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Cold Comfort This Winter

By Irish Pharmacist - 01st Dec 2022

flu

Coughs, colds and flu will present the usual challenges at the counter this winter but vaccination can help to alleviate many of these problems

Cold or influenza ( flu) are caused by viruses so have no cure, but the symptoms can be relieved by over-the-counter remedies. These symptoms include runny/blocked nose, sneezing/coughing, aches and pains, high temperature and sore throat. The flu comes on suddenly, whereas a cold develops over several hours.

Flu is a much more ‘hard-hitting’ illness than a cold and will usually leave the sufferer confined to bed for a few days (more about flu symptoms later in this article). The symptoms of a cold, while unpleasant, usually allow the sufferer to continue his or her normal daily activities; though with Covid-19 in our community, Covid-19 must be considered a possibility too. Symptoms of a cold are generally confined to the head, while a patient with the flu will feel sick all over. The treatment for both colds and flu are similar. Cold and flu symptoms generally last a maximum of seven days and need no specific treatment other than painkillers for aches, pains and temperature and simple measures such as decongestant rubs or vaporisers. Antibiotics are of no benefit, as both colds and flu are caused by viruses.

COLD AND FLU TREATMENT

 The age of the patient will influence choice of products.

  • Runny nose and congestion are both treated by decongestants.
  • Sneezing is treated by an antihistamine. u Cough may be due to irritation or to post-nasal drip. An expectorant mixture can help.
  • Headaches are due to inflammation of the sinuses and nasal passages and muscular or joint pain is common — this will need a painkiller.
  • Sinus pain worsens on leaning forward or lying down and may develop into an infection.
  • High temperature is more common in the flu than with a cold — paracetamol is very useful to bring down high temperature.
  • Sore throat is usually the first sign of a cold, and one of the common OTC sore throat lozenges will help.

PRECAUTIONS

 Many cold and flu remedies contain several drugs, so anyone on prescription medication should speak to the pharmacist. Anyone who is pregnant, has heart disease or lung disease or the very young or old, should also be seen by the pharmacist.

So, for example, if someone suffers from high blood pressure, it is best to avoid many cold and flu remedies which contain decongestants, as these products tend to raise blood pressure.

Asthmatics and people with stomach complaints such as stomach ulcers should avoid products which contain aspirin and non-steroidal anti-inflammatories (NSAIDs) like ibuprofen. This is because aspirin and NSAIDs can trigger asthma attacks in some asthmatics and irritate stomach ulcers. There are a vast number of preparations available for the treatment of cold and flu symptoms, some of which are combination preparations and may be capable of treating many symptoms at once.

COUGH

Essentially, there are two types of cough, a dry or a chesty cough. During a cold, a cough is often caused by a nasal drip irritating the back of the throat. Chesty coughs occur when mucus (also called phlegm or catarrh) builds up in the airways, and the cough occurs so the body can clear the mucus. Chesty cough mixtures with an expectorant like guaifenesin or carbocisteine liquefy the catarrh so it can be coughed-up easier. There are other cough mixtures that cause drowsiness which can be used at night to help sleep. Sugar-free versions of cough mixtures are available for diabetics.

Dry cough mixtures contain ingredients such as pholcodine, codeine and dextromethorphan. Dry cough mixtures come in drowsy or non-drowsy versions. There are also cough mixtures available which contain decongestants, which can be effective with a congested head as well as a cough.

WHEN TO SEE THE DOCTOR?

Patients should see their GP if they experience any of the following symptoms with cough, as it can be a sign of more serious conditions, ie, COPD, cancer: u Phlegm, which is green, yellow, or rusty colour.*

  • Coughing-up blood.
  • Cough lasting longer than two weeks.
  • Shortness of breath.
  • Chest pain on breathing or coughing.
  • Unexpected loss of weight.
  • Regular night-time cough.
  • Harsh barking cough in children (croup).
  • ‘Whooping’ sound when breathing in after a fit of coughing (whooping cough).

