Cough, Cold and Allergy

Faisal Al Shaibani, B.Pharm, MSc, PhD.
Winter 2022
OTC: Self-Care for,

(i)Cold
(ii)(ii) Allergy
(iii)(iii) Cough
1
Faisal Al Shaibani, B.Pharm, MSc, PhD. Winter 2022
(i)Common Cold
2
The common cold is a self-limited viral infection of the upper respiratory tract.
It can be caused by more than 200 different types of viruses, but the majority of colds in
children and adults are caused by rhinoviruses.
Transmission :
Self-inoculation: a person touches a contaminated skin surface (e.g., shakes hands with
an infected person) or environmental surface (e.g., door knob, telephone), then
inadvertently deposits the virus into his or her nose or eye.
A healthy person also may become infected through prolonged contact with aerosols
produced by coughing, sneezing, or talking.
3
Factors that increase a person’s susceptibility to colds include:

 Smoking.
 Allergic disorders affecting the nose or pharynx.
 Increased population density.
 A sedentary lifestyle.
 Chronic (duration 1 month or more) psychologic stress.
4
Symptoms begins 1 to 3 days after infection.

 A sore or “scratchy” throat appears first and usually resolves quickly.
 Nasal obstruction (i.e., congestion)
 Rhinorrhea predominate by day 2 or 3.
 Patients may have low-grade fever, but colds only rarely are associated
with a temperature higher than 100ºF (37.8ºC).
 A dry, nonproductive cough
 Complications include sinusitis, middle-ear infections, bronchitis, bacterial
pneumonia, and aggravation of asthma.
5
Exclusion of treatment
• Fever >101.5 °F (38.6 °C)
• Chest pain
• Shortness of breath
• Worsening of symptoms or development of additional symptoms during
self-treatment
• Concurrent underlying chronic cardiopulmonary diseases (e.g., asthma,
COPD, CHF)
• AIDS or chronic immunosuppressant therapy
• Patients of advanced age
• Infants <9 months of age
• Hypersensitivity to recommended OTC medications
6
Treatment and Prevention of the Common Cold:

There is no known cure for the common cold. Thus, the goal of self treatment is to reduce
bothersome symptoms.
Preventing transmission of common cold viruses is an important goal.
Wash their hands frequently with soap and warm water for 15 to 20 seconds.
Products containing ethyl alcohol (62% to 95% concentration), benzalkonium chloride,
salicylic acid, pyroglutamic acid, or triclosan have been proven effective.
Individuals who use gel sanitizers should rub their hands together until the gel is dry.
Rhinoviruses can survive up to 3 hours on skin and objects. Use of antiviral disinfectants
(e.g., Lysol) and antiviral tissues (e.g., Kleenex Anti-Viral) may help to prevent transmission
of the common cold.
Taking vitamin C before the onset of cold symptoms reduced the duration of symptoms
7
Nonpharmacologic Therapy
Maintaining adequate fluid intake,
Getting adequate rest,
Eating a nutritious diet as tolerated,
Increasing humidification with steamy showers, humidifiers, or vaporizers.
Saline nasal sprays or drops may be used to soothe irritated mucosal membranes and loosen
encrusted mucus
Saline gargles may help to ease sore throat.
Tea with lemon and honey, chicken soup are soothing and increase fluid intake
Medical devices such as Breathe Right nasal strips are marketed for temporary relief from
nasal congestion and stuffiness resulting from colds and allergies.
Aromatic products (e.g., Suda Care Shower Soothers vaporizing shower tablets, Triaminic
Flowing Vapors portable vapor fan, Theraflu Vapor Patch, Vicks VapoRub) produce a
soothing odor, which may ease nasal congestion.
8
Nondrug therapy for infants includes upright positioning to enhance nasal drainage,
maintaining an adequate fluid intake, increasing the humidity of inspired air, and irrigating
the nose with saline drops.
Because children typically cannot blow their own noses until about 4 years of age, carefully
clearing the nasal passageways with a bulb syringe may be necessary if accumulation of
mucus interferes with sleeping or eating.
Pharmacologic Therapy
Decongestants:
Systemic and topical decongestants are the mainstay of therapy for the common cold.
Decongestants are adrenergic agonists (sympathomimetics). Both oral and topical
decongestants produce vasoconstriction by stimulating adrenergic receptors, thereby
reducing the volume of blood circulated to the nasal mucosa and decreasing mucosal
edema.
9
Topical Decongestants:
Sprays -Phenylephrine, Naphazoline, Xylometazolin and oxymetazoline
Inhalers –levmetamfetamine(lacks vasopressor effect) and propylhexedrine.
o Naphazoline, phenylephrine --- short-acting.
o Xylometazoline ---intermediate-acting
o Oxymetazoline ---long-acting.
Topical decongestants are available as sprays and drops. Nasal drops are preferred for
children.
Patients may experience adverse effects from the product propellant or vehicle (e.g., burning,
stinging, sneezing, local dryness)
Use of topical decongestants should be limited to 3 to 5 days to reduce the risk of rhinitis
medicamentosa,
Oxymetazoline is the preferred topical decongestant during pregnancy. Intranasal
phenylephrine usually is safe for use by breastfeeding women. 10
Oral Decongestants:
Pseudoephedrine and phenylephrine are the only available non prescription systemic
decongestants.
The most common adverse effects of systemic decongestants are the result of CNS and
cardiovascular stimulation.
Possible CNS effects include restlessness, insomnia, anxiety, tremors, fear, and
hallucinations. Possible cardiovascular effects include elevated blood pressure, tachycardia,
palpitations, or arrhythmias.
Pseudoephedrine is compatible with breastfeeding and is the preferred decongestant for
women who are breastfeeding.
11
Antihistamines:
The symptoms of the
common cold are not
primarily histamine
mediated.
Antihistamines may help
to reduce rhinorrhea and
sneezing when used in
combination with
decongestants.
12
(ii)Allergic Rhinitis
13
Allergic rhinitis is a systemic disease with prominent nasal symptoms.

