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Drive home coughs and cold messages

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Drive home coughs and cold messages

It’s time to make the most of the winter ailments season and ensure your customers are ready to deal with colds and flu, as well as reinforcing the key message that most people will not need to be treated with antibiotics for their symptoms

As the number of prescriptions for antibiotics issued each year continues to rise, calls have been made for tougher measures to be taken against prescribers who issue “inappropriate” prescriptions, such as for coughs and sore throats caused by viruses. New NICE guidelines on antimicrobial prescribing aim to cut prescriptions by about a quarter, from the current 42 million a year.

As part of the new guidelines, health and social care practitioners, including pharmacy staff, should establish processes for developing, reviewing, updating and implementing local antimicrobial guidelines. Healthcare practitioners should work together to support antimicrobial stewardship by communicating and sharing consistent messages about use of antibiotics and share learning and experiences about antimicrobial resistance and stewardship.

Pharmacy staff can help

Some 44 per cent of people who visit their GP with a winter ailment expect antibiotics, according to Pharmacy Voice research for the Treat Yourself Better campaign. Antibiotics are rarely needed for coughs or sore throats, because these are usually caused by a virus.

Antibiotic resistance is an increasingly serious problem in the UK, and pharmacy staff are well placed to educate customers on both the dangers of antibiotic misuse and the importance of using them correctly when they are prescribed. “There is still a perception among the public that antibiotics can cure coughs and colds,” says Mimi Lau, Numark’s director of pharmacy services.

“The communication should explain that antibiotics must not be prescribed for inappropriate cases. Pharmacy staff can reinforce the national message locally by encouraging patients to come to them as their first port of call. Pharmacy staff are accessible, have time to advise and stock an armoury of OTC products to manage symptoms.”

“Pharmacists and their teams need to guide patients and tell them that most coughs and sore throats are caused by viruses and will clear up without the need for antibiotics. Ask the WHAM questions and then advise on suitable OTC remedies, some of which will be available on the minor ailments scheme,” says pharmacy manager Anne Connor at Whitworth Pharmacy, Blackpool.

“Try and encourage your customers to think ‘pharmacy first’ when it comes to minor winter ailments. And talk to them about having the flu jab and the importance of trying to prevent the spread of winter viruses via good hygiene: both hand washing and cleaning surfaces effectively.”

In cases where antibiotics have been prescribed, education is key. “Tell customers about the importance of taking their medication at the right times and the necessity of finishing the course, even if they feel better,” says Ms Connor. “Stress that they should never save antibiotics for future use or share them with other people.”

Pharmacy staff can help to discourage the misuse of antibiotics for coughs and sore throats by telling customers how long winter ailments generally last: up to three weeks for a cough; about a week for a sore throat. You can also help by explaining that not prescribing antibiotics isn’t about cost saving, but managing the real threat of resistance

Managing coughs

A cough is the body’s automatic way of clearing the airways of blockages or irritants. During winter, most coughs are caused by viruses such as colds and flu and can be safely managed at home using OTC remedies. Coughs are classified as ‘acute’ or ‘chronic’. An acute cough is most common and lasts up to three weeks.

It’s usually caused by a cold or flu virus and most improve after one to two weeks. This type of cough doesn’t need antibiotics, unless a serious infection, such as pneumonia, has developed. Signs of pneumonia include a high temperature, shallow breathing and coughing up coloured or blood-stained phlegm.

Chronic cough affects 10 per cent of adults and lasts for eight or more weeks. The most common causes include acid reflux, asthma, TB, COPD, bronchitis and smoker’s cough. Red-flag signs include: 􀀀

  • Coughing up blood
  • Unexplained weight loss
  • Night sweats
  • Cough worsening after three weeks
  • Shortness of breath
  • Voice changes
  • Lumps or swellings in neck ô€€€
  • Chest pain.

Dry or chesty cough?

A dry cough is caused by inflamed airways due to a viral infection such as a cold or flu. A chesty cough produces phlegm. This is caused by the lungs producing extra fluid due to an infection.

“It’s important to get a detailed overview of the patient’s symptoms,” says Ed Round, brand manager for cough medicine brand Covonia. Questions to ask include: “Is their cough productive? How long have they had the cough and what action has been taken? Pharmacists should ask if a patient has any medical condtions that may affect treatment recommendation.”

