Symptoms in the Pharmacy :Respiratory Problems (1)
Colds and flu
The common cold comprises a mixture of viral upper respiratory tract
infections (URTIs). Although colds are self-limiting, many people
choose to buy OTC medicines for symptomatic relief. Some of the
ingredients of OTC cold remedies may interact with prescribed therapy,
needs to be given to taking a medication history and selecting an
appropriate product.
What you need to know
- Age (approximate)
- Child, adult
- Duration of symptoms
- Runny/blocked nose
- Summer cold
- Sneezing/coughing
- Generalised aches/headache
- High temperature
- Sore throat
- Earache
- Facial pain/frontal headache
- Flu
- Asthma
- Previous history
- Allergic rhinitis
- Bronchitis
- Heart disease
- Present medication
Significance of questions and answers
Age
Establishing who the patient is – child or adult – will influence the
pharmacist’s decision about the necessity of referral to the doctor and
choice of treatment. Children are more susceptible to URTI than
adults.
Duration
Patients may describe a rapid onset of symptoms or a gradual onset
over several hours; the former is said to be more commonly true of flu,
the latter of the common cold. Such guidelines are general rather than
definitive. The symptoms of the common cold usually last for 7–14
days. Some symptoms, such as a cough, may persist after the worst of
the cold is over.
Symptoms
Runny/blocked nose
Most patients will experience a runny nose (rhinorrhoea). This is
initially a clear watery fluid, which is then followed by the production
of thicker and more tenacious mucus (this may be purulent). Nasal
congestion occurs because of dilatation of blood vessels, leading to
swelling of the lining surfaces of the nose. This narrows the nasal
passages, which are further blocked by increased mucus production.
Summer colds
In summer colds the main symptoms are nasal congestion, sneezing
and irritant watery eyes; these are more likely to be due to allergic
rhinitis.
Sneezing/coughing
Sneezing occurs because the nasal passages are irritated and congested.
A cough may be present either because the pharynx
is irritated (producing a dry, tickly cough) or as a result of irritation of
the bronchus caused by postnasal drip.
Aches and pains/headache
Headaches may be experienced because of inflammation and congestion
of the nasal passages and sinuses. A persistent or worsening
frontal headache (pain above or below the eyes) may be due to
sinusitis . People with flu often report muscular
and joint aches and this is more likely to occur with flu than with the
common cold .
High temperature
Those suffering from a cold often complain of feeling hot, but in general
a high temperature will not be present. The presence of fever may be
an indication that the patient has flu rather than a cold .
Sore throat
The throat often feels dry and sore during a cold and may sometimes
be the first sign that a cold is imminent .
Earache
Earache is a common complication of colds, especially in children.
When nasal catarrh is present, the ear can feel blocked. This is due to
blockage of the Eustachian tube, which is the tube connecting the
middle ear to the back of the nasal cavity. Under normal circumstances
the middle ear is an air-containing compartment. However, if the
Eustachian tube is blocked, the ear can no longer be cleared by
swallowing and may feel uncomfortable and deaf. This situation
often resolves spontaneously, but decongestants and inhalations can
be helpful . Sometimes the situation
worsens when the middle ear fills up with fluid. This is an ideal site
for a secondary infection to settle. When this does occur, the ear
becomes acutely painful and can require antibiotics. The infection is
called acute otitis media (AOM). AOM is a common infection in
young children. In the UK about 30% of children visit their GP with
AOM each year and 97% receive antibiotics. The evidence for antibiotic
use is conflicting with some trials showing benefit and others no
benefit for taking antibiotics. Antibiotics have also been shown to
increase the risk of vomiting, diarrhoea and rash, and it is known
that in about 80% of children AOM will resolve spontaneously in
about 3 days without antibiotics.
In summary, a painful ear can initially be managed by the pharmacist.
There is evidence that both paracetamol and ibuprofen are effective
treatments for AOM. However, if pain were to persist or be
associated with an unwell child (e.g. high fever, very restless or listless,
vomiting), then referral to the GP would be advisable.
Facial pain/frontal headache
Facial pain or frontal headache may signify sinusitis. Sinuses are
air-containing spaces in the bony structures adjacent to the nose
(maxillary sinuses) and above the eyes (frontal sinuses). In a cold
their lining surfaces become inflamed and swollen, producing catarrh.
The secretions drain into the nasal cavity. If the drainage passage
becomes blocked, fluid builds up in the sinus and can become secondarily
(bacterially) infected. If this happens, persistent pain arises in the
sinus areas. The maxillary sinuses are most commonly involved. When
the frontal sinuses are infected, the sufferer may complain of a frontal
(forehead) headache. The headache is typically worsened by lying
down or bending forwards.
Flu
Differentiating between colds and flu may be needed to make a decision
about whether referral is needed. Patients in ‘at-risk’ groups
might be considered for antiviral treatment. Flu is generally considered
to be likely if
. temperature is 388C or higher (37.58C in the elderly).
. a minimum of one respiratory symptom (cough, sore throat, nasal
congestion or rhinorrhoea) is present.
. a minimum of one constitutional symptom (headache, malaise, myalgia,
sweats/chills, prostration) is present.
Flu often starts abruptly with sweats and chills, muscular aches and
pains in the limbs, a dry sore throat, cough and high temperature.
Someone with flu may be bedbound and unable to go about usual
activities. There is often a period of generalised weakness and malaise
following the worst of the symptoms. A dry cough may persist for
some time.
True influenza is relatively uncommon compared to the large
number of flu-like infections that occur. Influenza is generally more
unpleasant, although both usually settle with no need for referral.
Flu can be complicated by secondary lung infection (pneumonia).
Complications are much more likely to occur in the very young, the
very old and those who have pre-existing heart or lung disease
(chronic bronchitis). Warning that complications are developing
may be given by a severe or productive cough, persisting high fever,
pleuritic-type chest pain or delirium.
Asthma
Asthmatic attacks can be triggered by respiratory viral infections.
Most asthma sufferers learn to start or increase their usual medication
to prevent such an occurrence. However, if these measures fail, referral
is recommended.
Previous history
People with a history of chronic bronchitis (defined as a chronic cough
and or mucus production for at least 3 months in at least 2 consecutive
years when other causes of chronic cough have been excluded) may be
advised to see their doctor if they have a badcold or flu-like infection as it
often causes an exacerbation of their bronchitis. In this situation the
doctor is likely to increase the dose of inhaled anticholinergicsandbeta-2
agonists and prescribe a course of antibiotics. Certain medications are
best avoided in those with heart disease, hypertension and diabetes.
Present medication
The pharmacist must ascertain any medicines being taken by the
patient. It is important to remember that interactions might occur
with some of the constituents of commonly used OTC medicines.
If medication has already been tried for relief of cold symptoms
with no improvement and if the remedies tried were appropriate and
used for a sufficient amount of time, referral to the doctor might
occasionally be needed. In most cases of colds and flu, however,
OTC treatment will be appropriate.
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