

What are soothing agents (7)

Answer 5

1. Glycerin
2. honey
3. simple linctus
4. These agents act to temporarily soothe irritation in the throat
5. dry tickly cough, though
6. short term relief for chesty coughs
7. Honey and glycerin are often found in combination with lemon in tickly cough products

Question 6

What are expectorants (7)

Answer 6

1. Guaifenesin
2. squill
3. sodium citrate
4. ammonium chloride.
5. productivecoughs
6. break up phlegm in the airways which is produced in a chesty cough
7. There is doubt whether expectorants really do help a chesty cough, although some evidence shows that guaifenesin may be effective

Question 7

What are the MHRA guidance and restrictions for OTC cough and cold medicines for young people (4)

Answer 7

1. The guidance is based on research into the benefits and risks of OTC cough and cold medicines.
2. These restrictions only apply to products licensed for coughs and colds.
3. For example, chlorphenamine is contained in some OTC cough and cold products but it is also available on its own for the symptoms of hay fever and other allergic conditions as a separate licensed product. Such a products can continue to be sold for children and infants, for the licensed condition, from the age that is specified by the manufacturer.
4. The MHRA has produced a full list of all the ingredients that are affected by this guidance.

Question 8

What restrictions apply for children under the age of six (4)

Answer 8

1. antitussives (dextromethorphan)
2. expectorants (guaifenesin)
3. nasal decongestants (ephedrine, oxymetazoline, phenylephrine, pseudoephedrine, and xylometazoline)
4. antihistamines (chlorphenamine, diphenhydramine, doxylamine, promethazine, and triprolidine)

Question 9

What can children under the age of six take (4)

Answer 9

1. Drinking plenty of fluids and getting adequate rest should be advised.
2. Paracetamoloribuprofencan be used to reduce temperature; the correct dose must be used.
3. Nasal saline drops can be used to help thin and clear nasal secretions, especially in young babies.
4. Paediatric simple linctus or hot lemon and honey**may be recommended to children over one year for dry coughs but a doctor should be consulted if the symptoms last longer than five days.

Question 10

What MHRA advice is there for children between the ages of 6 and 12 (4)

Answer 10

1. Products containing the 15 restricted ingredients may be sold for the treatment of coughs and colds as a second line option for children between the ages of 6 and 12 after simple advice and treatments have been tried.
2. Codeine is not recommended for adolescents (12 to 18 year olds) who have problems with breathing.
3. Codeine should not be used in children under 12 years as it is associated with a risk of respiratory side effect.
4. Codeine products should only be sold under the supervision of the responsible pharmacist, where he/she is available to give additional advice where necessary

Question 11

What non-pharmacological advice are there for colds and cough in children (2)

Answer 11

1. Raise the pillow/end of the bed if the child has a blocked nose
2. Increase fluid intake

Question 12

If medicine is required, what can be recommended for colds and cough in children (3)

Answer 12

1. Fever or pain can be treated with ibuprofen or paracetamol, used at the correct dose if suitable.
2. Simple cough mixtures for example glycerol, honey and lemon (for children over 1 years)
3. Blocked nose can be treated with saline drops or spray