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Staff training with Counterpart Plus – read, learn and refer
How to treat
coughs
and sore throats
Coughs and sore throats are common minor ailments. But with
a variety of different causes and symptoms, treating them is not
as easy as you might think
Helen Boreham
Coughs
A cough is a protective reflex action that helps clear
the airways of mucus and irritants such as dust
and smoke. In most cases it is a sign of infection,
inflammation or irritation.
t
C
ough and sore throat are two of the most
common ailments you will encounter
in the pharmacy. Most coughs and sore
throats are caused by a virus that has
infected the respiratory tract, such as the
common cold or flu. On average, adults experience two
to three sore throats per year and most colds will be
accompanied by a cough.
COUNTERPARTPLUS
Pharmacy staff training
COUNTERPARTPLUS
Module 0147
Coughs and sore throats
In this article you will learn:
• the different types of cough
• when cough treatments should be used
• how to manage a sore throat, and the
different ingredients available in lozenges
Download all the Counterpart Plus articles at
www.otcmag.com
20 OTC | October 2011
For the secrets to selling
more winter remedies, see
Category Focus in the October 15
issue of C+D
TRAINING
There are two main types of cough: dry
and productive/chesty.
A dry cough feels like a persistent
tickling in the back of the throat and is
non-productive, meaning that no mucus
is coughed up from the lungs. Dry coughs
happen when the throat and upper airways
become inflamed and swollen – the brain
thinks this inflammation is an obstruction
and tries to clear it with coughing.
In contrast, a productive or chesty cough
is one that produces mucus (also known as
phlegm or sputum). This thin, clear fluid is
cleared from the lungs and brought up with
each cough.
Colds and flu viruses tend to target the
throat or windpipe – known as the upper
airways – whereas lower respiratory tract
infections such as bronchitis and pneumonia
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affect the airways deeper down in the lung.
Coughs can also be classified as either
acute, subacute or chronic based on how
long they last. Acute coughs last for less
than three weeks and are usually caused by
a respiratory tract infection.
Subacute coughs last anywhere from
three to eight weeks. Chronic coughs
persist for more than eight weeks and
should always be referred to the pharmacist.
Around 10-20 per cent of adults suffer from
chronic coughing.
Possible causes include:
• smoking
• rhinitis
• asthma
• gastro-oesophageal reflux disease (GORD)
• a side effect of ACE inhibitors – drugs
used to treat heart failure and hypertension.
In children, a persistent cough can also be
a sign of a more serious condition such as
whooping cough. Symptoms to look out
for include intense hacking bouts of
coughing, a characteristic ‘whoop’
sound, production of thick phlegm
and vomiting (in infants and
young children). If you have any
suspicions that a customer’s
symptoms may be due to
whooping cough, always refer
the patient to the pharmacist.
Customers with the following
symptoms should also be referred
!
In children, a persistent
cough can also be a
sign of a more serious
condition such as
whooping cough
22 OTC | October 2011
to the pharmacist before recommending an
OTC cough remedy:
• green, yellow or rust-coloured phlegm –
this suggests a bacterial infection
• blood in the phlegm
• shortness of breath or wheezing
• painful cough
• fever lasting more than 72 hours
• difficulty swallowing.
Cough treatments
OTC treatments for cough include cough
suppressants, expectorants, demulcents and
antihistamines.
Cough suppressants
Cough suppressants – also known as
antitussives – act on the ‘coughing
centre’ in the brain to block the cough
reflex. Examples include pholcodine and
dextromethorphan.
These products are best for treating dry,
tickly coughs. They generally have few
side effects and are safe to take with other
medications. However, it is important not
to recommend them to customers with
productive, chesty coughs – suppressing
this type of cough will stop phlegm being
cleared from the airways, making breathing
more difficult and increasing the chance of a
secondary bacterial infection.
Expectorants
A wide range of expectorant cough
medicines is available containing
active ingredients such as guaifenesin,
ipecacuanha, ammonium chloride and squill.
They are used to treat productive, chesty
coughs.
Expectorants work by stimulating
bronchial secretions to increase production
of thin, watery fluid. This helps dilute
and loosen the thick, sticky mucus in
the airways, allowing it to be cleared by
coughing. Expectorant cough medicines only
contain small quantities of the active agent,
so are unlikely to cause side effects
or interact with other drugs.
