Coughs, Colds and Sore Throat

Question 1

What are common causes of coughs and what questions should you ask to find out the cause?

Answer 1

Medications (e.g. ACE inhibitors) - are you taking any medications?
Viral infection (e.g. upper respiratory tract) - have you had any other symptoms?
Allergens (e.g. pollen, dust or moulds) - do you suffer from any allergies?
Irritants (e.g. smoking) - do you smoke?
Medical conditions (e.g. COPD) - do you suffer from any medical conditions?

Question 2

What are the two types of cough?

Answer 2

Productive vs Non Productive

• A productive cough is one that brings up sputum whereas a non productive cough does not
• A productive cough is a beneficial one as it helps to bring stuff off the chest
• Cough suppressants like codeine are NOT useful for productive coughs

Question 3

What is the referral criteria for a cough?

Answer 3

Longer than three weeks - how long have you had this for
Any blood in sputum - could be more sinister
Child coughing at night - could be sign of asthma
Suspected bacterial infection - ask about sputum colour and other symptoms

Question 4

Treatment Options

What is there for children?

Answer 4

Demulcents - soothing effect - HONEY&LEMON
Expectorants - help bring sputum off chest - GUANIFENESIN
Antitussives - cough suppressant - CODEINE
Antihistamines - dry up secretions by mucus membranes - CHLORPHENAMINE

Children do not have many options for coughs as side effects can be a problem

• vapour rubs
• warm drinks of honey and lemon
• remain hydrated
• warm showers for steam

Question 5

What are some of the important questions to ask if someone comes in with a suspected cold?

Answer 5

• What are your symptoms?
• How severe are these symptoms? - more severe could mean flu
• Are you experiencing any fatigue, loss of appetite, nausea/feeling sick? - could mean flu
• Did these symptoms come on gradually or overnight?
• Have you tried anything so far? Has this worked?
• Do you take any regular medication? Prescription OR OTC OR Herbal?
  DO NOT GIVE DECONGESTANTS TO HIGH BP
• Do you have any allergies?
• Any symptoms in particular that are most bothersome?

Question 6

How can you treat a cold?

Pharmacological and non pharmacological

Answer 6

• Simple Analgesia
  Paracetamol - take one to two tablets every 4-6 hours (max 8 tablets a day)
  Ibuprofen - take one to two tablets every 6 hours (max 6 tablets per day)
  Aspirin but not for under 16s
• Decongestants for stuffy nose - nasal congestion
  *max 7 day use as more likely to get side effects with prolonged use
• Steam inhalants
• Sedating antihistamines
• Stay hydrated - drink plenty of fluids
  -Get plenty of rest
• Lozenges/pastilles if sore throat is a symptom
• Cough treatments if coughing is a symptom

See GP if no improvement after 1-2 weeks

Question 7

What criteria is indicative of a bacterial sore throat?

Answer 7

• Tonsillar exudate
• Swollen glands
• No cough
• Fever
• 3/4 criteria is 80% chance of bacterial infection
• needs referral to GP for antibiotics

Question 8

When should you refer with a sore throat?

Answer 8

• For longer than 2 weeks so it is important to ask how long
• Dysphagia
• Treatment failure
• Bacterial
• Skin rash
• Hoarseness 3+ weeks
• Medication related
• Reoccurring

Question 9

How can you treat a sore throat?

Answer 9

Explain to patient that this should go away by itself so need to treat the symptoms

• Pastilles and lozenges
• Mouthwashes and sprays
• Simple analgesia
• Gargle warm water and salt - not children
• Drink plenty of water
• Eat soft foods
• Rest
• Avoid smoking/smokey places

Question 10

Scenario
Patient comes into your pharmacy asking for advice about her child who is suffering from a cold. Provide your usual care.

Answer 10

• Hi my name is Blythe I’m the pharmacist working today how can I help you?
• What symptoms is your child experiencing? Headache, coughing, stuffy nose
• Is the cough chesty or dry? Dry
• Have these come on overnight or gradually? Gradually
• Do they have any other symptoms like loss of appetite, feeling sick or being sicks or feeling tired? No
• Are the symptoms mild or more severe? Milder
• Have you tried anything? No
• Does your child have any allergies? No
• Does your child take any regular medication? No
• How old is your child? 6

I think you’re right this sounds like symptoms of a cold. It can be quite difficult to offer treatments for these kind of symptoms in children. For his headache I would recommend paracetamol. Here I can give you a paracetamol oral suspension 250mg/5ml. Use the 5ml spoonful to give him one spoonful every 4-6 hours but no more than 4 doses in 24 hours. For a stuffy nose and the cough I would recommend a vapour rub like Mentholatum. As this is for a child I would recommend rubbing on the chest and back 2-3 times a day as inhaling steam from hot water could cause child to be burnt. Make sure he is drinking plenty of water and resting as often as possible. He has a dry cough so it would make no sense to give him something that would bring up secretions as there seems to be none. A demulcent like a honey and lemon drink in warm water can sooth the cough.

Do you have any questions?
Come back if you see no improvement in two weeks and we can see what the next steps are.