URTIs (Self-Care)

Question 1

What are the some of common S/Sx of cold?

Answer 1

VIral infection of the upper respiratory tract
During incubation period (1-3 days):
- Sore/scratchy throat*
- Sneezing*
- Nasal discharge (profuse)
- Nasal stuffiness
- Malaise / generalised discomfort (mild)
- Muscle aches & pains (e.g. headache)

Peak 3-4 days later:
- Non-productive cough*, becoming loose & productive

Question 2

How long does it take to recover from a cold without pharmacological management?

Answer 2

7-14 days, due to self-limiting nature of viral infection

Question 3

What are some differential diagnoses (DDx) that may help identify whether a patient may have a cold?

Answer 3

Vs Influenza:
- Onset of influenza is abrupt, unlike gradual onset of cold!!*
- Fever is more common for influzena than cold
- Myalgia is more severe and common for influenza than cold
- Malaise is more severe in influenza than cold

Vs Allergic Rhinitis (AR):
- Nasal congestion is clear for AR, but purulent in cold
- Sneezing is repeated for AR, but occasional in cold
- Itchy eyes are often present in AR, but rarely in cold
- Nasal pruritus is often present in AR, but uncommon in cold

Vs COVID-19:
- Diarrhea is more common in COVID-19
- Loss of taste / smell more frequently attributed to COVID-19

Refer when Abx may be required (e.g. yellow/green purulent nasal discharge) or when S/Sx of COVID-19 are present

Question 4

When should you refer a patient during DDx of a cold?

Answer 4

Refer:
- Chest pain (angina)
- Hemoptysis (blood in sputum)
- Yellow/green purulent mucus/phlegm -> 2nd bacterial infection
- S/Sx of COVID-19 are present
- Wheeze/SOB
- Duration > 3 weeks -> indicative of infections
- Recurrent cough -> evening cough indicative of asthma OR ACEi-induced
- Persistent nocturnal cough in children -> asthma

Conditions to eliminate:
1) Post nasal drip (nasal discharge flow behind nose to throat)
- Chlorpheniramine useful due to anticholinergic SE to dry up secretions (xerostomia)

2) Acute bronchitis
- Usually dyspnoea, wheeze, SOB; requires Abx

3) Chronic bronchitis (COPD)
4) Asthma
5) ACEi-induced cough
- Check PMHx & past medications to narrow DDx

Question 5

What are some non-pharmacological recommendations you can provide for management of cold?

Answer 5

1) Vaccine prevention via annual influenza vaccinations & COVID-19 immunisations/bivalent boosters
2) Frequent hand washing (7 steps) with soap or alcohol disinfectants / hand sanitisers

Preventive Abx NOT effective!!

Question 6

Based on TTSH P-Sales formulary, which medications are available for the symptomatic management of patients with colds?

Answer 6

1) Rhinitis/Rhinorrhea:
- Chlorpheniramine 4mg tab
- Cetirizine 10mg tab
- Loratadine 10mg tab
- Fexofenadine 120mg or 180mg tab
- Avamys/Nasacort/Exemis(?) intranasal sprays, if antihistamines insufficient

2) Sore Throat:
- Difflam (Benzydamine - anti-inflammatory & analgesic) Mint lozenges (GSL)
- Dorithricin lozenges (tyrothricine - Abx / benzalkonium chloride - antiseptic / benzocaine - ester local anaesthetic)
- Difflam Forte throat spray
- Difflam (C) gargle

3) Nasal Congestion (Antihistamines/Decongestants):
- Telfast-D (Fexofenadine/Pseudoephedrine) tabs
- Zyrtec-D (Cetirizine/Pseudoephedrine) tabs
- Loratidine/Pseudoephedrine tabs
- Decolgen (Paracetamol 400 mg, phenylpropanolamine HCl 12.5 mg, chlorpheniramine maleate 1 mg) tabs

4) Cough
(A) Suppressants & Antitussives (Codeine, Dextromethorphan & Pholcodine)
- Robitussin Syrup (Dextromethorphan)
- Durotuss Expectorant (Pholcodine & Bromhexine)
- Durotuss Forte / Durotuss (Pholcodine)
- Tussils 5 Lozenges (Dextromethorphan)
(B) Expectorants
- Guaifenesin (GSL) - Reduce surface tensions to improve expectorant ability of purulent secretion
(C) Mucolytics
- Flumicil-A (Acetylcysteine) effervescent tablets
- Mucosolvan (Ambroxol) tablets / syrups
- Bromhexine 8mg tablets / syrups