Module 2. Coughs, Colds and Influenza

Transcription

1 Module 2 Coughs, Colds and Influenza

2 MODULE 2 INTRODUCTION Introduction Colds and flu are both classified as viral infections 1. The definition of a virus A virus is a small infectious organism much smaller than a fungus or bacterium that must invade a living cell in order to reproduce (replicate) 1. The Common Cold What we refer to as the common cold but is not usually accompanied by a is a viral infection of the membranes fever (afebrile) and the condition is one of the nose, sinuses, throat and large that resolves itself when its course is run airways 2. It usually leaves the patient (self-limited) 3. with unpleasant symptoms (acute), MODULE 2 THE COMMON COLD The lifecycle of a virus The organism or virus secures itself to a cell and then enters it, turning the cell into its host. Here it releases its genetic material, DNA or RNA, and starts to manipulate the cell, forcing it to duplicate the virus. After this replication process the infected cell may die, since it cannot return to its natural function 1. When the cell dies, it releases newly cloned viruses, which can in turn infect other cells 1. And so the virus spreads. Viruses usually have a preferred host cell. Each type of virus tends to affect only one type of cell 1. The rhinovirus is most commonly associated with the common cold 2. It specifically infects the cells of the upper respiratory tract, which leads to a runny nose (rhinorrhoea), cough and sore throat 3. There are more than 100 different strains, or serotypes, of rhinovirus 3! Virus invades the cell membrane The cell reproduces the virus and dies Sphenoidal sinus Frontal sinus Nasal conchae Nasal cavity Nose Pharynx Larynx Trachea Alveoli Bronchus Once inside the cell it takes control This leads to the unpleasant symptoms of cold or flu, such as fatigue Right lung Diaphragm Bronchioles Left lung Virus invading cell. Adapted from Porter RS (Ed.) Viral Infections: Overview of Viral Infections 1 The Respiratory System 22 23

3 MODULE 2 SYMPTOMS Facts about the Common Cold Swollen tissues cause It is not mucus, but inflammation 5 that makes your nose feel stuffy. The blood vessels in your nose swell up because of the increase in white blood cells. As your blocked nose they swell they narrow the passages in your nose and restrict airflow 5. Women are more Women get colds more often than men 5. Overall women interact with children more often, and children get around 3 or 4 times as many colds susceptible to colds as adults do in a year 5. This means childminders and teachers are exposed to more cold viruses. There is no cure for Because both colds and influenza are viral infections, they cannot be treated with antibiotics these are only effective against diseases caused by bacteria the common cold 6. Thick mucus is caused As a cold progresses, mucus changes from thin and clear to thick and white or yellow by white blood cells 6. It is not bacteria that cause this change in colour, but rather countless white blood cells 6 that have travelled to the nose, to defend you from the virus, and are now being expelled with the mucus. Key symptoms of a cold 2,3,11 Cough generally mild and can last up to 2 weeks Runny or congested nose Discharge from the nose may become thick and yellow or green as the cold progresses Itchy or sore throat Low-grade fever occasionally Mild fatigue Watery eyes Slight body aches or a mild headache Sneezing Did you know You can catch a cold through your eyes 6 The cold virus is spread through droplets from sneezes and coughs. If such a droplet lands on your hand you can transfer the virus to your eye by casually touching your face. Once in your eye the virus easily travels through a duct to the nasal cavity. It s a good habit to learn not to touch your face throughout the day. MODULE 2 TREATMENT You can t catch a cold from being cold The frequency of contracting colds decrease as you age Sufficient sleep keeps colds away The cold was given its name because the symptoms of the disease are so similar to those found in a person that has been exposed to low temperatures 7. But it is not true that you can catch a cold from being cold or wet 2. On average children get 7 to 10 colds a year, compared to adults who only get 2 or 3 8. Individuals who sleep less than six hours may be more than four times as likely to catch a cold as those who get over seven hours of sleep a night 9. Treatment Treating a cold accompanied by a cough Because antibiotics do not affect the course of a viral infection 12, symptoms are usually treated 2. One of the common symptoms of viral illnesses such as colds and flu is coughing 12. Wet vs. Dry Coughs 12 Infants and the aged are at greater risk Babies and the elderly can develop chest infections such as bronchiolitis caused by the cold virus which can, in some cases, be fatal 10. Wet A wet or productive cough produces phlegm or mucus. This is the body s natural way of clearing mucus and sputum from the lungs. Symptoms Dry A dry or non-productive cough produces no phlegm or mucus. These types of coughs develop toward the end of a cold, or are caused by allergies or exposure to an irritant. How to spot a cold 2,11 The symptoms of a cold usually appear about 1 to 3 days after the subject has been exposed to the virus. A cold is at its most contagious during the first 1 or 2 days after symptoms have developed. This is why it is important to take precautions, such as washing your hands, after being in contact with a person with a runny nose or mild cough. TIPS: Home care for the patient 2,13,14 : Stay warm and comfortable Avoid stressful situations that can further tire out your immune system Rest at home if you have a fever or more severe symptoms Drink fluids 2 with extra electrolytes Inhale steam from a vaporiser to loosen secretions so they can be expelled Ease high temperatures with ibuprofen and paracetamol 24 25