A cough suppressant, such as pholcodine or dextromethorphan, stops the cough reflex in a dry cough. An expectorant helps to bring up phlegm in a chesty cough. These include guaifenesin, diphenhydramine hydrochloride and ipecacuanha. Children under six shouldn’t be given cough medicines, except a simple linctus containing glycerol or honey.

Sore throat

A typical sore throat lasts up to a week and is usually caused by a virus. Most cases won’t respond to antibiotics and even those caused by a bacterial infection will normally clear up by themselves. 

“Patients should be referred to their GP if they have a persistent fever of 38oC-plus that doesn’t improve with analgesics, they have any difficulty swallowing or breathing or they are in severe pain,” says Ms Connor.

Treating sore throat

Advise customers to drink plenty of fluids and take analgesics at regular intervals to ease pain. Lozenges and throat sprays can help ease pain, in addition to a salt water gargle to reduce inflammation.

Cough and sore throat market

According to Reckitt Benckiser, during the 2014/15 season more consumers were treating coughs, while medicated sore throat lozenges were the key value driver in the sore throat category. Their Strepsils Extra brand grew by 17 per cent last season (AC Nielsen).

Research by Reckitt Benckiser found shoppers spend longer browsing the cold/flu category than any other fixture, spending 56 seconds choosing a cough remedy, compared with just 34 seconds for analgesics. Shoppers also tend to be more engaged in their cold/flu purchase and pick up 2.34 products before making a purchase. Customers are still creatures of habit, according to Mintel’s cold and flu remedies report (May 2015).

Some 51 per cent of adults who’ve experienced cold/flu in the past 12 months choose the same remedy they’ve always used. However, sugar-free remedies are growing in popularity. Some 68 per cent of adults said they were interested in these, especially for coughs and sore throats.

“Last year, coughs and sore throats affected more than 35 million people in the UK (GB TGI 2015). It’s important pharmacies stock a wide range of winter remedies to accommodate a range of illnesses, as purchases are often made with little planning,” says Jakemans brand manager Miriam Luff.

 

Lung cancer alert

Patients who’ve had a persistent cough for more than three weeks should see their GP to rule out lung cancer. Symptoms to look out for to prompt a GP visit include:

  • A cough that worsens or changes
  • Repeated chest infections
  • Coughing up blood
  • Feeling more tired than usual
  • Losing weight
  • Persistent ache or pain in the chest or shoulder.

 

Build a better category

“Pharmacy managers should consider the range of medicines stocked – the more successful local pharmacies take note of the brand market share levels and build their fixture accordingly,” says Mr Round at Covonia. The brand currently holds 24 per cent market share.

According to Reckitt Benckiser, difficulty navigating the cold/flu category is the biggest obstacle to customers not purchasing (TNS Retail & Shopper survey, 2014). Customers say that brand is crucial in shaping their decisionmaking in winter medicines. Some 66 per cent look for brands, 46 per cent for price and 41 per cent for format.

Stocking brands in a variety of formats will help meet customer needs, say Reckitt Benckiser. When customers look at winter remedies, targeting symptoms becomes more important than either strength or active ingredient. Some 75 per cent look at symptoms in terms of type and number versus 45 per cent who look for strength, says the company.

“Leading brands play a fundamental role in helping the customer navigate towards the cold and flu fixture, so it’s important these are displayed towards the top of the shelf,” says Cathy Crossthwaite, Numark’s marketing coordinator. Cold/flu shoppers tend to buy across the fixture and potential for link sales is good. Site products next to each other across the category to help shoppers find what they need quickly.

“The split of cough, cold and flu into distinct subcategories helps simplify the fixture and makes it easier to navigate for those who prefer to self-serve. Advice leaflets available at the fixture can help customers with choosing appropriate products,” says Ms Crossthwaite.

“POS is really useful to help signpost the category and also useful to advertise services such as flu vaccinations. Clip strips are a great tool for the fixture, allowing you to display products among the medicines which will catch customer’s eye and encourage link purchases,” says Ms Crossthwaite.

“Raise awareness in your community of the services the pharmacy can offer for winter ailments. Visit schools, nurseries, care homes and tell them what you offer,” adds Ms Connor.

“Offer the flu vaccine in yourpharmacy. Be proactive with advice and leaflets and create a lively and informative in-store display.”

 

European Antibiotic Awareness Day

European Antibiotic Awareness Day (18 November) is a Europe-wide public health initiative that encourages responsible use of antibiotics. A toolkit is available on the website, which offers advice on how campaign organisers can engage with the general public to promote appropriate and responsible use of antibiotics.

