OTC - cough

Question 1

Symptoms?

Answer 1

• non productive = dry/tickly

- productive = chesty, sputum

Question 2

Referral criteria?

Answer 2

• > 3weeks
• chest pain
• wheezing
• SOB
• pain on inspiration
• recurrent night-time cough (asthma? check for other symtpoms e.g. wheezing)
• whooping cough (whooping sound when breathing in after coughing)
• croup (barking cough, breathless and inspiratory stridor)
• Green/yellow/brown sputum (bacterial chest infection?)
• blood in sputum:
  
  • pink frothy = heart failure (with SOB, orthopnoea)
  • rust = CAP (with fever, malaise, breathless pleuritic pain)
  • dark red = TB (with persistent night sweats)

Question 3

OTC products?

Answer 3

DRY: anti-tussives (cough suppressants) 6+
- pholcodeine (1st line)
- dextromethophan (1st line)
- codeine linctus (18+) (abuse potential)
s/e = sedation and constipation

CHESTY: expectorants 6+ (decrease sputum viscosity)

• guaifenesin (most common and safest)
• ipecacuanha (covonia herbal mucus cough)
• ammonium chloride (unicough)
• squill (buttercup original cough mixture)

CHESTY: antihistamines 6+ (dries secretions)

• diphenhydramine (benylin chesty cough)
• promethazine (night nurse)
• brompheniramine
• triprolidine (actifed multi-action chesty cough)

ANY COUGH: demulcents (coats back of throat; reduces irritation)

• glycerol (3+ months)
• simple linctus (1+ )

Question 4

Advice?

Answer 4

• dry, tickly coughs are self limiting; usually caused by viral infection
• do not treat chesty coughs with an anti-tussive: mucus accumulates in lungs; risk of chest infection
• sugar free products in diabetics; e.g. robitussin range. sugar-free products do not contain glucose, fructose or sucrosre