4 MODULE 2 INFLUENZA Influenza Flu is a viral infection of the lungs and airways by an influenza virus 15. About 95% of influenza cases are caused by Type A. About The Flu Vaccine 16 Influenza vaccines have been available and in use for over 60 years. The vaccine usually protects against three different strains of the virus. The makeup of the vaccine evolves each year as the virus adapts. Medical staff led by the World Health Organisation (WHO) base their current vaccine on the strains that seem most likely to spread in the influenza season that lies ahead. MODULE 2 SYMPTOMS There are 3 types of influenza virus 15. Type A Type B Type C Fast fact Within Type A and B there are a wide variety of subtypes or strains that cause seasonal flu. Type C occurs less frequently, mainly in children, and does not cause a typical influenza illness. How to spot the flu Symptoms Symptoms tend to be more severe than those of a cold. They usually appear about 1 to 4 days after the patient has been exposed to the virus 15. Flu becomes contagious 1 day before symptoms develop and 5 to 7 days after the person becomes sick 19. Pandemics 18,22 An influenza pandemic occurs when there is a global spread of a new virus. A new virus means that the body has no natural immunity against it. This can cause serious symptoms in even the History 17 When it comes to the flu, the time from infection to illness, generally known as the incubation period, is about 2 days 16. healthiest of patients. Past influenza pandemics, like the H1N1 (2009) virus, otherwise known as Swine Flu, have typically originated from animal influenza viruses. Body aches and pains Severe headaches and light sensitivity may occur Chills or chilly sensations (usually the first symptom) Fever (up to 39 C) Key symptoms of influenza 1,15 Fatigue and weakness Warm, flushed skin Respiratory symptoms include: Scratchy sore throat Dry cough, which may develop into a wet cough Runny nose and watering eyes Burning sensation in the chest Pandemics are much less common than epidemics. In the last two centuries there have been 6 major influenza pandemics, typically named after the location of their origin. Pneumonia is the most common complication of flu. This can present as a viral or bacterial infection 15. Key symptoms are a worsened cough, difficulty breathing, persistent fever, and blood in the sputum : Russian influenza (H2N2) 1900: Old Hong Kong influenza (H3N8) 1918: Spanish influenza (H1N1) 1968: Hong Kong influenza (H3N2) 2009: Swine influenza (influenza A [H1N1] pdm09) Bacterial infections 2,20 Bacteria are single-celled micro-organisms that can exist independently or as parasites. Some bacteria can cause disease. The Streptococcus bacterium, for instance, causes strep throat. These infections develop when congestion, caused by colds, block the normal drainage in the nose, and allows bacteria to grow in the resulting collection of secretions