The toolkit contains template materials and some suggested key messages focusing on self-medication with antibiotics. It offers ideas for awareness-raising activities, and suggests ways to get the messages across to the general public regarding prudent use of antibiotics, especially to people self-medicating with them.

 

Market update

Covonia Hot Dose Cough & Cold Syrup is a new pharmacy-only product that offers night-time relief from dry coughs and congestion from colds. The launch follows research by Covonia which discovered that 58 per cent of sufferers prefer to take their medicine hot and that 62 per cent buy a cough medicine to help get a better night’s sleep. Strepsils Extra triple action lozenges are now available in cherry flavour.

Also new are Strepsils Sore Throat & Blocked Nose and Strepsils Sore Throat & Cough lozenges. Research found that on the last sore throat occasion, 83 per cent of patients suffered from a sore throat with cold and flu symptoms. Lempsip Max All in One has been repackaged with a premium look to increase shelf standout and highlight the all-in-one message.

The product contains paracetamol, phenylephrine and guaifenesin to tackle headache, fever, blocked nose, sore throat and chesty cough. Covonia Chesty Cough Sugar Free syrup is a new addition to the brand. The product is also alcohol-free, making it the first sugar and alcohol-free remedy in the UK. The brand will be supported by its largest ever TV, press, PR and social media campaign this season.

Jakemans has extended its range of menthol confectionary with the addition of 10-sweet stick packs for its Throat & Chest Honey & Lemon lozenges. POS and window display material is available to support the launch.

 

Flu jab was 34% effective in 14/15

Last winter’s flu jab worked in 34 per cent of cases, according to a final Public Health England report. The figure is higher than was initially predicted at the beginning of last season, based on prevalent strains.

“Whilst it’s not possible to fully predict the strains that will circulate in any given season, flu vaccination remains the best protection we have against an unpredictable virus which can cause severe illness and deaths each year among at-risk group,” said Professor Paul Cosford, PHE’s director for health protection.

 

Comment

Vishal Mashru, VM Pharmacy Services, Leicester ‘This is massive for our pharmacy. Cold and flu take up a lot of NHS time and resources, so being able to supply product over the counter to patients and customers is important. It’s a big part of our business, especially in the winter. Getting a patient’s symptoms right is the most important thing. It’s crucial to make sure they are taking the right products for their treatment regime and age and that anything we give them doesn’t interfere with any other medication they take. We’ve struggled with stock supply in recent years – it seems to be a problem across pharmacy. It’s annoying when you have a product that’s perfect for the patient, but you can’t give it to them because you can’t get hold of it. We’re also trying to help patients to understand how important having a flu vaccine is, and advising them to use hand sanitisers when they have cold or flu. The number of people who die from influenza each year makes this an important category.’

 

Rena Dadra, Village Pharmacy, Harlington ‘This category is very important to us and I’ve noticed more people coming back this year because of the advice and training I’ve given staff. As well as offering OTC products, I like to give them advice on products to help them boost immunity, for example advice on vitamin C, zinc and echinacea. We have a lot of elderly people in with cold and flu symptoms, and they can already be on a lot of medications. Many of the elderly customers who come in with cold and flu symptoms are on warfarin and we can only really give them natural remedies and nasal sprays. We tell people to keep warm and drink plenty of hot drinks, but prevention is better than cure and healthy eating is important. We don’t currently offer the flu jab, but we will from next year. Sometimes we don’t even sell them a product. I might suggest that they try lemon and ginger tea, with some honey and that can work wonders. You don’t always have to sell people things; it’s not all about profit. You have to give the right advice and natural options can help as well.’

 

Ranjit Mann, Ringwood pharmacy, Coventry ‘The cold and flu category represents a very important part of our pharmacy sales. The core products we tend to stock are Day and Night Nurse, the all-in-one preparations; the sugar-free products; the ones that are suitable for patients who have hypertension and diabetes, for example. The other main products we stock are the nasal sprays, as they are quite useful. Sterimar is good because it can be used for children as well, to help to flush out bacteria from their noses, using no active ingredients. We advertise the cold and flu category well within the pharmacy and of course our staff have all been trained to recognise the symptoms of cold and flu and the right advice to give. It’s important to go through the right questioning process to make sure that we’re recommending the right product to the customer. It depends on how the patient responds to the questions for us to decide which product is most suitable for them.’

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