Demulcents
Demulcents such as glucose, glycerine and
honey form a protective coating over the
Key points
• Patients with a dry cough should take a cough
suppressant, or antitussive, while those with a chesty
cough should take an expectorant
• You should refer patients with painful coughs,
discoloured sputum (especially if there is blood) or
difficulty breathing to the pharmacist
• Always ask the patient if they are on any other
medication – particularly for diabetes, as many cough
syrups contain sugar
• Most sore throats ease within three to seven days,
and treatment focuses on making the patient as
comfortable as possible with lozenges.
COUGHS AND SORE THROATS
check first if a product has paracetamol
throat and help ease the irritation that
in it and – if it does – remind customers
causes coughing. These products give shortnot to exceed the recommended dose or
term relief from dry, irritating, tickly coughs.
take it with other paracetamol-containing
Antihistamines
products.
Antihistamines help to dry up secretions
In most cases, a cough will clear up on its
and suppress coughs. Examples include
own within two weeks. Cough medicines
diphenhydramine and promethazine. They
should not be taken for any longer than
are most suitable for treating dry coughs.
this. Any cough lasting longer than two
The antihistamines in cough medicines are
weeks, or getting progressively worse,
often ‘sedating’, which means they cause
needs to be checked by a GP.
drowsiness and can help aid sleep (which
may be disrupted by coughing). These
products are best taken in the evening.
Sore throats
Patients should be advised to avoid
The majority of sore throats are caused
driving or operating heavy machinery if
by infection with viruses or bacteria.
affected by drowsiness. If a customer says
Common cold viruses are responsible for
they are taking other medicines, particularly
25 per cent of all sore throats. The bacteria
antidepressants or drugs that cause
Streptococcus accounts for a further one in
drowsiness, check with your pharmacist as
10 adult cases and a third of sore throats in
interactions may occur with antihistamines.
children. Other possible infectious causes
Because many cough medicines contain
include the influenza virus, herpes simplex
sugar, it is important to ask if a customer
type one (the virus that causes cold sores)
has diabetes before recommending a
and candida (the yeast that causes thrush).
product. Sugar-free options are available,
Once an infection has taken hold, it
so consult your pharmacist for advice on
causes redness and swelling at the back
dealing with diabetic patients.
of the throat and in the tonsils. This
Also refer to your pharmacist for the best
inflammation results in the pain of a sore
way to treat coughs in young children. OTC
throat.
cough and cold medicines are not suitable
Less commonly, sore throats can result
for children under six years of age.
from a non-infectious cause such as:
Some cough medicines also contain
• irritation – such as from cigarette
paracetamol to help relieve the pain and
smoke, coughing or mucus in the back UC Trade
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fever associated
withfinal:Layout
colds and flu. Always
the throat
• GORD
• inflammation of the skin in the mouth
(oral mucositis) – a side effect of cancer
treatment
• rare conditions such as Kawasaki disease
or leukaemia.
One third of sore throats will have no
obvious cause.
Patients should be referred to the
pharmacist if their sore throat has lasted
more than five days or is accompanied by
coloured spots on the throat, tonsils or
tongue, fever, stiff neck, rash or difficulty
breathing or swallowing.
These symptoms may indicate a more
serious underlying infection such as
tonsillitis or meningitis.
Customers taking other prescription
medicines such as carbimazole should be
referred to the pharmacist immediately.
One of the more serious side effects of
carbimazole, a treatment for an overactive
thyroid gland, is bone marrow suppression –
signs of which include infection and
sore throat.
Treating a sore throat
Simple sore throats usually resolve on their
own within three to seven days. In the
meantime, you can recommend from the
range of OTC products available to help
ease pain and discomfort.
Most sore throat treatments are
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October 2011 | OTC 23
TRAINING
formulated as lozenges or pastilles that
target the affected area directly.
Sucking throat sweets has the added
advantage of increasing saliva production,
which itself helps to lubricate and moisten
the throat.
Most pastilles and lozenges contain
demulcent ingredients to soothe inflamed
membranes and relieve irritation. Examples
include glycerine and honey, which can be
taken safely by most people.
However, as many throat lozenges have a
high sugar content, customers with diabetes
should be referred to the pharmacist. Sugarfree versions of most products are available.
Antibacterials
Many sore throat lozenges contain
additional antiseptic agents – such as
benzalkonium, hexylresorcinol and
tyrothricin – to help fight the underlying
infection as well as relieve symptoms.