5 MODULE 2 DIAGNOSIS Diagnosis The difference between colds and flu 13,14 It can prove difficult to assist customers The table below will help you to ask your who aren t feeling well and are not quite customers exactly the right questions, sure about all the facts regarding their so you can quickly distinguish between condition. It is especially tricky since the two ailments 11,12,14, and offer an colds and flu share many of the same effective solution. common symptoms. Urgent assistance Tip for pharmacy staff When it comes to assisting customers, front shop assistants and pharmacist assistants are tasked with referring any customer asking for a product recommendation to the pharmacist on duty. Pharmacists should, in turn, refer customers who have severe symptoms to a general practitioner (GP) immediately. MODULE 2 URGENT ASSISTANCE SYMPTOM COLD FLU Refer adults to a doctor when they have the following symptoms 21 : Sore throat (often scratchy) Shortness of breath, or difficulty breathing Pain or pressure in the chest or abdomen Cough 11,12,14 (mild and short duration) (can last for weeks) Sudden dizziness Headache (usually mild) (usually more severe) Confusion Discomfort in the eyes (watering eyes) (often light sensitivity and painful eyes) Severe or ongoing vomiting An improvement in symptoms, followed by a return of the General malaise or tiredness (usually mild) (often accompanied by weakness) fever and a worse cough Sneezing/runny nose/blocked nose (often one of the first symptoms to appear) Refer children to a doctor when they exhibit the following symptoms 21 : Rapid breathing or difficulty breathing General aches and pains in the body (mild or not at all) A bluish or grey skin colour Fever (usually not) Not drinking enough fluids Severe or ongoing vomiting Not waking up, or not interacting Irritability, especially if child does not want to be held An improvement in symptoms, followed by a return of the fever and a worse cough 28 29

6 MODULE 2 TREATMENT How to avoid the flu 15,22,23,24 It typically takes 2 weeks for the influenza vaccine to become effective, so it is essential for the patient to be extra vigilant and boost their immune system during this time. Here are some of the things that can be done to avoid getting sick: MODULE 2 TREATMENT 1 Wash your hands frequently. It is recommended to wash your hands for 20 seconds at a time, to make sure you get rid of any unwanted micro-organisms. 2 Avoid people who are coughing or sneezing. The flu virus can be transmitted through air or by touch. Treatment The majority of people recover from continue for days or weeks 15. At the fever and other symptoms in about pharmacy, treatment is aimed at 7 days without needing medical relieving symptoms and OTC remedies attention 16, though coughing, wheezing, overlap with those used to treat weakness, sweating and fatigue may symptoms of the common cold 15. Bonus Section: Home care Tips for the Patient 13,15 3 Eat plenty of fruits and vegetables. A balanced diet with lots of vitamins and minerals will boost the body s immune system, making it easier to fight off viruses. Make sure you eat a good mixture of green, red and yellow vegetables and a variety of fruit to get the maximum benefit. 4 Do aerobic exercises. Any activity that gets your heart pumping helps increase the natural virus-killing cells in your body. Get plenty of rest Drink lots of fluids Avoid exertion 5 Drink plenty of warm drinks in the winter months. This helps you stay hydrated, it soothes the throat and also washes it clear of potentially harmful intruders. Did You Know Germs can survive for several hours on tissues. Dispose of your used tissues as soon as possible 13. Did you know Influenza viruses can be spread by airborne droplets, person-to-person contact, or contact with contaminated items 22. This is why sanitary habits are essential to help prevent flu. In fact, good hygiene is the best way to prevent infections

