Symptoms in the Pharmacy :Respiratory Problems (5)

 

When to refer (cough)

• Cough lasting 2 weeks or more and not improving
• Sputum (yellow, green, rusty or blood-stained)  Chest pain
• Shortness of breath
• Wheezing
• Whooping cough or croup
• Recurrent nocturnal cough
• Suspected adverse drug reaction
• Failed medication

After a series of questions the pharmacist should be in a position to

decide whether treatment or referral is the best option.

Treatment timescale

Depending on the length of time the patient has had the cough and

once the pharmacist has recommended an appropriate treatment,

patients should see their doctor 2 weeks after the cough started if it

has not improved.

Management

Pharmacists are well aware of the debate about the clinical efficacy of

the cough remedies available OTC. In particular, the lack of scientific

evidence that expectorants have any effect and the use of combinations

with apparently contradictory ingredients have been cited.

However, many people who visit the pharmacy for advice do so

because they want some relief from their symptoms and, while the

effectiveness of cough remedies remains unproven, they can have a

useful placebo effect.

The choice of treatment depends on the type of cough. Suppressants

(e.g. pholcodine) are used to treat unproductive coughs, while expectorants

such as guaifenesin (guaiphenesin) are used in the treatment of

productive coughs. The pharmacist should check that the preparation

contains an appropriate dose, since some products contain sub therapeutic

amounts. Demulcents like Simple Linctus that soothe the throat

are particularly useful in children and pregnant women as they contain

no active ingredients.

The BNF gives the following guidance.

Expectorants: A simple expectorant mixture may serve a useful

placebo function and is inexpensive.

Suppressants: Where there is no identifiable cause (underlying disorder),

cough suppressants may be useful; e.g. if sleep is disturbed.

Demulcents: Preparations such as simple linctus have the advantage

of being harmless and inexpensive. Pediatric simple linctus is particularly

useful in children, and sugar-free versions are available.

Productive coughs should not be treated with cough suppressants

because the result is pooling and retention of mucus in the lungs and a

higher chance of infection, especially in chronic bronchitis.

There is no logic in using expectorants (which promote coughing)

and suppressants (which reduce coughing) together as they have opposing

effects. Therefore, products that contain both are not therapeutically

sound.