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2017 HCHB_digital

Coughs: Productive

Coughs: Productive Coughs are considered productive, chesty or wet when secretions such as phlegm or mucus (sputum) are coughed up. The secretions may have drained from the nasal passages (postnasal drip) or come up from the lungs. Most people also feel congested, tight or sore in their chest. Symptoms are typically worse on awakening, while talking or during exercise. Since coughing is the body’s way of removing excess secretions from the airways, a productive cough should generally not be suppressed. Common causes of a productive cough include: • viral infections (productive coughs commonly occur with a cold) • bacterial and other infections (eg, pneumonia, bronchitis, rarely tuberculosis) • chronic lung disease or congestive heart failure • gastroesophageal reflux disease • smoking or other tobacco use. Treatment is usually with an expectorant to help expel secretions from the lungs (eg, guaiphenesin) and/or a mucolytic (eg, bromhexine) which helps liquefy mucus, allowing easier clearance. Combination products (eg, those containing decongestants) should be used only if other troublesome symptoms are present. Avoid antihistamines, since these tend to dry up and thicken secretions, making it difficult to cough them up. Cough suppressants are also not recommended for a productive cough because they suppress the cough reflex, taking away a person’s ability to cough up excessive secretions. 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. With productive coughs, you can usually hear the rattle of secretions while the person is coughing. People with dry coughs have nothing to cough up, so the cough sounds like it is just coming from the back of the throat. Children with whooping cough usually cough continuously for several TREATMENT OPTIONS Category Examples Comments Expectorants Mucolytics Steam inhalations Natural / herbal products / supplements [GENERAL SALE] eg, guaiphenesin (Mucinex Maximum Strength*, Robitussin Chesty Cough, Coldrex PE Cough, Cold & Flu (with paracetamol and phenylephrine) [PHARMACY ONLY MEDICINE] eg, guaiphenesin-containing mixtures + bromhexine (Benadryl Chesty Forte*, Benadryl Mucus Relief Double Action Forte Cough Liquid*) + phenylephrine (Benadryl Mucus Relief Plus Decongestant*, Benadryl PE Chesty Cough & Nasal Congestion*, Robitussin Chesty Cough & Nasal Congestion PE) eg, anhydrous morphine + squill (Pharmacy Health Gees Linctus*) eg, other (Bonnington's Irish Moss) [PHARMACY ONLY MEDICINE] eg, bromhexine (Bisolvon Chesty Forte*, Duro- Tuss Chesty Cough Liquid – Regular/Lozenges), + guaiphenesin (Benadryl Chesty Forte, Duro- Tuss Chesty Cough Forte, Robitussin Chesty Cough Forte, Robitussin Mucus Relief Double Action) [GENERAL SALE] eg, combinations of volatile oils (Olbas Oil Inhalant Decongestant, Vicks Vapo Steam Inhalant) eg, GoVir Defence, Kaloba, Comvita Winter Wellness range (Herbal elixir, Cof Ex, Children’s Elixir, Lozenges) Camphor, ivy leaf, olive leaf Expectorants (eg, guaiphenesin, anhydrous morphine + squill) help expel mucus from the lungs. Bromhexine is a mucolytic which helps to liquefy mucus. Phenylephrine is a decongestant that can help relieve congestion in the nose and sinuses. Mucolytics (eg, bromhexine) are often included with cough expectorants as these help to liquefy the mucus and phlegm aiding its passage from the lungs to the mouth. Products containing other ingredients, such as decongestants (eg, phenylephrine), should only be used if nasal symptoms (ie, blocked nose, sinus congestion) are present and troublesome. 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. Mucolytics help break down thick, sticky chest phlegm, making it easier to cough up. Guaiphenesin helps to expel mucus from the lungs. Steam helps break down mucus and also aids in expectoration (coughing it up). Place a few drops of the oil or inhalation either in a bowl of hot water and the steam inhaled, or on a tissue which is held near the face or tucked inside a pillow case at night. Avoid in very young children. Natural ingredients found in GoVir Defence and Kaloba relieve symptoms, boost the immune system and shorten the duration of a cold or the flu. Comvita Winter Wellness products contain Unique Manuka Factor (UMF) manuka honey. Camphor used in a topical rub can reduce chest pain caused by coughing. Ivy leaf is an expectorant and is commonly used in Germany alongside conventional medicines for asthma and bronchitis. Olive leaf boosts the immune system. Products with an asterisk have a detailed listing in the Coughs: Productive section of OTC Products, starting on page 231. Page 46 HEALTHCARE HANDBOOK 2017-2018 Common Disorders

CONTINUING OTC EDUCATION 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). 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 • Keep warm and rest. • Drink plenty of fluids such as water, diluted non-sweetened fruit juice and clear, warm soups. Liquids help thin the mucus in the throat and lungs and make it easier to cough up. • Gargle with plain water for one minute, three times a day – this can ease symptoms. • Humidify the air if it is dry. If a humidifier is not available, steam from a hot shower will also help break down mucus. • Combination cough suppressant/expectorant cough mixtures are not recommended for productive coughs; however, may be soothing for unproductive coughs (see Coughs: Dry). • 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 to reduce spread if the cough is from an infectious source. • Always use tissues (not handkerchiefs) and dispose of them hygienically following a single use. 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 five days or does it recur on a regular basis? • Does the customer smoke? • Has the customer recently lost weight or have general muscle aches? • Have any new medications been started recently? • Does the customer have any allergies to medicines? Mucinex Maximum Strength fights mucus with one tablet to break up chest congestion and relieve chesty coughs. ✔ FAST ACTING ✔ Convenient vs Cough Liquids ✔ LONG LASTING HOURS ✔ Supports Patient Compliance Mucinex is indicated for the relief of chest congestion by thinning and loosening mucus. Not recommended for children under 12 years. Precautions are asthma, bronchitis, COPD, emphysema pregnancy and lactation. Possible side effects are GI upset. Guaiphenesin 1200mg. Dosage 1200mg every 12 hours. Reckitt Benckiser, Auckland. 0508 731 234. TAPS DA1540DB Page 47

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