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2017 HCHB_digital

Coughs: Dry Coughs are

Coughs: Dry Coughs are called dry or non-productive when no mucus is produced or coughed up. Dry coughs are a reaction of the body to an irritated airway and most people describe having a dry or tickly throat, or wanting to ah-hem all the time. Their voice may also sound hoarse or raspy. Generally, if a person’s chest also feels congested and/or breathing is tight or impaired, then the cough is probably productive in nature and should be treated as such (see Coughs: Productive). Coughing is common, especially among children. It is usually a symptom of an underlying problem. Common causes of a dry cough include: • viral infections (dry coughs commonly occur with the flu) • atmospheric conditions (eg, dry air) or a change in temperature • chronic medical conditions (eg, asthma) • exposure to cigarette smoke or pollution • medicines (eg, ACE inhibitors). Treatment is usually with a cough suppressant (eg, dextrome thorphan or pholcodine). Combination products should only be used if other troublesome symptoms are present. Most coughs resolve themselves, although some adults and children may continue coughing for several weeks after a viral infection has cleared. Refer to the pharmacist anybody with a cough lasting longer than 10 days for further advice. Any cough that lasts longer than four weeks is not normal and should be referred to a doctor. Initial assessment Sometimes, deciding what type of cough your customer has may be difficult. Ask if they mind coughing into a tissue for you and listen to the sound their cough makes. People with dry coughs have nothing to cough up, so the cough sounds like it is just coming from the back of the throat. With productive coughs, you can usually hear the rattle of secretions while the person is coughing. Children with whooping cough usually cough continuously for several seconds, followed by a "whoop" sound as they attempt to breathe in air. Croup causes more of a "barking" cough that gets worse at night. Use the Refer to pharmacist questions to help identify which customers to refer to a pharmacist. Advice for customers • Avoid dry environments and drink plenty of water. Hot steam from a shower creates a humid environment that may help ease croup symptoms. • One to two teaspoonfuls of honey taken at night is effective at relieving cough, but make sure honey is from a reliable source and do not give to children aged less than one year. • Always cover your mouth when you cough, preferably with a tissue, or cough into the crook of your arm. • Wash your hands after coughing, before preparing food, and before touching other people if the cough is from an infectious source. Refer to PHARMACIST The following questions aim to identify customers who would benefit from further input from a pharmacist. Your initial assessment or a caregiver's history may have already provided some answers. Decide if any further questions still need to be asked and refer any “yes” answers to a pharmacist. • Does the person have any other health conditions (eg, heart or lung problems, immunosuppression, diabetes, is pregnant or breastfeeding)? • Does the person take any other medication, either prescribed by a doctor or bought from a shop or supermarket (including herbal/ complementary medications)? • Is the customer a child aged less than 12 years or elderly? • Are there any other symptoms, eg, fever, ongoing headache, sore ears or rash? • Is blood or pink-tinged mucus (phlegm) being coughed up? • Is the customer very short of breath or wheezy? • Does the customer have any chest pain or does it hurt to breathe in? • Does the cough occur mainly at night? • Has the cough changed, lasted longer than 10 days or does it recur on a regular basis? • Does the customer smoke? • Has the customer recently lost weight? • Have any new medications been started recently? • Does the customer have any allergies to medicines? Cough and cold medicines in children Coughs frequently occur in children, most commonly as a symptom of a cold. While nasal symptoms of a cold usually improve within seven to 10 days, coughs may persist for up to three weeks or more. Advise parents or caregivers not to give cough and cold medicines to children aged less than six years, and to seek pharmacist advice before using these preparations in children aged six to 12 years. Instead, paracetamol may be used to relieve any pain or discomfort, and natural remedies containing ingredients such as glycerol, honey, or lemon can be suggested to help soothe irritated throats in children older than one year (see Sore Throat for more information about recognising Strep. Throat and who to refer). Page 44 HEALTHCARE HANDBOOK 2017-2018 Common Disorders

