flu, is also a viral infection andcan cause similar symptoms tothe common cold. However,people with flu are more likely tosuffer from headaches, tiredness,aching muscles and fever, whilenasal symptoms such as sneezingand a runny nose are much lessprominent than they are duringa cold. People with flu are alsomore likely to loose their appetiteand suffer insomnia. They mayfeel that their eyes become moresensitive to light and feel hot orsore. The Government tracks thenumber of people with flu eachyear, and if it exceeds a certainthreshold, it is considered anepidemic.

Colds and flu are both spreadby droplets expelled duringcoughing or sneezing that arethen inhaled by another person,or passed on via direct contact or

Winter ailments are among themost common reasons whypeople turn to their localpharmacy for advice and productrecommendations. It is thereforeimportant that the whole teamhas a sound understanding ofseasonal conditions such as thecommon cold, influenza andcoughs so they are able toprovide the advice and supportthat customers need.

SymptomsThe term ‘common cold’ is usedto describe an upper respiratorytract infection of viral origin.Many different viruses can causea cold, sometimes several at atime, which is the main reasonit has not been possible forscientists to find a cure.

Symptoms usually come onsuddenly and include sneezing,a runny or congested nose, asore throat, coughing and ageneral feeling of being unwell,which often worsens for a coupleof days before beginning toimprove. Colds often last longerthan a week and many peoplefind that they have a lingeringcough for quite a while after allof the other symptoms havedisappeared.

Influenza, often referred to as

THE MAGAZINE FOR PROFESSIONAL ASSISTANTS44 TM NOVEMBER 2014

Welcome to our CPDmodule series forcommunity pharmacytechnicians. Written inconjunction with thePharmacy MagazineCPD series, it will mirrorthe magazine’s

programme throughout the year. The serieshas been designed for you to use as part ofyour continuing professional development.Reflection exercises have been included to helpstart you off in the CPD learning cycle.

Contributing author: AshaFowells MRPharmS, communitypharmacist and freelancepharmacy writer

CPD module

current thinking on...

winter health

MODULE NUMBER: 51

Aim: To describe how three common winter ailments – colds, influenza and coughs – can present inthe pharmacy and how they should be managed.

Objectives: After reading this module, pharmacy technicians will:• Appreciate the differences between the common cold, influenza and coughs, and be aware of someof the conditions that can cause similar symptoms• Understand the self-help tips and OTC products that may help to relieve winter ailment symptoms • Be able to advise on some of the preventative measures that people can take to reduce the risk ofsuffering from, or passing on, one of these conditions.

sharing objects. Sufferers,particularly children, may remaincontagious for several weeks aftertheir symptoms have gone.

While most cases of colds andflu clear up on their own andcause no further problems,complications can affect aminority of people. After a cold,inflamed and infected sinuses(sinusitis) are the most commonproblem in adults and olderchildren, although some peoplemay develop pneumonia oracute bronchitis, particularly ifthey are predisposed becausethey smoke, are elderly, havepoor immunity or have a pre-existing respiratory conditionsuch as asthma. For youngerchildren, acute middle earinfection (otitis media) is themost common complication,with croup, bronchiolitis and

pneumonia tending to affectinfants. Asthma flare-ups mayalso occur after a cold or flu. Flusufferers who experience acomplication may develop acutebronchitis, pneumonia, sinusitisor otitis media, while pregnantwomen may go into prematurelabour, have a baby with a lowerthan expected birth weight, ormay even suffer a stillbirth ormiscarriage.

A cough is a symptom ratherthan a condition in its own right,and is the result of a reflexresponse to the airways beingirritated. Coughs can be classifiedas acute, if they are present forless than three weeks, sub-acute,if they last between three andeight weeks, or chronic, if theycontinue for longer than eightweeks. Dry coughs – felt as atickly throat – are often caused

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take up to two weeks for animmune response to developfully.

