Page 40 - Demo

38 COUGHS & COLDS FROM PAGE 37 Different causes for dry and chesty coughs Dr Moles says a chesty cough is the result of the presence of mucus in the lungs. “Nearly everyone will start a cold with a bit of a sore throat, then symptoms move to the nose, which results in mucus that then moves to the chest,” she said. “This means that often patients are most likely to have a chesty cough at first. As the mucus clears through coughing, they may end up with a bit of irritation in the throat, which makes the cough drier. “So, most of the time, someone with a cold will first have a ‘chestier’ cough that morphs into a dry cough towards the end of the cold.” She emphasises that if a patient has a dry cough, it’s up to the pharmacy to work out whether it’s asthma related or something similar. How can pharmacies help patients avoid negative drug interactions? Pharmacists can do much to avoid negative drug interactions in patients “by asking the right questions”, Dr Moles says. “A pharmacist wouldn’t treat a patient with high blood pressure with a product containing pseudoephedrine, which would dry up their nose,” she said. “So, it’s all about getting a full history and inquiring after other medicines to avoid negative drug interactions.” How to navigate OTC products for coughs and colds Pharmacies need to carefully register the patients’ symptoms, then try to match an ingredient to the symptoms, Dr Moles says, so, again, asking the right questions is key. This means, she adds, that if a patient is experiencing nasal congestion, they need only buy a product that works for this symptom, whereas if they’re experiencing a chesty cough, they need only buy a product for the cough. “What happens, though, is pharmaceutical companies get clever and they put ingredients in a specific medicine so that it has a bit of everything,” Dr Moles said. “So, I can’t reiterate how important it is that the right questions are asked and that patients explain their symptoms so they can recommend the best products for the symptoms.” As to natural remedies, Dr Moles says there are many on offer with varying degrees of evidence as to their efficacy. “Personally, I don’t think we have enough evidence for the majority of them, some of which could even cause harm,” she said. She points to echinacea, which many people think is good for them and a booster for their immune system, yet it can also trigger asthma in people who are susceptible to this. “So, here again, it’s important that pharmacy assistants ask the right questions without assuming that ‘natural’ naturally means safe,” Dr Moles said. “On that note, some of the medical products on shelves are not natural remedies but \[they\] too have little evidence to support their efficacy.” At times, she says, people don’t immediately buy something for their cough and cold, but wait until day three or four into it, then think a product has worked because the cold has naturally waned, which it would do anyway as it is “self limiting”. Cia Connell, Manager for Clinical Evidence at the Heart Foundation and a Specialised Cardiology Pharmacist, says sometimes it can be difficult for a pharmacist to diagnose a type of cough and determine when to refer on for specialist attention. “A cough can really be caused by many things,” she said. “We know that heart failure causes extra fluid to build up and can cause symptoms such as difficulty breathing or shortness of breath, swollen ankles, a bloated stomach, pain in the chest, palpitations, dizziness, coughing and loss of appetite.” Patients who haven’t been diagnosed with heart failure but have a combination of symptoms that are persisting, or worsening, should be sent to their GPs, Ms Connell advises. Pharmacist intervention on the ground Alvin Narsey, owner of Priceline Pharmacy West Brunswick in Melbourne, says his approach to patients with coughs and colds is holistic. “We use natural medicines and pharmacy medicines, as we’re trained to look at the whole picture,” he said. The pharmacist on duty checks first on the patient’s history in terms of the symptoms being experienced, followed by what other medical conditions they have and what medication they’re taking, Mr Narsey says. From there, the pharmacist formulates a plan as to the best treatment for the patient. “In addition to treating the symptoms, we give the patient an understanding of the cause and try and help them manage the cause,” Mr Narsey said. He says the coronavirus pandemic is causing people, when they have a cough or cold, to become concerned and seek some reassurance. “They can be sure that if they have the virus, they’ll get way sicker than if they have the common cough or cold,” he said. Mr Narsey says the spread of the virus has also led to the pharmacy experiencing “stock issues” with hand sanitisers and masks. “We’ve explained to people that a mask is really only necessary if they feel they have the virus, but they seem to think that wearing it will protect them from the virus,” he said. “Stock issues are also extending to medication as people stockpile out of fear of supply issues.” Meanwhile, the pharmacy is also using its position in the community to give timely advice, Mr Narsey says, on matters such as vitamin C intake. It’s rare that a person will overdose on vitamin C, he advises, but it’s possible that they may take too much and begin to feel ill. “A small percentage of the population is sensitive to vitamin C,” he said, “which results in diarrhoea flushing high doses through the system.” “A mask is really only necessary if people feel they have the virus, but they seem to think that wearing it will protect them from the virus.” RETAIL PHARMACY ASSISTANTS • MAY 2020