Symptoms in the Pharmacy :Respiratory Problems (12)
Practical points
Diabetes
Mouthwashes and gargles are suitable and can be recommended.
Sugar-free pastilles are available but the sugar content of such products
is not considered important in short-term use.
Mouthwashes and gargles
Patients should be reminded that mouthwashes and gargles should not
be swallowed. The potential toxicity of OTC products of this type is
low and it is unlikely that problems would result from swallowing
small amounts. However, there is a small risk of systemic toxicity from
swallowing products containing iodine. Manufacturers’ recommendations
about whether to use the mouthwash diluted or undiluted should
be checked and appropriate advice given to the patient.
Sore throats in practice
Case 1
A woman asks your advice about her son’s very sore throat. He is 15
years old and is at home in bed. She says he has a temperature and that
she can see creamy white matter at the back of his throat. He seems
lethargic and hasn’t been eating very well because his throat has been
so painful. The sore throat started about 5 days ago and he has been in
bed since yesterday. The glands on his neck are swollen.
The pharmacist’s view
It would be best for this woman’s son to be seen by the doctor. The
symptoms appear to be severe and he is ill enough to be in bed.
Glandular fever is common in this age group and is a possibility. In
the meantime you might consider recommending some paracetamol in
soluble or syrup form to make it easier to swallow. The analgesic and
antipyretic effects would both be useful in this case.
The doctor’s view
The pharmacist is sensible in recommending referral. The description
suggests a severe tonsillitis, which will be caused by either a bacterial or
viral infection. If it turns out to be viral, then glandular fever is a strong
possibility. The doctor should check out the ideas, concerns and expectations
of the mother and son and then explain the likely causes and
treatment.
Often it is not possible to rule out a bacterial (streptococcal)
infection at this stage and it is safest to prescribe oral penicillin, or
erythromycin if the patient is allergic to penicillin. Depending on the
availability of laboratory services, the doctor may take a throat swab,
which would identify a bacterial infection. If the infection has gone on
for nearly 1 week, then a blood test can identify infectious mononucleosis
(glandular fever). Although there is no specific treatment for
glandular fever, it is helpful for the patient to know what is going on
and when to expect full recovery.
Case 2
A teenage girl comes into your shop with her mother. The girl has a
sore throat which started yesterday. There is slight reddening of the
throat. Her mother tells you she had a slight temperature during the
night. She also has a blocked nose and has been feeling general aching.
She has no difficulty in swallowing and is not taking any medicines,
either prescribed or OTC.
The pharmacist’s view
It sounds as though this girl has a minor URTI. The symptoms
described should remit within a few days. In the meantime, it would
be reasonable to recommend a systemic analgesic, perhaps in combination
with a decongestant.
The doctor’s view
The pharmacist’s assessment sounds correct. Because she has a
blocked nose, a viral infection is most likely. Many patients attend
their doctor with similar symptoms understandably hoping for a quick
cure with antibiotics, which have no place in such infections.
Case 3
A middle-aged woman comes to ask your advice about her husband’s
bad throat. He has had a hoarse gruff voice for about 1 month and has
tried various lozenges and pastilles without success. He has been a
heavy smoker (at least a pack a day) for over 20 years and works as
a bus driver.
The pharmacist’s view
This woman should be advised that her husband should see his doctor.
The symptoms that have been described are not those of a minor
throat infection. On the basis of the long duration of the problem
and of the unsuccessful use of several OTC treatments, it would be
best for this man to see his doctor for further investigation.
The doctor’s view
A persistent alteration in voice, with hoarseness, is an indication for
referral to an ENT specialist. This man should have his vocal cords
examined, which requires skill and special equipment that most family
doctors do not have. It is possible he may have a cancer on his vocal
cords (larynx), especially as he is a smoker.
Diabetes
Mouthwashes and gargles are suitable and can be recommended.
Sugar-free pastilles are available but the sugar content of such products
is not considered important in short-term use.
Mouthwashes and gargles
Patients should be reminded that mouthwashes and gargles should not
be swallowed. The potential toxicity of OTC products of this type is
low and it is unlikely that problems would result from swallowing
small amounts. However, there is a small risk of systemic toxicity from
swallowing products containing iodine. Manufacturers’ recommendations
about whether to use the mouthwash diluted or undiluted should
be checked and appropriate advice given to the patient.
Sore throats in practice
Case 1
A woman asks your advice about her son’s very sore throat. He is 15
years old and is at home in bed. She says he has a temperature and that
she can see creamy white matter at the back of his throat. He seems
lethargic and hasn’t been eating very well because his throat has been
so painful. The sore throat started about 5 days ago and he has been in
bed since yesterday. The glands on his neck are swollen.
The pharmacist’s view
It would be best for this woman’s son to be seen by the doctor. The
symptoms appear to be severe and he is ill enough to be in bed.
Glandular fever is common in this age group and is a possibility. In
the meantime you might consider recommending some paracetamol in
soluble or syrup form to make it easier to swallow. The analgesic and
antipyretic effects would both be useful in this case.
The doctor’s view
The pharmacist is sensible in recommending referral. The description
suggests a severe tonsillitis, which will be caused by either a bacterial or
viral infection. If it turns out to be viral, then glandular fever is a strong
possibility. The doctor should check out the ideas, concerns and expectations
of the mother and son and then explain the likely causes and
treatment.
Often it is not possible to rule out a bacterial (streptococcal)
infection at this stage and it is safest to prescribe oral penicillin, or
erythromycin if the patient is allergic to penicillin. Depending on the
availability of laboratory services, the doctor may take a throat swab,
which would identify a bacterial infection. If the infection has gone on
for nearly 1 week, then a blood test can identify infectious mononucleosis
(glandular fever). Although there is no specific treatment for
glandular fever, it is helpful for the patient to know what is going on
and when to expect full recovery.
Case 2
A teenage girl comes into your shop with her mother. The girl has a
sore throat which started yesterday. There is slight reddening of the
throat. Her mother tells you she had a slight temperature during the
night. She also has a blocked nose and has been feeling general aching.
She has no difficulty in swallowing and is not taking any medicines,
either prescribed or OTC.
The pharmacist’s view
It sounds as though this girl has a minor URTI. The symptoms
described should remit within a few days. In the meantime, it would
be reasonable to recommend a systemic analgesic, perhaps in combination
with a decongestant.
The doctor’s view
The pharmacist’s assessment sounds correct. Because she has a
blocked nose, a viral infection is most likely. Many patients attend
their doctor with similar symptoms understandably hoping for a quick
cure with antibiotics, which have no place in such infections.
Case 3
A middle-aged woman comes to ask your advice about her husband’s
bad throat. He has had a hoarse gruff voice for about 1 month and has
tried various lozenges and pastilles without success. He has been a
heavy smoker (at least a pack a day) for over 20 years and works as
a bus driver.
The pharmacist’s view
This woman should be advised that her husband should see his doctor.
The symptoms that have been described are not those of a minor
throat infection. On the basis of the long duration of the problem
and of the unsuccessful use of several OTC treatments, it would be
best for this man to see his doctor for further investigation.
The doctor’s view
A persistent alteration in voice, with hoarseness, is an indication for
referral to an ENT specialist. This man should have his vocal cords
examined, which requires skill and special equipment that most family
doctors do not have. It is possible he may have a cancer on his vocal
cords (larynx), especially as he is a smoker.
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