Allergic rhinitis is triggered by indoor and outdoor environmental allergens.
14
The predominant symptoms of non allergic rhinitis are

I.Posterior rhinorrhea that is watery or thick and may be mucopurulent
II.Nasal obstruction that may be severe;
The presence of itchy, watery eyes, and/or nasal pruritus is what differentiates allergic
rhinitis from the common cold.
Allergic rhinitis may be classified as seasonal, perennial, episodic, or
occupational. a. Seasonal: Symptoms may occur with repetitive and predictable seasonal
symptoms.
b. Perennial: Symptoms persist throughout the year without regard to season changes.
c. Combination: Symptoms persist throughout the year with seasonal exacerbations..
Exclusions to self-treatment of allergic rhinitis
1. Symptoms of otitis media or sinusitis
2. Symptoms that suggest lower respiratory tract problems
3. History of nonallergic rhinitis 15
16
Treatment of Allergic Rhinitis

Allergic rhinitis cannot be cured.
Pharmacists should educate patients that the best method of treating allergic rhinitis is to
avoid allergens.
Pharmacists also should recognize the limitations of allergen avoidance.
Patients with allergic conjunctivitis may instill artificial tears as needed.
Applying cold compresses to the eyes three to four times daily can help to reduce redness
and itching.
Non prescription medication options for allergic rhinitis include oral and ophthalmic
antihistamines, topical and oral decongestants, and the mast cell stabilizer cromolyn
sodium. Because no single medication is ideal for all symptoms, combination drug
regimens are commonly used .
17
Because treatment of allergic rhinitis is for extended periods, oral decongestants

should be used for nasal congestion rather than topical decongestants
Fexofenadine is taken on empty stomach with water. Avoid taking fexofenadine with fruit
juices because fruit juices reduce the bioavailability of fexofenadine by greater than 30%.
18
Oral Antihistamines:
Used to relieve symptoms of sneezing, rhinorrhea, and itching.
Non sedating antihistamines also inhibit the release of mast cell mediators.
Antihistamines are most effective when used regularly rather than episodically.
Patients with intermittent allergic rhinitis should initiate therapy before being exposed to
known allergens and continue therapy throughout the exposure (e.g., during pollen
season).
Patients with persistent allergic rhinitis should take antihistamines on a regular basis
(daily if needed).
Non sedating antihistamines are recommended as first-line therapy for allergic rhinitis.
Loratadine and cetirizine currently are the nonsedating antihistamines available without a
prescription.
19
Chlorpheniramine is the systemic antihistamine of choice in pregnancy because of its long

history of safety.
Ophthalmic Antihistamines:
Ophthalmic antihistamines are used for rapid relief of ocular symptoms of allergic rhinitis.
Antazoline and pheniramine maleate are available for non-prescription use in combination
products that also contain the ophthalmic decongestant naphazoline. These products may be
used three to four times daily
Ketotifen (Zaditor) became available as a nonprescription product in 2007 and is the only
available ocular antihistamine that does not contain a decongestant.
Ketotifen fumarate is considered to be the safest and most effective option for ocular
symptoms. It is approved for use for patients 3 years of age and older.
20
Intranasal Cromolyn Sodium:

Cromolyn sodium is an anti-inflammatory agent that stabilizes mast cells, thereby
preventing mediator release.
Cromolyn sodium is the initial drug of choice for the treatment of allergic rhinitis in
pregnant women. It also is a good choice for women who are breastfeeding.
Cromolyn sodium has a short duration of action and, therefore, must be dosed three to four
times daily.
Cromolyn sodium is approved for use in patients 2 years of age and older.
No drug interactions with intranasal cromolyn sodium have been reported. Sneezing is the
most common adverse effect reported for intranasal cromolyn.
21
(iii) Cough
22
Cough is an important defensive respiratory reflex that serves to clear the respiratory
passages of foreign material and excess secretions.
Classification and Causes of Cough