OTC productsFor headache, aching muscles orfever, paracetamol or ibuprofencan be used, assuming thecustomer has no reason not totake them. Both can be takensimultaneously if symptoms aresevere. However, they should becombined rather than alternatedto reduce the risk of confusionand accidental overdose. Aspirinand other NSAIDs are notrecommended.

Steam inhalations can beeffective at loosening mucus andrelieving congestion, and there isno harm in adding products suchas menthol crystals or eucalyptus.Care needs to be taken to reducethe risk of scalding, particularlywith children, so sitting in abathroom with the showerrunning on the maximumtemperature may be a saferoption. Saline nasal drops andirrigation products can also easecongestion, although somecustomers find them unpleasantto use.

Topical decongestants,such as ephedrine andxylometazoline, have beenshown to be more effectivethan systemic products such aspseudoephedrine andphenylephrine, but they shouldonly be used for a maximum offive to seven days because of therisk of rebound congestion. Dueto their mode of action,decongestants are not suitablefor everybody, so read thepatient information leafletscarefully and ask whether thepatient takes any othermedication or suffers from anyother conditions before making arecommendation. Pharmacyteams also need to be mindful ofthe sales restrictions that apply to

by an infection in the upperrespiratory tract such as a cold,whereas a chesty cough –sometimes described asproductive because of thephlegm that is produced – canindicate a problem further intothe chest, such as a chestinfection, mucus draining fromthe nose or lung damage causedby smoking.

Could it be anything else?While colds, flu and coughs aregenerally considered easy todiagnose, pharmacy teamsshould have an understanding ofthe symptoms that mightsuggest another condition. Theseinclude a noticeably higherbreathing rate (above 30 breathsper minute), a significantly raisedheart rate (in excess of 130 beatsper minute) and anyone whoappears to be drifting in and outof consciousness, is complainingof chest pain or whose breathingis so laboured that it is makingthem feel exhausted.

Conditions that can causesimilar symptoms to colds andflu but are medical emergenciesinclude meningitis, a blood clotin the lung (pulmonaryembolism), trapped air betweenthe lung and chest wall(pneumothorax), and a foreignbody lodged in the respiratorytract. Anyone who appears to behaving an asthma or chronicobstructive pulmonary disease(COPD) attack that they areunable to control themselvesrequires urgent care.

There are also someconditions that require a GP’sassessment rather than self-treatment. These includeundiagnosed or uncontrolledasthma or COPD, gastro-oesophageal reflux disease,whooping cough (pertussis),glandular fever, malaria, lungcancer, tuberculosis and heartfailure. Generally, if somethingdoesn’t seem quite right – forexample, if the patient describes

symptoms that do not normallyoccur during a cold or flu, referthem to the pharmacist.

Relieving symptomsMost colds, flu and coughs canbe managed using self-helpmeasures and OTC products.Pharmacy teams play a vital rolehere both in advising onremedies and providingreassurance that while symptomsmay be unpleasant, theygenerally improve within a weekor two.

The two mainstays ofrecovering from a cold or flu arenot to push the body beyondwhat feels comfortable – in otherwords, rest if exhausted – anddrink plenty of fluids to replenishthe amount lost through a runnynose and sweating because of afever.

Suffering a winter ailment canprompt smokers to considerquitting. Be prepared to raise thetopic and discuss the supportthat is available, both in terms ofsmoking cessation services andnicotine replacement products.

Supplements such asechinacea, vitamin C, zinc andgarlic are often heralded as waysof preventing or shortening acold, and can be taken tosupport the immune system.

It is impossible to completelystop someone with a cold or flupassing their infection on tosomebody else. However,practising good hygienemeasures can be effective atminimising the risk of infection.These include frequent andthorough hand washing with hotwater and soap, and not sharingpersonal objects. Hand sanitiserscan be useful if soap and water isnot readily available.

