Cough & Cold

Cold comfort: How to prepare for the annual cough, cold & flu season

provided from the training company and the instructions on the vaccine product. This led to a number of patients receiving below the recommended dose and these patients required revaccination. Evaluation has shown vast improvements with the service in the past year. The number of patients accessing the flu vaccination service increased, with 27% of patients accessing the vaccination service for the first time, according to the Irish Pharmacy Union (IPU). It is essential that some members of the general public be vaccinated at the beginning of the flu season and in particularly those in the at risk groups. These include:

persons 65 and over those with a long-term medical

condition such as diabetes, heart or lung disease

people whose immune system

is impaired due to disease or treatment other long stay institutions (BMI) over 40 Developments in pharmacy in the past three years have made the pharmacist the principal health care professional for the cough, cold and flu market. The cough and cold and allergy market in Ireland was worth 73.7million in 2012 according to Euromonitor. Cough remedies were worth 19.9m and decongestants 6.8m. This category is the highest seller in Irish pharmacies. Euromonitor predict that the category will grow at a rate of 1% over the forecasted period to 2017. Euromonitor the global market researcher says of the market, There are a wide range of factors affecting consumers choice of products. Whilst brand- loyalty and a family history of use are strong features in the Irish market, so too is efficacy, as well as recommendations from health professionals such as doctors and pharmacists. They added, Whilst generic products increased in popularity in Ireland, as spending concerns amongst consumers continued to drive purchasing patterns, it remained an area of slow growth, mainly due to strong brand recognition and loyalty. FLU VACCINATION The Pharmaceutical Society of Irelands (PSI) most recent report on the influenza vaccination service showed that in 2012-2013 the service operated effectively with no safety issues. In 2011/2012 there were some safety issues of under dosing in some patients due to an inconsistency with information

residents of nursing homes and persons with a body mass index pregnant women(can be given at
any stage of pregnancy) pharmacists)

healthcare workers (including carers people with regular close

contact with poultry, water fowl or pigs

The seasonal flu vaccination is

updated every year and, even if a patient received a vaccination last year they will still need to be revaccinated every year.

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The 2013/2014 vaccine contains three strains as recommended by the World Health Organisation (WHO).

An A/California/7/2009 (H1N1) pdm09-like virus; like the cell-propagated prototype virusA/ Victoria/361/2011; virus.

A specific part of the immune system, called T-cells, is thought to be able to recognise proteins in the core. A team at Imperial used the 2009 swine flu pandemic to test the theory. The outer shell should have been a completely new experience to the immune system, but the core may have been encountered before in other flu viruses. The team compared levels of one kind of T-cells at the start of the pandemic with symptoms of flu in 342 staff and students at the university. They showed that the higher the levels of the T-cells a patient had, the milder their symptoms were. Researchers then teased out the specific part of the immune system that offered some pandemic flu protection and which part of the virus it was attacking. Prof Ajit Lalvani, who led the study, told the BBC: Its a blueprint for a vaccine. We know the exact subgroup of the immune system and weve identified the key fragments in the internal core of the virus. These should be included in a vaccine. In truth, in this case it is about five years [away from a vaccine]. We

have the know-how, we know what needs to be in the vaccine and we can just get on and do it. Prof Sarah Gilbert, who is developing a universal flu vaccine at the Jenner Institute in Oxford, said: Live attenuated influenza vaccines which are given by nasal spray and will be used in children in the UK from this autumn are much better at increasing the number of influenza-specific T cells, but these vaccines only work in young children who havent yet had much exposure to influenza virus, so we need an alternative approach for adults. The new publication contains information on the precise characteristics of the influenzaspecific T cells which were protective, and this information will be useful in monitoring the immune response to vaccination when testing novel influenza vaccines which are designed to provide protection against pandemic as well as seasonal influenza viruses. KNOWING THE DIFFERENCE The symptoms of a common cold are often confused with that of the influenza virus and other respiratory conditions. Symptoms of a cold tend to

An A(H3N2) virus antigenically

A B/Massachusetts/2/2012-like
UNIVERSAL FLU VACCINE Just this month, scientists have made a significant leap towards creating a vaccine that would protect against every form of flu. A team at Imperial College London say they have made a blueprint for a universal flu vaccine. Their discovery is published in the journal Nature Medicine. Influenza is able to change the proteins that protrude from the surface of the virus as readily as people change outfits. However, the material on the inside is common to many strains of flu. Vaccine researchers believe targeting the core of the virus may be the way to develop a universal vaccine.

