SELF-MEDICATION: COUGH AND COLD


Common Cold

Common cold is one of the most frequently presented conditions in community pharmacies. It is a complex symptom affecting upper respiratory tract. The symptoms usually last for 7 days and are usually acute and self-limiting and may be caused by one of many viruses. Therefore, a cold may present symptoms, individually or in combination with nose, throat, larynx or bronchi. Although colds are self-limiting, it can cause significant discomfort and contributes to loss of productivity through absenteeism at work. Therefore, many people choose to buy medicine for symptomatic relief. In most cases, children are more commonly afflicted then adults. Thus, pharmacists play an important role in assisting the self-treating patients to select and use cough and cold preparations properly.

1. Symptoms
   
   There are many symptoms associated with the common cold. These include coughing, sneezing, runny nose or blocked nose, headache, sore throat, high temperature, ear-ache, watery eyes and even chills.

1. Most patients will experience runny nose. This is initially a clear watery fluid which then followed by the production of thicker and more tenacious mucus. Nasal congestion occurs because of inflammed blood vessels, leading to swelling of the lining surfaces of the nose. This narrows the nasal passages, which are further blocked by increased mucus production.

2. The combination of nasal irritation, discharge and congestion gives rise to sneezing. Cough may present because the pharynx is irritated. At its onset, cough is usually dry and non-productive (without sputum). At later stages, in most common cold however, heavy bronchial congestion may produce wet and productive cough. The cough and sneeze reflex are essential body defense mechanisms by which the respiratory airways leading to the lungs are kept free from foreign bodies and accumulate secretions.

3. Headache may be experienced because of inflammation and congestion of nasal passages and sinuses.

4. Those suffering from cold often complain of feeling hot, but in general a high temperature will not be present. Usually it will subside within one week.

5. The throat often feels dry and sore during a cold and sometimes may be a first sign that a cold is imminent.

Symptoms of common cold usually last for about 7 days. Some symptoms, such as cough, may persist after the worst of the cold is over.

2. Why Do You Get Cold ?

1. Cold weather usually adds stress to our body. Thus, it makes us susceptible to bacteria or virus invasion.

2. Fatigue or weak.

3. Over expose to cold virus.

4. Recent or present infection or allergic reaction.
   
   
   

3. When Should You Consult Your Doctor?
   
   Patient should see a doctor if:

1. Experience hot and cold shivery feeling, muscular aches, and pains in the limbs with high temperature. Body temperature usually more than 38.5oC with severe or productive cough (cough associated with mucus ).

2. Chest pain.

3. Symptoms persist more than a week.

4. Bleeding cough.

5. Facial pain or frontal headache. May be caused by sinusitis (pain around the eyes)

6. Severe and painful sore throat especially in children. May be caused by bacterial (Streptococcus) infection.

7. Patient with history of:

1. Asthma

2. Streptococcus infection

3. Chronic bronchitis

4. Rheumatic fever

5. Chronic lung disease
   
   
   

4. What Should You Do ?
   
   Self-treatment of common cold is intended to relieve symptoms. There are no curative remedies and specific treatment for the common cold. Thus, management of common cold remains focused on symptoms. Goals of treatment include symptomatic relief, minimization of communicability and prevention of complications.
   
   In general, adequate rest and prevention of chilling add to the patient’s comfort. Adequate fluid intake is necessary to prevent dehydration and enhance expectoration. Inhaled steam to loosen nasal congestion and ease expulsion of mucus, blow nose frequently and do not smoke. Using saline gargles several times a day may help relieve an inflammed throat. However, patients using saline gargles should be warned against swallowing the solution. Patient should adopt a well balanced diet as a prevention of common cold. However, if symptoms persist for more than 10 days or complication began to set in, patient should consult a pharmacist or a doctor.

Cough

Coughing is a protective reflex action when the airways is being irritated or obstructed. Its purpose to clear the airways so that breathing can continue normally. Majority of cough present are caused by inflammation of upper respiratory tract usually due to viral infection (eg: common cold, flu) or due to the increased production of mucus or phlegm from common cold.

1. Nature of cough

1. Unproductive
   
   Dry, thickly or tight. In an unproductive cough, no sputum is produced. These coughs are usually caused by viral infections and are self- limiting.

2. Productive
   
   Productive cough produces sputum. Sputum appears as green, yellow or rusty colored thick mucus. Sometimes blood may be present in it.
   
   This may indicate a chest infection such as bronchitis or pneumonia and patient should see a doctor.

3. Croup
   
   Cough has a harsh barking quantity. Usually occur in infants and associated with difficulty in breathing and an inspiratory stridor.
   
   
   

2. Symptoms

1. Itchy or sore throat, cold and catarrh may be associated with a cough.

2. Sudden unintended expulsion of air from the lungs with an explosive noise sometimes accompanied by phlegm.

3. Allergy, which sets off spasm in the air passages (eg: asthma )

4. Excessive phlegm or secretions due to respiratory infection or disease ( flu, bronchitis, laryngitis )
   
   
   

3. When Should You Consult Your Doctor?
   
   Patient should see a doctor when:

1. Cough persist for 2 weeks or more.

2. Complain of chest pain.

3. Sputum is yellow, green, rusty or blood stained.

4. Shortness of breath or wheezing.

5. Recurrent nocturnal cough.

6. Failed medication.
   
   
   

Treatment

1. Common Cold
   
   Four classes of medicines that should be considered to treat symptoms of the common cold are decongestants, expectorants, cough suppressants and antipyretic or analgesics. Decongestants and expectorants are two groups of medicines that help to open congested nasal passages, so that drainage of mucus and circulation of air will help to stimulate the flow of respiratory tract secretions. Cough suppressants are used to reduce the frequency of a cough. Antipyretic or analgesic agents relieve feverishness and headache. Antihistamines ( use as an anti-allergy agent) can also reduce some of the symptoms of cold such as runny nose and sneezing.

2. Cough
   
   The choice of treatment for cough depends on the type of cough. Suppressants are effective in treating unproductive (dry) cough, while expectorants are effective in the treatment of productive (wet) cough. Lozenges also helped to relieve dry irritating cough, whereas mucolytics will make mucus more watery.
   
   
   

Conclusion

There are ranges of over-the-counter medicines in the treatment of common cold and cough is because such products are easily available and well advertised. In some diseases, the combination of two or more medicines are needed to provide a convenient dosage form. However, combination products are usually more expensive, are limited by fixed doses in the preparation and may have additive adverse effect. Therefore, patient should consult a pharmacist before buying their medicine.

In the need for self-treatment, pharmacist should be the first health professional to be contacted. Patients cannot depend only on reading materials or package instructions. Product selection must be based not only on the presence of an effective agent in a therapeutic amount but also on underlying disorder that may be influenced adversely by the recommended therapy. Having chosen the product, patient should consult pharmacist on how to take their medication, and what to expect from it with regard to both symptomatic relief and adverse effects. Patients should always refer to the pharmacist if they have any queries.