Respiratory system

Question 1

8.1 cold and flu

Answer 1

symptoms:
• blocked/runny nose, sneezing
• cough
• sore throat
• fever, aches and pain
• headache, sinus pain
• earache
• irritated, watery eyes (conjunctivitis)
referral:
• no improvement - 2 weeks
• middle ear pain not improving with
analgesics
• persisting productive cough and high
grade fever
• vulnerable patients - COPD, asthma,
kidney disease, diabetes, immunocompromised
OTC products:
fever, aches and pains
• oral analgesics
• paracetamol 2 x 500mg QDS
• ibuprofen 200-400mg TDS
• aspirin 1-3 x 300mg QDS
nasal congestion
• nasal decongestants - constrict dilated
blood vessels in the nasal mucosa
oral decongestants - pseudoephedrine, phenylephrine
legal restriction - pseudoephedrine (60mg x 12 tablets)
nasal spray - xylometazoline, oxymetazoline
do not use for >7 days - rebound congestion
avoid in:
• hypertension
• hyperthyroidism
• diabetes, CVD, glaucoma, BPH
Antihistamines
e.g. diphenhydramine in cold/flu
combination products
• dries up nasal secretions to relieve
runny nose and sneezing via anticholinergic action
legal considerations for children under 6
• certain ingredients in cough and cold
remedies should not be given to
children under 6 years
• in children aged 6-12 years it should
be given second-line to best practice
for 5 days only
• best practice for nasal congestion =
steam inhalation
advice:
• vitamin c and echinacea
• wash hands regularly
• cough or sneeze into a tissue
• annual flu jab if at risk group

Question 2

8.2 cough

Answer 2

symptoms:
• non-productive = dry, tickly
• productive = chesty, sputum
referral:
• >3 weeks
• chest pain
• wheezing
• SOB
• pain on inspiration
• recurrent night-time cough
• whooping cough
• croup
• coloured sputum - infection
• blood in sputum
OTC products:
dry cough
6+ anti-tussives (cough suppressant)
• pholcodine
• dextromethopran
• codeine linctus (18+)
side effects = sedation and constipation

Chesty cough
6+ expectorants (decrease sputum viscosity)
• guaifenesin
• ipecacuanha
• ammonium chloride • squill
6+ antihistamine (dries secretions) • diphenhydramine
• promethazine
• brompheniramine
• tripolidine
any cough demulcents
• glycerol (3+ months)
• simple linctus (1+)
• safe alternative for pregnant women,
children under 6
best practice for coughs
• warm fluids/lemon and honey
• simple cough mixtures
advice:
• dry, tickly coughs are self-limiting
• do not treat chesty coughs with an
anti-tussive
• sugar-free products in diabetes

Question 3

8.3 hay fever/allergic rhinitis

Answer 3

symptoms: •
• itchy, watery eyes
• nasal symptoms - runny, itchy, sneezing

referral:
• chest tightness
• wheezing
• SOB
• cough
• eye infection
• painful ear/sinuses

OTC products:
• antihistamines

Newer antihistamines -
- acrivastine- Benadryl (12-65 TDS)
- Cetirizine 6+ (2+ liquid) OD
- Loratidine 2+ OD

Older antihistamines sedating:
Chlorphenamine (Pirtion)- 6+ (liquid 1+)
Promemthazine (2+) 5+= promethazine hydrochloride - phenrgan

Side effects:
• older antihistamines = more sedative
and anticholinergic
• caution in: BPH, glaucoma, epilepsy
• MAOI contraindicated with sedating
antihistamines
Steroid nasal sprays 18+, 3 months
• reduce inflammation of the nasal
passages
• fluticasone
• beclometasone
Eye drops
• relieves water, itchy, irritated eyes
• sodium cromoglicate
• xylometazoline/antazoline
advice:
• control allergen exposure Hayfever
• close windows, stay indoors when
pollen count is high
• use wrap around sunglasses
• avoid grade fields, parks and gardens perennial allergic rhinitis

exclude pets from areas of the house e.g. bedroom
acaricide sprays kill house mites strict bedroom cleaning regime