*The meaning of different colours of phlegm: Green phlegm means a bacterial infection; yellow phlegm means a viral infection; brown or reddish phlegm can mean the presence of blood (serious sign); and clear phlegm means no infection.

A type of blood
pressure medication
can cause a
persistent dry cough
in some people

SELF-HELP FOR COUGHS

 STOP SMOKING

 If you are determined to continue smoking, at least stop for the duration of the cough. This gives the lungs an opportunity to try to clear the infection. When you stop smoking, you will find you cough more for a few weeks as your lungs clear the tar that coated your lungs while you smoked.

STEAM INHALATIONS

 Steam inhalations can be useful, particularly in productive (chesty) coughs. Simply putting hot steaming water (not boiling) in a basin, putting a towel over one’s head and inhaling the steam can accelerate the clearing of catarrh. The steam helps to liquefy lung secretions and the warm, moist air is comforting. Adding a little eucalyptus to the steaming water is a favourite of some people.

INCREASE FLUID INTAKE

 Maintaining a good fluid intake helps to hydrate the lungs. Hot drinks like hot lemon and honey provide a soothing and comforting effect.

COULD THE COUGH BE DUE TO BLOOD PRESSURE MEDICATION?

A type of blood pressure medication can cause a persistent dry cough in some people. The class of drug that causes this cough is ACE inhibitors. Examples include ramipril, perindopril, and lisinopril. About 10-to-15 per cent of people who use this class of blood pressure medication experience a dry cough. The incidence of cough appears to be higher in women. It is a persistent dry cough, which is worse when lying down and generally does not start for 24 hours after starting an ACE inhibitor. If the dry cough occurs, the doctor will need to change to another drug (ie, to an angiotensin 2 inhibitor). The cough will subside once the ACE inhibitor is stopped.

COUGHS IN CHILDREN

Coughs are more usual during school term and are caused by common viruses, which are regularly passed from child-to-child in school. While rarely serious, coughs and colds are an inconvenience and lead to many missed school days. Some prevention tips help prevent coughs and colds: Examples, which have become more common due to Covid-19, include ensuring your child washes their hands regularly and properly, especially after touching their nose or mouth and before handling food. Teach them to always sneeze and cough into tissues to prevent spreading infection. Sharing cups and utensils is a common way to spread colds and flu.

Chesty coughs are especially common during school terms. An antibiotic is rarely needed. Only 20 per cent of chest infections are bacterial, so antibiotics are ineffective in most cases.

GUIDELINES FOR COUGH AND COLD REMEDIES FOR CHILDREN

Guidelines introduced in 201 restricted the sale of cough and cold remedies to children under 6. The Health Products Regulatory Authority (HPRA) brought these guidelines out not because of any safety concern in children under 6, but because they recognised that coughs and colds in children are frequent and normally self-limiting, and there is no real evidence to support the use of these products in children under 6. So, due to these guidelines, pharmacies can no longer sell products containing cough suppressants, decongestants, or antihistamines to under-6s.

Common OTC remedies can no longer be given to children under 6. For a child under 6, the best advice is rest and take plenty of fluids. Most coughs and colds in children under 6 will pass quickly but if it is not improving or there are signs of a bacterial chest/nasal infection (green mucus is a sign), an antibiotic may be needed, however over 80 per cent of coughs and colds are viral, so no antibiotic is normally needed. Saline drops or spray are a good and safe option to clear sinuses in children over 6.

Decongestant rubs or drops can be put on the child’s chest or on a hankie beside the bed, and can be comforting for the child. Paracetamol liquid is still recommended for high temperature for under-6s. For children over 6, there are many OTC products and there is no one that stands out as best. Always double-check the dose before giving, as there are different doses for different ages.

PREVENTION

 As so many different viruses can cause the common cold, there is no vaccination against it. Some prevention tips are:

  • Wash your hands regularly and properly, most importantly after touching the nose or mouth and before handling food.
  • Always sneeze and cough into tissues to prevent spreading infection.
  • Do not share cups or kitchen utensils with others. Use your own cup, plates, and cutlery.