7 MODULE 2 OTC TREATMENT Over the counter (OTC) treatment MODULE 2 BENYLIN Colds cannot be cured once they have started 2, which is why over-the-counter (OTC) treatments relieve symptoms. A variety of OTC remedies often sold as combinations 2 can assist patients while they wait for their body to fight off the virus or for the symptoms to abate. When a cold or flu comes with a cough, Benylin is there to help you get better and get back out there as fast as possible. The Benylin range of products treat the symptoms of coughs, colds and flu quickly and effectively. These OTC treatments work to relieve fever, aches, pains, coughs and nasal congestion - only to be recommended by pharmacists. OTC REMEDY EFFECT BENYLIN PRODUCT Nonsteroidal anti-inflammatory drugs(nsaids) 2 /analgesics/ antipyretics, such as aspirin, paracetamol, ibuprofen 2 Relieve aches and pains and reduce fever 2 Cough suppressants, such as dextromethorphan 33, May help relieve cough 33 diphenhydramine and codeine 2 Benylin Daytime Flu Tablets and Benylin 4 Flu Benylin Original Benylin with Codeine and Benylin Dry Cough Decongestants, such as pseudoephedrine, xylometazoline and oxymetazoline 2 Help to clear nasal passages and/or dry runny nose 2 Benylin Daytime Flu Tablets and Benylin 4 Flu Expectorants, such as guaifenesin 2 May help loosen mucus 2 Benylin Wet Cough, Benylin Wet Cough Menthol, Benylin Children s Wet Cough and Benylin Bronchospect When your cold or flu comes with a cough, Benylin can help provide relief so you can get back out there. The Benylin range helps to provide relief for a number of coughs, and includes expectorants that help thin mucus when you have a productive cough, as well as suppressants to control the cough reflex in the case of dry, hacking coughs

8 MODULE 2 BENYLIN What is it for? What s inside? Dosage MODULE 2 BENYLIN Relief of a general nonspecific cough. Active ingredients: Diphenhydramine HCl 26,27,28 (starts to work in 15 min and lasts up to 12 hours) and ammonium chloride reduce coughs. Contains sugar and alcohol. Adults & children over 12 years: 5 10 ml every 3 4 hours. Children 6 12 years: ml every 4 hours. Maximum of 4 doses per day. children under 6 years old. Cough suppressant. Active ingredients: Diphenhydramine HCl 26,27,28 (starts to work in 15 min and lasts up to 12 hours), codeine phosphate and ammonium chloride to relieve coughs. Contains sugar and alcohol. Adults & children over 12 years: 5 10 ml every 4 hours. Children 6 12 years: ml every 4 hours. children under 6 years old. Max 4 doses a day. What is it for? What s inside? Dosage Active ingredient: For relief of an irritating non-productive cough. Active ingredient: Dextromethorphan hydrobromide 29 (starts to work in 15 min and lasts up to 6 hours) elevates the threshold for coughing. Reduces frequency and intensity of coughs. Sugar and alcohol free. Adults: 5 ml every 4 hours or 10 ml every 6 8 hours. Children 6 12 years: ml every 6 8 hours. Children 2 6 years: 2.5 ml every 6 8 hours. Not for children under 2 years old. BENYLIN WET COUGH MENTHOL BENYLIN WET COUGH Alleviation of wet cough. Helps thin and loosen chest mucus. Alleviation of wet cough. Helps thin and loosen chest mucus. Guaifenesin 32 (starts to work in 30 min and lasts up to 6 hours) used to reduce chest congestion. Contains sugar. Active ingredient: Guaifenesin 32 (starts to work in 30 min and lasts up to 6 hours) used to reduce chest congestion. Sugar, alcohol and colourant free. Adults: ml every 4 hours. children under 12 years old. Adults: ml every 4 hours. Children 6 12 years: 5 10 ml every 4 hours. Children 2 5 years: ml every 4 hours. children under 2 years old. Active ingredients: Symptomatic relief of cough associated with bronchospasm in children. Terbutaline sulphate 30,31 (starts to work in 30 min and lasts up to 8 hours) and guaifenesin 32 (starts to work in 30 min and lasts up to 6 hours) used to reduce tight chest congestion. Sugar, alcohol and colourant free. Children 7 years and older: 5 10 ml three times daily. Children 3 6 years: ml three times daily. children under 3 years old. BENYLIN CHILDREN S WET COUGH To alleviate coughing in children. Helps thin and loosen chest mucus. Active ingredient: Guaifenesin 32 (starts to work in 30 min and lasts up to 6 hours) used to reduce chest congestion. Sugar, alcohol and Colourant free. Children 6 12 years: ml every 4 hours. Children 2 5 years: 5 10 ml every 4 hours. children under 2 years old

