Pharmacists can help people with colds understand the importance of not ‘soldiering on,’ writes Karalyn Huxhagen
Today was a bitterly cold, rainy and dark day in my home town.
The pharmacy was full of coughing, sneezing and very miserable customers. Many of these customers work on mine sites or have similar occupations where they are drug tested. Recommending symptom relief for these customers requires thought as to what ingredients are safe and effective.
Symptoms that were presented included:
- blocked or runny noses;
- sore throat;
- red or watery eyes;
- sneezing; and
- generally feeling unwell.
As these customers work in a confined area and share living and working conditions with other people, it is very important that they understand how easily the viruses that cause the common cold can spread.
Many of the mine sites ‘hot bed,’ where the same bed/accommodation unit is shared by two to three people within a 24-hour period. Office dongas, machinery cabins, camp kitchens and camp bedrooms can become contaminated easily.
A discussion on good hand hygiene and how to minimise the spread of viruses is vital when discussing how to make these patients well again.
- Hand washing.
- Use of hand sanitisers.
- Wiping of surfaces such as telephones, computer keyboards, steering wheels, door handles with antibacterial wipes.
- Using disposable tissues.
- Wearing of face masks to reduce the spread of droplets when coughing and sneezing.
- Trying not to touch the nose or surrounding face.
- Not sharing towels or bed linen.
As the common cold is a self-limiting condition and should resolve within five to seven days it is important to inform the customer what to do if their condition continues beyond this time or if their condition worsens.
Some patients may have a cold for longer, especially if they are living or working in an environment where continual exposure to the virus is occurring.
Other conditions that may be the cause of their symptoms:
- Acute rhinosinusitis.
- Acute otitis media.
These conditions require referral to the doctor.
Trying to work through with a heavy viral cold can have consequences if the virus causes complications.
During the H1N1 outbreak we lost two relatively young male customers to the influenza virus. These were normally healthy men who kept going to work and did not rest when their seemingly bad cold became a lot worse to the point that they were severely dehydrated, and both died from cardiac arrest.
They both had developed vomiting and stomach issues and continued to take over-the-counter cold tablets. The paracetamol component of what they were taking may have caused toxicity in their dehydrated state. They had been counselled to seek medical attention but could not be told.
So what do you recommend for those who work where they will be drug tested?
The GPs in our clinic recommend the non-sedating antihistamines at a dose of one tablet daily for the nasal congestion, nasal drip. There is not a great deal of evidence to support the use of the non-sedating antihistamines for the common cold but they may provide a small amount of relief.
Short term nasal decongestant sprays can be used. The use of saline nasal sprays and washes provide relief and reduce mucosal swelling. The use of nasal sprays containing ingredients such as steroids or ipratropium can stabilise the cells from producing mucus.
Vicks inhalers and rubs such as Vicks vaporub give short-term nasal congestion relief. I also recommend products such as Breathe right strips and a room vaporiser to help with sleep when you have a cold. Simple tips such as sleeping with your head elevated helps to breathe better as you sleep.
Relief of aches and pain and headaches is best resolved with paracetamol.
Sore throats can be resolved with gargles, lozenges, sprays and tinctures. Be careful not to recommend a product containing alcohol as that may show up on a mine site breath test.
The use of immunity boosters to reduce the length of the cold does have evidence to support this recommendation.
Products such as bromhexine will assist in liquefying mucous and helps to reduce congestion.
Simple suggestions such as chicken soup, inhaling steam from a bowl , resting and staying hydrated and eating healthy all are good points to raise.
The common cold is a self-limiting viral disease which may produce a diversity of symptoms. At best we can provide symptom relief and advice on lifestyle measures to consider.
As pharmacists we should always end our advice giving with a firm recommendation to see their GP if the cold lasts longer than a week or if their condition deteriorates further.
Karalyn Huxhagen is a community pharmacist and was 2010 Pharmaceutical Society of Australia Pharmacist of the Year. She has been named winner of the 2015 PSA Award for Quality Use of Medicines in Pain Management and is group facilitator of the Mackay Pain Support Group.