INFLUENZA

 (FLU) Influenza (flu) is a highly infectious, acute respiratory illness caused by the influenza virus. It can affect people of any age. The seasonal flu vaccine (flu jab) protects against four strains of flu virus. These are the strains most likely to be circulating this flu season based on WHO evidence of virus circulation in the Southern Hemisphere in their previous flu season. The four strains in the 2022/23 vaccine are:*

  • An A/Victoria/2570/2019 (H1N1) pdm09-like virus.
  • An A/Darwin/9/2021 (H3N2)-like virus.
  • A B/Austria/1359417/2021 (B/Victoria lineage)-like virus.
  • A B/Phuket/3073/2013 (B/Yamagata lineage)-like virus. Flu vaccination is available through GP surgeries, local pharmacies, and some workplaces.

Flu characteristically
causes a temperature
of 38-to-40°C
that lasts
three-to-four days

SYMPTOMS OF FLU

Symptoms of flu include sudden fever, chills, headache, muscle pain, sore throat, non-productive dry cough, exhaustion, and weakness. Flu characteristically causes a temperature of 38-to-40°C that lasts three to four days.

DIFFERENCE BETWEEN COLD AND FLU

 A cold will develop slowly over a few days, with symptoms like a sore throat and a blocked or runny nose.

The symptoms of flu hit you suddenly and severely, with symptoms like fever and muscle aches. Flu hits you ‘like a brick’. Often, people suffering from a bad cold wrongly believe they have flu. Flu causes extreme exhaustion, muscle aches, severe sweats and leaves you so weak you will not be able to get out of bed. Work and other normal routines are not possible with flu.

COMPLICATIONS OF FLU

Most people recover from flu in two to seven days, but in some it can last for up to two or three weeks. Flu can be severe and can cause serious illness and death, especially in the very young and in the elderly.

Serious respiratory complications can develop, including pneumonia and bronchitis. Older people and those with certain chronic medical conditions are at particular risk of these complications. Pregnant women and women up to six weeks after giving birth have also been found to be at increased risk of the complications of flu. Eighty-to-90 per cent of reported deaths from influenza occur in the elderly, mainly from bacterial pneumonia (200 deaths per year in Ireland), but also from the underlying disease.

THOSE CONSIDERED MORE ‘AT-RISK’ FROM FLU

Some people are more at risk of getting complications if they catch flu. People can get the HSE flu vaccine for free if they:*

  • Are 65 years of age and over.
  • Healthcare worker.
  • Are pregnant.
  • Are children aged two-to-17 years. 
  • Are an adult or child aged six months or older at increased risk for flu-related complications, including:
  • Those with long-term conditions:

Chronic heart disease, including acute coronary syndrome, Chronic liver disease, Chronic renal failure, Chronic respiratory disease, including chronic obstructive pulmonary disease (COPD), cystic fibrosis, moderate or severe asthma or bronchopulmonary dysplasia, Chronic neurological disease including multiple sclerosis, hereditary and degenerative disorders of the central nervous system, Diabetes mellitus, Haemoglobinopathies, Morbid obesity ie, body mass index (BMI) over 40, Immunosuppression due to disease or treatment (including treatment for cancer). l Children with moderate-to-severe neurodevelopmental disorders such as cerebral palsy, Children on long-term aspirin therapy, Those with any condition that can compromise respiratory function (ie, spinal cord injury, seizure disorder or other neuromuscular disorder), especially those attending special schools or day centres, Were born with Down syndrome, Live in a nursing home or other longterm care facility.

  • People who are in regular contact with pigs, poultry or waterfowl should get the flu vaccine.

  Not all household contacts are eligible for the free flu vaccine. NIAC has recommended the flu vaccine only for household contacts of people with certain long-term medical conditions or people who have Down syndrome.

The following household contacts are not recommended for the free flu vaccine from the HSE: Household contacts of:

  • People aged 65 and over.
  • Pregnant women.
  • Children aged two-to-17.
  • Healthcare worker.
  • Carers.