9 MODULE 2 BENYLIN Benylin has a range of products especially designed to quickly and effectively treat the symptoms of coughs, colds, flu and congestion for the whole family, helping them to get better and get back out there. What is it for? For effective daytime relief of symptoms associated with cold and flu, including: fever, blocked nose, body pains and headaches. MODULE 2 BENYLIN What is it for? For relief of symptoms associated with cold and flu, including: fever, body pains, blocked nose and cough. What s inside? Active ingredients: Pseudoephedrine for nasal congestion and runny nose. Ibuprofen to reduce pain, fever and inflammation. Dosage 1 tablet every 4 6 hours. Do not exceed 6 tablets in 24 hours. Do not recommend this product for children under 12 years old. What s inside? Active ingredients: Paracetamol reduces pain and fever. Pseudoephedrine for nasal congestion and runny nose. Diphenhydramine HCl 26,27,28 (starts to work in 15 min and lasts up to 12 hours) relieves cough. Dosage Tablets Adults: 2 tablets 4 times daily. Do not exceed 8 tablets within 24 hours. Children (6 12 years): 1 tablet 4 times daily. Do not exceed 4 tablets within 24 hours. Do not recommend for children under 6 years. Liquid Adults, elderly and children over 12 years: 20 ml 4 times daily. Quick Question Explain the statement There is no cure for the common cold