Most people who are eligiblefor an NHS flu vaccination willprobably have had it done bynow, but it is not too late forthose who have not or whoare willing to pay. Note thatfollowing a vaccination, it can

Next month: Clinical review of 2014

THE MAGAZINE FOR PROFESSIONAL ASSISTANTS 45TM NOVEMBER 2014

Once you have read this article, use the following CPD questions to help youreflect on what you have learned and how it might affect your everyday work.Remember to record your learning on the GPhC website if you areregistered (www.uptodate.org.uk). Otherwise, it is goodpractice to record it in your ongoing learning anddevelopment folder.

l What did I learn that was new? (Evaluate)

l How have I put this into practice? (Provide examples of how learning has been applied.) (Evaluate)

l Do I need to learn anything else in this area? (Reflect)

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CPD module

Record your learning

products containing ephedrineor pseudoephedrine: only onepack of either may be sold pertransaction.

Antihistamines are included insome cold and flu remedies tohelp dry up nasal secretions.There is also some evidencesupporting the use of sedatingantihistamines (e.g.chlorphenamine) in combinationwith a decongestant. However,side effects can be a problem.Non-sedating antihistaminessuch as loratadine are generallynot thought of as useful forrelieving colds and flu.

Many people rely on coughmedicines, although there isactually very little evidenceeither for or against their use.The most common ingredientsof chesty cough medicines areexpectorants such asipecacuanha, guaifenesin andsquill. Cough suppressants(opioids such as pholcodine,codeine and dextromethorphan)form the mainstay of productsfor dry coughs. Alternatively,some products include sedatinganthistamines, which arethought to work by inducingdrowsiness. Many coughmedicines contain a demulcent,such as glycerol, honey or syrupto soothe the throat. These aregenerally inexpensive and donot cause adverse reactions.However, their high sugarcontent should be taken intoconsideration for patients withdiabetes.

OTC cough and coldproducts containing coughsuppressants or expectorants,antihistamines or decongestantsare not suitable for childrenunder six years of age. And theyshould only be considered forchildren aged six to 12 years ifother measures have been triedunsuccessfully. In this case,dosing should be kept low and

treatment should not exceedfive days. Codeine-containingcough medicines are anexception – they should not beused by anyone aged under 18years of age.

Many winter remediescontain more than oneingredient. It is necessary to notethe product’s active ingredientsand reinforce the correct dosageto the customer in order tohighlight the risk of adversereactions and accidentaloverdose.

Prescription medicationThe ineffectiveness of antibioticsfor the common cold, flu and thevast majority of coughs has beenat the centre of healthcampaigns for many wintersnow, and prescribing them canactually cause patients harm asits puts them at risk of adverseside effects without any benefit.Some antivirals may be used toreduce the severity and durationof flu symptoms, but only incertain patient groups and underset circumstances, such as duringan epidemic and by thoseconsidered at risk ofcomplications.

Useful websitesl NHS Choices (www.nhs.uk/Conditions/Cold-common) –provides information on the common cold and links to the otherwinter health conditions discussed in this modulel NHS Live Well(www.nhs.uk/Livewell/coldsandflu/Pages/Isitacoldorflu.aspx) – agood resource for patients who are trying to work out if they havea cold or flul Cardiff University’s Common Cold Centre(www.cardiff.ac.uk/biosi/subsites/cold/) – a hub for clinical trialsand research for cold and flu treatmentsl NHS flu vaccination programme (www.nhs.uk/Conditions/flu-campaign/Pages/Flu-2014.aspx) – information on eligibilitycriteria for immunisation and resources on flu for schools,healthcare providers and workplacesl Treat Yourself Better (www.treatyourselfbetter.co.uk/) – a publichealth campaign highlighting the ineffectiveness of antibiotics forcold and flu symptoms.

reflection exercise

l Do you know the groupsof people who are eligiblefor free flu vaccinationsunder the NHS? Where canthese people go for theirinjection? What aboutpeople who aren’t eligiblefor a free jab, but areprepared to pay for thevaccination? If you haven’talready got notes on thisdisplayed in yourpharmacy, make a list andshare it with yourcolleagues.

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