Cough and Cold symptoms management updates

For cough, suggest trying plain honey, up to 2 teaspoons as needed. Avoid it in kids under 1 year due to botulism risk. Recommend a saline nasal spray

Introduction

As a community pharmacist, you should always be aware of the latest developments in the treatment of coughs and colds. This year’s spike in respiratory viruses will have patients asking which OTC to take for cough and cold symptoms.

Continue to emphasize nondrug options like fluids, cool-mist humidifiers, ice chips for sore throat, etc. And reinforce flu and COVID-19 vaccination, handwashing, staying home if sick, etc. There’s not much evidence of benefit with any OTC cough and cold med. But people often want to try something. Help ensure choices aren’t harmful. For example, steer away from OTC cough and cold meds for kids under 6, except analgesics.

Symptoms Management

Cough

Suggest trying plain honey, up to 2 teaspoons as needed. Avoid it in kids under 1 year due to botulism risk. Educate that guaifenesin doesn’t work better than water to thin secretions or reduce congestion. But it’s safe. Keep in mind, studies with dextromethorphan are mixed about whether it reduces cough. Plus dextromethorphan can interact with other serotonergic medications (SSRIs, etc). Antihistamines or decongestants are often found in combo OTC products. But there are no good data that they reduce cough.

Nasal symptoms

Recommend a saline nasal spray first. Ensure safe use if patients want to try nasal irrigation (neti pot, etc). If that’s not enough for congestion, consider oral pseudoephedrine, oral phenylephrine doesn’t work better than placebo. But go with an intranasal decongestant (Afrin, Otrivin, etc) over oral for many patients, such as those with BPH or uncontrolled hypertension. Emphasize that most intranasal decongestants shouldn’t be used for more than 3 days, due to risk of rebound congestion. Clarify that data suggest oral or nasal antihistamines, or nasal steroids, don’t help congestion, runny nose, or sneezing due to colds.

Pain or fever

Recommend acetaminophen (Panadol) or ibuprofen (Brufen) if appropriate. Don’t advise alternating or combining them, this isn’t shown to further reduce discomfort and may lead to errors. If patients ask about supplements for cold and flu (echinacea, elderberry, vitamin C, etc), explain that most lack good evidence.

References

Malesker MA, Callahan-Lyon P, Ireland B, Irwin RS; CHEST Expert Cough Panel. Pharmacologic and Nonpharmacologic Treatment for Acute Cough Associated With the Common Cold: CHEST Expert Panel Report. Chest. 2017 Nov;152(5):1021-1037.
DeGeorge KC, Ring DJ, Dalrymple SN. Treatment of the Common Cold. Am Fam Physician. 2019 Sep 1;100(5):281-289.