Cough is classified according to duration of symptoms:
 Acute cough (duration less than 3 weeks).
 Subacute cough (duration 3 to 8 weeks).
 Chronic cough (duration more than 8 weeks).
23
 Viral upper respiratory tract infections (e.g., the common cold) are the most
common cause of acute cough.
 Subacute cough is commonly caused by infection, bacterial sinusitis, and asthma.
 The most common causes of chronic cough in adult nonsmokers are upper airway
cough syndrome (previously known as postnasal drip), asthma, and
gastroesophageal reflux disease (GERD).
 Coughs are further classified as productive or nonproductive.
24
Exclusions for Self-Treatment
Exclusions for Self-Treatment
Cough with thick yellow sputum or green phlegm
Fever >101.5°F (38.6°C)
Unintended weight loss
Drenching night time sweats
History or symptoms of chronic underlying disease associated with cough (e.g.,
asthma, COPD, chronic bronchitis, CHF)
Suspected drug-associated cough
Cough for >7 days
Cough that worsens during self treatment
Development of new symptoms during self-treatment
25
Nonpharmacologic Therapy
• Non medicated lozenges or hard candies, which reduce throat irritation and may decrease
coughing.
• Honey, to provide symptomatic relief of nocturnal cough associated with childhood
upper respiratory infection.
• Humidification, which increases the amount of moisture in inspired air and may soothe
irritated airways.
• Adequate hydration, which may promote the formation of secretions that are less viscous
and thus easier to expel.
Neither lozenges nor honey should be used to relieve cough in children younger than 1
year of age. Lozenges represent a potential choking hazard; honey may cause infant
botulism.
26
Treatment of Cough
Pharmacologic therapy is targeted at either suppressing the cough with antitussive
agents or changing the volume and character of the respiratory secretions with
protussive agents (i.e., expectorants).
Antitussives (cough suppressants) are recommended for a nonproductive cough.
Dextromethorphan is the most common oral nonprescription antitussive.
Dextromethorphan blocks serotonin reuptake, and the combination of monoamine oxidase
(MAO) Inhibitors.
Dextromethorphan should not be administered for at least 14 days after MAO inhibitor
therapy is discontinued.
27
 Dextromethorphan may be abused (particularly by teenagers) for its euphoric effect,

which is similar to that produced by phencyclidine. Possible consequences of abuse
include psychosis and mania.
 The antihistamine diphenhydramine also is approved by the FDA as an antitussive.

The volatile oils camphor and menthol are approved as topical antitussives.
 Antitussives should not be used by patients with productive coughs unless

absolutely necessary. Suppression of productive coughs may lead to retention of
lower respiratory tract secretions and potentially adverse consequences.
28
Expectorants, also known as mucolytic agents or Protussives are the drugs of choice for
coughs that have difficulty expelling thick, mucus secretions from the lungs.
Expectorants only to treat a productive cough.
Guaifenesin (glyceryl guaiacolate) is the only FDA-approved expectorant. It loosens and
thins lower respiratory tract secretions, thereby making minimally productive coughs more
productive.
Guaifenesin also should not be used for chronic cough associated with lower respiratory
tract diseases such as asthma, COPD, emphysema, or smoker’s cough.
Camphor and menthol are the only FDA-approved topical antitussives.
29
30
Case : Common Cold

GP, a 57-year-old woman, approaches the pharmacist with a package containing a combination
product intended for the relief of common cold and flu symptoms. Each caplet contains
acetaminophen 325 mg, dextromethorphan hydrobromide 10 mg, and phenylephrine hydrochloride 5
mg; the dosage is two caplets every 4 hours. GP asks the pharmacist whether this is a good choice for
her symptoms and with her other medications.
GP describes symptoms suggestive of the common cold, with nasal stuffiness, “runny nose,” sneezing,
and a scratchy throat the past two or three mornings. GP identifies congestion and rhinorrhea as the
most troublesome symptoms. Her current medications are:
• Aspirin 81 mg daily.
• Vicodin ES (hydrocodone 7.5 mg/acetaminophen 750 mg) one capsule four
times daily as needed for pain.
31
What should the pharmacist tell GP about the product she has selected?
a. The cold and flu product is an ideal choice for GP’s symptoms.
b. The cold and flu product is a good choice but should be used for 1 or 2 days only.
c. GP should not purchase this product. She would be better served by a different product.
d. GP should not purchase this product. She should check with her primary care provider
before attempting self-treatment.
32

Cough, Cold and Allergy

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Cough, Cold and Allergy

Uploaded by

Copyright:

Available Formats

Faisal Al Shaibani, B.Pharm, MSc, PhD.

OTC: Self-Care for,

Factors that increase a person’s susceptibility to colds include:

Symptoms begins 1 to 3 days after infection.

Treatment and Prevention of the Common Cold:

Allergic rhinitis is a systemic disease with prominent nasal symptoms.

The predominant symptoms of non allergic rhinitis are

Treatment of Allergic Rhinitis

Because treatment of allergic rhinitis is for extended periods, oral decongestants

Chlorpheniramine is the systemic antihistamine of choice in pregnancy because of its long

Intranasal Cromolyn Sodium:

Classification and Causes of Cough

 Dextromethorphan may be abused (particularly by teenagers) for its euphoric effect,

 The antihistamine diphenhydramine also is approved by the FDA as an antitussive.

 Antitussives should not be used by patients with productive coughs unless

Camphor and menthol are the only FDA-approved topical antitussives.

Case : Common Cold

You might also like