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Oral antitussivess and topical antitussives are effective for cough management. If a patient has a persistent cough it could be because of something more sinister and the source should be explored. A cough should not last more than 10 days. Treatment should be appropriatefor patients who are on multiple medications or who have previous medical conditions and with small children and children under the age of 16. Patients in the high risk group should be advised to visit their GPs first in order to avoid complications, such as chest infections or pneumonia. Likewise, patients whose symptoms linger or worsen should be advised to visit their GP. Dr Laura Noonan develop over a period of one to three days and start gradually such with sneezing or the sniffles and a sore and/or irritated throat. This will be followed by nasal congestion. Side effects will include fatigue, aches and pains and a cough. A common cold can last from seven to 14 days and sometimes more. Patients who can come along to the pharmacy suffering from the influenza virus will present with severe aches and pains, a fever, headaches, extreme exhaustion and sometimes a cough. There are times, however, when patients do not have the strength to visit a pharmacy and go straight to bed and, where possible they will send a relative or friend to the pharmacy for them. Unlike the symptoms of a cold, seasonal flu symptoms will present themselves suddenly. Although the symptoms of both a cold and the seasonal flu can be severe and force some patients to take some time off work or school, if a patient is fit and healthy, most symptoms can be relieved with over the counter products from the pharmacy. Patients who have been at work during the symptom stage will probably have infected their fellow workers as well. Decongestants, systemic analgesics and antihistamines are all effective treatments for symptoms of cold and flu. Products are available in many different varieties such as nasal swabs and sprays, topical vapour rubs, anaesthetic lozenges and soothers can all ease the uncomfortable symptoms of cold and flu and are often pharmacy exclusive OTC products. A chesty cough, which is the most common cough present with a cold or flu, can be treated using expectorants, mucolytics and steam inhalation. JUNIOR COUGH, COLD AND FLU A pharmacy is usually the first port of call for parents when children come down with coughs, colds and/or flu. In recent years, some over-the-counter medicines were restricted to Ages over Six by the Irish Medicines Board (IMB) and are now only available in pharmacies. The restricted active ingredients include: brompheniramine, diphenhydramine, doxylamine, triprolidine, dextromethorphan, pholcodine, guaifenesin, ipecacuanha, phenylephrine, pseudoephedrine, oxymetazoline, xylometazoline. These restrictions were imposed because no evidence could be found to show that such medicines were effective, if given to children under the age of 6 and because the restricted medicines could cause side effects, such as allergic reactions and drowsiness. However, medicines containing paracetamol or ibuprofen can still be used to reduce a childs temperature, even under the ages of six. Simple measures for small children, such as ensuring that the child has plenty of fluids and gets enough rest will help to combat both cold and flu symptoms. When giving fluids to infants, it is advisable to feed them breast milk or formula, particularly in those younger than 6 months. It is important not to give water to babies younger than 6 months because their kidneys cannot process water correctly and an electrolyte imbalance may occur. An oral electrolyte solution designed for infants can be given to prevent such a complication from arising. For children older than 12 months, water, diluted juice and milk can be given. Often, parents believe that they

should not give milk to their child because it promotes mucus building. Parents should be advised that this is an old wives tale with no scientific backing and that the antibodies in the mothers breast milk will hugely benefit the baby who has been affected by a cold. Nasal saline drops may help to relieve congestion in children and infants. Saline drops can make it easier for an infant to breathe, allowing it to nurse or take the bottle more comfortably. Placing a humidifier or a cool mist vaporizer in a childs bedroom to increase the moisture in the room can also help to ease the symptoms of colds and congestion. COMMON COLD COMPLICATIONS Although most children with colds do not develop complications, it is, however important to be aware of the signs and symptoms of potential complications. Ear infection. Between 5 and 15 per cent of children with a cold develop a bacterial or viral ear infection. If a child develops a fever (temperature higher than 38 C) after the first three days of a cold, an ear infection may be to blame. Asthma. Colds can cause wheezing in children, who have not wheezed before, or can worsen asthma in children with a history of this condition. Sinusitis. Children, who have nasal congestion that does not improve over the course of 14 days may have a bacterial sinus infection. Pneumonia. Children, who develop a fever after the first three days of cold symptoms may have bacterial pneumonia, especially if the child also has a cough and is breathing rapidly. Antibiotics are not effective in treating colds or flu. However, they may be necessary if the cold is complicated by a bacterial infection. If a parent is concerned that their child has developed one of these infections, they should be advised to contact their GP. ANTIBIOTIC USE FOR COLD AND FLU Many members of the public hold the common misconception that an anti-biotic will cure them of colds and flu and they can recover from the illness swiftly with the medication. They may ask for them but they are a prescription drug. Rory ODonnell, President of the IPU said, Lots of people do not understand when it is appropriate to take antibiotics and when it is not. Antibiotics are a precious medicine, designed only to be

used for infections caused by bacteria. Unfortunately, antibiotics are the only medicine in which widespread use decreases their effectiveness so taking them for the wrong reason or taking them incorrectly allows bacteria to develop resistance against antibiotics. GPs have a lead role to play in deterring patients from incorrectly using antibiotics. However, if asked for an anti-biotic a pharmacist is a position to explain that cold and flu cannot be treated with antibiotics because these conditions are caused by bacteria and not by a virus. Dr Laura Noonan, who conducted an award winning project in which she devised a patient information leaflet to reduce anti-biotic prescriptions, toldIrish Pharmacy News, Pharmacists are ideally placed to inform, educate and symptomatically treat patients and they can make patients feel better and that is what the research tells us is the most important factor for patients. Noonan carried out her study in her own GP practice as she felt there was limited research into the area of patients knowledge and attitudes towards antibiotics particularly among the Irish population. The first part of the study consisted of a questionnaire to assess the knowledge and attitudes of the general public regarding antibiotic use.

The results of the questionnaire are surprising with 73.3% of respondents demonstrate knowledge of the correct use of antibiotics by answering questions that prove that they understand that antibiotics do cure bacterial infections but do not cure viral infections. 50% of patients when unwell try an over the counter medication first. A significant difference in knowledge was identified between medical card (60%) and private patients (80%). The same difference was noted for having heard of antibiotic resistance with 40% of medical card patients having heard of resistance compared to 95% of private patients who reported having heard of resistance. This data shows the importance of educating patients about the correct use of and indications for antibiotics. Those patients who understand the role of antibiotics are less likely to present to the GP and instead seek remedies from their pharmacist.

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