CONTINUING OTC EDUCATION TREATMENT OPTIONS Category Examples Comments Cough suppressants Demulcents and other Combination lozenges Combination liquids Combination tablets Natural / herbal products / supplements [GENERAL SALE] eg, dextromethorphan (Strepsils Dry Cough Lozenges) [PHARMACY ONLY MEDICINE] eg, dextromethorphan (Robitussin Dry Cough Forte) [PHARMACY ONLY MEDICINE] eg, pholcodine, (Benadryl Dry Tickly Cough, Duro-Tuss Range, Pharmacy Health Stubborn Dry Tickly Cough*), Pholcodine linctus [GENERAL SALE] eg, glycerol (Lemsip Dry Cough) eg, Bonnington's Irish Moss* [PHARMACY ONLY MEDICINE] Duro-Tuss Dry Cough Lozenges, Difflam Cough Lozenges [PHARMACY ONLY MEDICINE] eg, dextromethorphan + phenylephrine (Benadryl PE Dry Cough & Nasal Congestion*), dextromethorphan + phenylephrine + brompheniramine (Pharmacy Health Congested Cold & Cough*), pholcodine + phenylephrine (Duro-Tuss PE Dry Cough Plus Nasal Decongestant), pholcodine + bromhexine (Duro-Tuss Expectorant), dextromethorphan + guaiphenesin (Robitussin Cough & Chest Congestion) [PHARMACY ONLY MEDICINE] eg, paracetamol + dextromethorphan + phenylephrine (Panadol Cold & Flu Relief + Cough) eg, paracetamol + dextromethorphan + doxylamine (night) (Dimetapp Daytime Night-time) eg, paracetamol + phenylephrine + dextromethorphan +chlorpheniramine (at night) (Codral Cold & Flu + Cough*) eg, Kaloba, Comvita Winter Wellness, Duro-Tuss Child Ivy leaf Extract, Kiwiherb Children's Chest Syrup, honey Cough suppressants (eg, pholcodine, dextromethorphan) control or suppress the cough reflex and can provide relief from a dry, unproductive cough. Be aware that dextromethorphan can interact with other medicines that also have serotonergic activity (eg, antidepressants, tramadol, lithium, St John’s wort). Linctuses (eg, pholcodine) are best taken in warm water and sipped slowly. Sucking lozenges helps stimulate saliva flow to lubricate irritated throats. Lozenges are easier to carry around than bottles of syrup. Glycerol is a demulcent which coats the mucosa of the pharynx and provides short-term relief from the irritation that promotes reflex coughing. Bonnington's Irish Moss contains menthol, camphor, liquorice extract and carrageenan (a seaweed extract). Lozenges contain either pholcodine or dextromethorphan and usually various other combinations of ingredients, eg, antiseptics, analgesics, anti-inflammatories or anaesthetics. The action of sucking also stimulates saliva production, which soothes the throat, reducing irritation and coughing. Products containing combinations of ingredients should only be used if other symptoms are present and troublesome. Expectorants (eg, guaiphenesin) or mucolytics (eg, bromhexine) may be useful for unproductive coughs due to a soothing effect, but a combination expectorant and cough suppressant should not be used for productive coughs (see Coughs: Productive). Phenylephrine is a decongestant that can help relieve congestion in the nose and sinuses. Products containing guaiphenesin, ipecacuanha, dextromethorphan, pholcodine, phenylephrine, pseudoephedrine [PRESCRIPTION], doxylamine, brompheniramine, promethazine, chlorphenamine, triprolidine or diphenhydramine should NOT be given to children aged less than six years and pharmacist advice should be sought before using them in children aged less than 12 years. Products containing combinations of ingredients should only be used if other symptoms are present and troublesome. May be useful for a dry cough associated with the flu. Antihistamines (eg, doxylamine, chlorpheniramine) may cause drowsiness and affect a person’s ability to drive or operate machinery. They may also dry out the mucous membranes and have the potential to irritate a dry cough further. Avoid alcohol with sedating antihistamines. See text above for more information on the various ingredients contained in these products. Supplements may help natural body defences fight against winter ailments, ills and chills. Kaloba’s plant-based active ingredient relieves symptoms, boosts the immune system and shortens the duration of a cold or the flu. Ivy leaf soothes and moistens dry irritated airways. Comvita Winter Wellness products contain Unique Manuka Factor (UMF) manuka honey. Honey can help soothe a dry throat and relieve cough – a single night-time dose of 2.5–10ml was as effective in children as dextromethorphan. Products with an asterisk have a detailed listing in Coughs: Drysection of OTC Products, starting on page 230 Now you can complete your ENHANCE modules on your phone or tablet www.pharmacytoday.co.nz Page 45

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