10 MODULE 2 REFERENCES References 1. Porter RS (Ed). Viral Infections: Overview of Viral Infections. The Merck Manual Home Health Handbook. Available at home/infections/viral-infections/overview-of-viral-infections. Accessed on 2 March Porter RS (Ed). Viral Infections: Common Cold. The Merck Manual Home Health Handbook. Available at Accessed on 2 March Porter RS (Ed). Respiratory Viruses: Common Cold. The Merck Manual of Diagnosis and Therapy. Available at Accessed on 2 March Bruce Blaus. Wikiversity Journal of Medicine. Wikimedia Commons. Available at: Accessed on 2 March Mayo Clinic Patient Care & Health Info. Common Cold: Symptoms. Available at symptoms/con Accessed on 2 March Institute for Quality and Efficiency in Health Care (IQWiG) (Ed). US National Library of Medicines Fact Sheet: The Common Cold. Available at Accessed on 2 March Harper, Douglas. Online Entomology Dictionary. Available at: Accessed on 2 March NHS Choices. Five Facts About Colds. Available at Accessed 2 March HealthDay. Too Little Sleep Can Quadruple Risk for the Common Cold. Available at Accessed on 2 March Cardiff University. The common cold. Available at 2 March Medicine.net. Definition of Bacteria. Available at Accessed on 2 March Web MD Cold, Flu, & Cough Health Center. Coughs: Age 12 and Older. Available at Accessed on 2 March NHS Choices. Coping With Colds and Flu. Available at Accessed 2 March Boots WebMD. Flu guide. Available at Accessed 2 March Porter RS (Ed). Viral Infections: Influenza. The Merck Manual Home Health Handbook. Available at viral-infections/influenza-flu. Accessed on 2 March World Health Organization. WHO Facts Sheets: Influenza (Seasonal). Available at Accessed on 7 November Porter RS (Ed). Respiratory Viruses: Influenza. The Merck Manual Home Health Handbook. Available at infectious-diseases/respiratory-viruses/influenza. Accessed on 7 November World Health Organization. FAQs: What is a pandemic? Available at en/. Accessed on 7 November How Flu Spreads. Centers for Disease Control and Prevention. Available at Accessed on 7 November WebMD. Cold, Flu & Cough Health Center. Coughs, Age 12 and Older Prevention. Accessed on 15 November The National Institute for Communicable Diseases (NICD) in collaboration with The South African National Department of Health and World Health Organization (WHO). Healthcare Workers Handbook On Influenza (last updated: May 2014). Available at Healthcare%20Workers%20Handbook%20on%20Influenza%20in%20SA%20_12%20May%202014(1).pdf. pp 17. Accessed on 7 November Centers for Disease Control and Prevention. When and How to Wash Your Hands. Accessed on 15 November WebMD. Cold, Flu & Cough Health Center. 8 Natural Tips to Help Prevent a Cold. Available at Accessed on 15 November NHS Choices. Preventing colds and flu. Available at Accessed 3 December Porter RS (Ed). Overview Of Viral Respiratory Tract Infections In Children. The Merck Manual Home Health Handbook. Available at Accessed on 7 November Nurses Drug Handbook. 2010, Jones and Bartlett Pub. 9th Edition, pp Donaldson, M., Gizzarelli, G. & Chanpong, B. 2007, Oral Sedation: A Primer on Anxiolysis for the adult patient. Anaesth Prog. 54: pp Goodman and Gilman s. 2011, The Pharmacological Basis of Therapeutics, Twelfth Edition, Diphenhydramine HCl. p. 921: Table Drugs.com. Dextromethorphan Hydrobromide. Available at Accessed on 25 February AHFS Monograph 2013 Terbutaline Sulphate. 31. Terbutaline Sulphate Monograph. Martindale. 32nd Edition p Data on file. 33. Wick, Jeannette. OTC Diphenhydramine For Cough: The Evidence Is In". Pharmacy Times. N.p., Web. 20 Apr Apr MODULE 2 REFERENCES S2 BENYLIN ORIGINAL. Each 5 ml contains: Ammonium Chloride 125 mg and Diphenhydramine HCl 12.5 mg. Ref. No. G829 (Act 101/1965). S2 BENYLIN WITH CODEINE. Each 5 ml contains: Ammonium Chloride 125 mg, Codeine Phosphate 10 mg and Diphenhydramine HCl 12.5 mg. Ref. No. G830 (Act 101/1965). S2 BENYLIN DRY COUGH. Each 5 ml contains: Dextromethorphan HBr 15 mg. Reg. No. Z/10.1/5. S0 BENYLIN WET COUGH. (ALCOHOL, SUGAR & COLOURANT FREE LIQUID). Each 10 ml contains: Guaifenesin 200 mg. Reg. No. 37/10.1/0061. S0 BENYLIN CHILDREN S WET COUGH (ALCOHOL, SUGAR & COLOURANT FREE LIQUID). Each 5 ml contains: Guaifenesin 50 mg. Reg. No. 35/10.1/0266. S0 BENYLIN WET COUGH MENTHOL. Each 10 ml contains: Guaifenesin 200 mg. Reg. No. 28/10.1/0374. S2 BENYLIN FOUR FLU LIQUID. Each 20 ml contains: Diphenhydramine HCl 25 mg, Paracetamol mg, Pseudoephedrine HCl 45 mg. Reg. No. 33/5.8/0345. S2 BENYLIN FOUR FLU TABLETS. Each tablet contains: Diphenhydramine HCl 12.5 mg, Paracetamol 500 mg and Pseudoephedrine HCl 22.5 mg. Reg. No. 33/5.8/0509. S2 BENYLIN DAYTIME FLU TABLETS. Each tablet contains: Pseudoephedrine HCl 30 mg and Ibuprofen 200 mg. Reg. No. 36/5.8/0206. S2 BENYLIN BRONCHOSPECT. Each 5 ml contains: Guaifenesin 66.5 mg, Terbutaline Sulphate 1.5 mg. Reg. No. 31/10.1/