These are beneficial when treating sore
throats with an obvious infectious cause.
Local anaesthetics
Found in some lozenges and also available
as throat sprays, anaesthetic agents such
as benzocaine numb the pain and are
particularly useful for customers with
difficulty swallowing due to a sore throat.
These products are not suitable for
children or elderly people and should not be
used for more than five days.
Analgesics and anti-inflammatories
Conventional painkillers such as
paracetamol and ibuprofen provide
effective relief from sore throat pain and
inflammation. Specialised lozenges are also
available containing the NSAID flurbiprofen
in combination with honey and lemon.
For customers complaining of a very
inflamed throat, you can suggest gargling
with soluble aspirin dissolved in water.
Neither ibuprofen or aspirin are suitable
for patients with a previous peptic ulcer or
liver or kidney problems, and aspirin should
never be given to children under 16 years
of age.
Antibiotics are not generally
recommended for the treatment of sore
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throats, but may be needed if there is
a severe infection (such as tonsillitis) or
for patients with weak immune systems
or certain underlying medical conditions.
In these cases, a 10-day course of the
antibiotic penicillin V is usually prescribed.
Erythromycin or clarithromycin are
effective alternatives for penicillin-allergic
patients.
Self management
As well as OTC treatment advice, you
can suggest self-care tips that can help
customers cope with their coughs and sore
throats.
Inhaling steam from a bowl of hot water
with a towel over the head loosens phlegm
and is particularly good for chesty coughs.
Some oils can be added to the water can
help relief nasal congestion.
Advise customers to keep warm and
get plenty of rest. To keep hydrated, it is
important to drink eight to 10 glasses of
fluid a day – hot drinks with lemon and
honey are particularly soothing for sore
throats. Gargling with warm salt water can
also help ease pain and inflammation in
the throat.
By increasing their intake of vitamin C
and zinc customers can boost their immune
system which, together with frequent
handwashing, may help prevent infection
with cough and sore throat-causing viruses
in the future.
Stopping smoking can also improve cough
and sore throat symptoms.
Related products
Strepsils tackles coughs and
sore throats
Covonia launches
herbal syrup
Strepsils has
launched a
new lozenge
with dual
action to treat
both sore
throat and
tickly coughs.
Strepsils
Sore Throat
& Cough
lozenges, which hit shelves last month,
contain two antiseptics and levomenthol,
a mild local anaesthetic and counterirritant. The launch of the lozenges was
supported by a £4.5 million promotional
campaign across TV, radio and online.
Reckitt Benckiser Healthcare (UK)
0500 455456
Cough brand Covonia
has extended its range
with the introduction of
Covonia Herbal Mucus
Cough Syrup. The herbal
product contains the
natural expectorants
liquorice, ipecacuanha
and squill to help clear
a chesty cough, and is
non-drowsy and suitable
for vegetarians. The launch is being
supported by the largest-ever advertising
campaign by the brand throughout the
cough and cold season. The syrup retails
at £4.99 for a 150ml bottle.
Thornton & Ross
01484 842217
www.covonia.co.uk
Throaties celebrates 86 years
Ultra Chloraseptic back in
black…currant
Throaties pastilles are ready to soothe
sore throats this winter season. The
soft pastilles, which were first launched
in 1925, come in both Strong Original
and Blackcurrant flavours. Throaties
Antibacterial Pastilles, which contain
amylmetacresol, are also available, and
are offered in redcurrant and rosehip or
honey and lemon flavours.
Ernest Jackson & Co
01363 636100
Throat spray Ultra Chloraseptic is now
available in blackcurrant flavour to
help ease patients’ sore throats. The
anaesthetic spray, which can work in
seconds, comes in a pocket-sized bottle
containing over 100 sprays. Adults should
use three sprays for relief, while children
aged six to 12 years should use one spray.
The 15ml bottle is available at £5.10.
Ceuta Healthcare
0844 243 6661
Evaluation
• Look at the cough preparations
available in your pharmacy.
Do you know their main
ingredients, and which products
to recommend to whom?
• Keeping hydrated is especially
important when you are ill. Why?
• There are several causes of sore
throat. Check you know about the
differences between them, and
ask the pharmacist to go through
points you are unsure about.
24 OTC | October 2011