Household contacts that are not in a recommended group themselves cannot avail of the flu vaccine provided through the HSE programme and instead, they must source the flu vaccine privately should they wish to get vaccinated. Bear in mind, the flu vaccine is not free for medical card or doctor-visit card holders unless they are part of the ‘at-risk’ groups mentioned above.

FLU VACCINES AVAILABLE FOR THE 2022/23 SEASON

 This year, there are two different types of flu vaccine being offered to different groups:

1. Quadrivalent influenza vaccine (QIV) for at-risk groups including people who are 65 and over; are pregnant; are aged 18-to-64 and have a long-term medical condition; or are a healthcare worker.

2. Nasal spray flu vaccine for children aged two-to-17 years.

THERE ARE TWO BRANDS OF QIV VACCINE AVAILABLE THIS YEAR:

  1. Quadrivalent Influenza Vaccine (split virion, inactivated) manufactured by Sanofi Pasteur.
  2. Influvac Tetra manufactured by Mylan. Pharmacies must purchase flu vaccines privately from wholesalers to administer to private patients who are not in the above risk groups, ie, patients who must pay privately for the flu vaccine. The earlier the patient gets the vaccine, the better, as they can take up to two weeks to work.

FLU VACCINE SIDE-EFFECTS

 There may be a mild fever and aching muscles for a couple of days after having the vaccine. The arm where the vaccine was given may also be a bit sore. Serious side-effects of the flu vaccine are very rare. There is no aluminium, thiomersal, mercury, gelatin or porcine gelatin in the Influenza vaccines used in the 2022/23 campaign. 

FLU VACCINE AND COVID-19 BOOSTER

 The flu vaccine and the Covid-19 booster are two separate vaccines. You can get both at the same time if you are due a Covid-19 booster dose.

FLU VACCINE FOR CHILDREN

 Children are more likely than adults to get severe complications of flu. Children who are sick with flu miss days in crèche, childcare and school. They also miss out on their usual activities, such as hobbies and sports. Children aged two-to-17 can now get the nasal flu vaccine for free. The flu vaccine will help protect a child against flu and reduce the spread of flu to others. For example, their brothers and sisters, parents, and grandparents.

The vaccine is given as a single spray in each nostril of the child’s nose. The child can breathe normally while getting the vaccine. There is no need to take a deep breath or sniff. The vaccine is not painful and is absorbed quickly. It will work even if the child has a runny nose, sneezes, or blows their nose after the vaccination. Most children need only one dose of the vaccine each year. Some children with chronic health conditions like chronic heart or lung conditions may need two doses. The doses are given four weeks apart for these high-risk children if they have never had a flu vaccine.

SIDE-EFFECTS OF THE NASAL FLU VACCINE

The most common side-effects are mild and include:

  • A runny or blocked nose.
  • Headache.
  • Muscle aches.

Some children get a fever (temperature) after the vaccine. It is usually mild and goes away on its own. If the child has a fever or a headache, paracetamol or ibuprofen can help. Aspirin, or any medicines that contain aspirin, should never be given to children unless prescribed by a doctor (due to risk of Reye’s syndrome). This is especially important in the four weeks after getting the flu vaccine. Serious side-effects such as a severe allergic reaction are rare. There is no evidence that you can catch flu from the nasal flu spray.

*Reference HSE 2022/23 flu vaccine update Thanks to the HSE for flu vaccine 2022/23 updates. Other references on request

Disclaimer: Brands mentioned in this article are meant as examples only and not meant as preference to other brands

Written by Eamonn Brady MPSI (Pharmacist). Whelehans Pharmacies, 38 Pearse St and Clonmore, Mullingar. Tel 04493 34591 (Pearse St) or 04493 10266 (Clonmore). www.whelehans.ie Eamonn specialises in the supply of medicines and training needs of nursing homes throughout Ireland. Email ebrady@whelehans.ie

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