...help

[miss.mystery]

I went into boots yesterday as I had to ask a few questions to a Pharmacist and I did not get much help so I am hoping Pharmacists on this forum can help. I need to know generally how you counsell a patient that has coughs (can be of any age) including the three most common points.

Thanks for your time

[johnep]

There are only a few active ingredients to a cough syrup;
1) Demulcents/humectants to keep the throat moist. Examples are sugar syrup, honey, glycerin.
2) Expectorants. These increase mucus production leading to thinner secretions allowing easier expectoration. Used to be ammonium salts, mainly ammonium chloride, ipecac. Now guafenesin is standard.
3) Cough suppressants. Classic was opiods such as morphine and codeine.
Dextromethorphan used today or though opinions vary on efficacy.
4) Antihistamines. These tend to dry up secretions and have replaced atropine. The older ones have sedative properties which can be a benefit at night.
5) Decongestants- Subject to a big row at the moment and looks as if pseudoephedrine will be replaced by phenylephrine.

Cough syrups are just permutations of these ingredients.
johnep

[pharout]

Sounds like an exam question..but I'll try to help. First of all, I do not know that there are "three" most common points, that may be perceived differently by the person counselling. The other things you need to ask regard ruling out other causes (i.e. other than the common cold). Examples would be:
-Do they smoke? Do they have asthma(or other pulmonary probs), if so is it well controlled?
-Do they have GERD, if so is it well controlled?
-Are they on an ACE inhibitor (as a dry cough can be a problem in 25% of people who take these)?
-Does throat hurt as well?

If answers are all negative, then simple counselling points for cough due to a cold would be:
-if pediatric, then almost always a viral infection. Just have to treat the symptoms (age-appropriately) and wait it out.
-If adult, treat symptoms with topical anaesthetics (i.e. menthol cough drops).
-If adult, could try a codeine-based product or dextromethorphan-based product (not sure what's available in the UK?)
-I would emphasize drinking lots of fluids/getting rest
-I would also suggest that if it persists for more than a couple of weeks, have it checked out.

As you can see, I'm not sure there are a common three answers. These are just the one's off the top of my head.

[Jeff]

Originally Posted by miss.mystery

I went into boots yesterday as I had to ask a few questions to a Pharmacist and I did not get much help so I am hoping Pharmacists on this forum can help. I need to know generally how you counsell a patient that has coughs (can be of any age) including the three most common points.

Thanks for your time

Depends on the results of the preliminary 2WHAM questions.
Age is a factor - would have to at least consider possibilty of asthma in a child - COPD in an adult smoker - or even heart failure.
Assuming therefore that patient is otherwise healthy - and no lifestyle advice needs to be given.
1. If it's not better in a week see your doctor
2. Plenty of fluids
3. They don't make an awful lot of (any) difference - but as long as you feel happier that you are doing something - I'm happy to take your money.

Jeff

[miss.mystery]

Thanks for your help everyone!!