With people worried about job security reluctant to take time off work for a cough, pharmacy is a key source of advice

Coughs account for over half of all new consultations in primary care and are the most common symptom for which people seek medical advice. About one in five people in the UK suffers with an acute cough during the winter months, with 2.6 million GP consultations for cough every year. Most coughs are caused by viral upper respiratory tract infections. According to the Community Pharmacy Management Of Minor Illness report (Pharmacy Research UK), almost 30 per cent of customers seek help for a URTI such as cough and sore throat from a pharmacy.

“Over the past few years, we’ve seen the colds and flu season starting later and going on well into the New Year,” says Lindsey Tier, Ultra Chloraseptic brand manager at Ceuta Healthcare. “However, this year the signs are that it’s starting earlier, with incidence up by 400 per cent in early September, so pharmacists need to be well stocked up and prepared.”

Whooping cough alert

There have continued to be high rates of whooping cough infection each year since the national outbreak in 2012. The temporary vaccination programme for pregnant women is set to continue until at least 2019 to protect babies from birth until their first immunisation at two months. The infection is most common – and most serious – in babies under three months. However, there are high numbers of whooping cough cases in adolescents and adults who’ve had the vaccination in childhood, too. In England alone, there were 898 confirmed cases from January to March 2017.

Whooping cough is often not picked up quickly enough because either patients or healthcare professionals don’t spot the signs. A hospital study found that among children admitted with severe respiratory symptoms, 23 per cent tested positive for whooping cough. A study of school-age children found evidence of recent pertussis infection in 20 per cent of those who had a persistent cough that lasted two to eight weeks.

Public Health England says health professionals should look out for the following and report any suspected cases.

Anyone with an acute cough lasting 14-plus days without an obvious cause, plus one or more of the following:

• Coughing fits
• Vomiting after coughing
• Whooping sound
• Undiagnosed apnoeic attacks in children
• Anyone with signs of pertussis who has been in contact with a confirmed case in the past 21 days.

“The characteristic is that the coughing comes in serious bouts, during which there is no chance to breathe in as the coughing is so intense,” says a PHE spokesperson. “In older people, they often vomit after a bout.”

“It’s important for all staff to know the signs of whooping cough and to refer any suspected cases to their GP quickly,” agrees Alphega pharmacist Lila Thakerar at Shaftesbury Pharmacy in Harrow.

Antibiotic message

Most coughs and sore throats are caused by a virus, so it’s important for health professionals including the pharmacy team to reinforce the message to customers that in most cases, a course of antibiotics won’t help and could result in antibiotic resistance.

“It’s still important to keep reinforcing this message to your customers,” says Ms Thakerar. “Tell them about the dangers of taking antibiotics when they’re not needed. Instead, you can recommend an effective OTC remedy to ease a sore throat or cough, giving faster relief than waiting for a doctor’s appointment.

“If a customer has been prescribed antibiotics, they will often only take them for a couple of days and stop when they start to feel better, then save up the rest for another time. It’s important to warn patients about the dangers of doing this.”

Pharmacists can assess whether a patient’s condition is self-limiting and encourage them to manage it themselves. “They can also educate patients on the difference between a viral and a bacterial infection, and advise on average duration of common self-limiting conditions to reassure the patient, reducing the risk of them seeking antibiotics from the GP,” says Well pharmacist Rob Severn.

He suggests that pharmacists refer to the Royal Pharmaceutical Society’s 6Rs checklist on self-limiting conditions. “I try to ensure all patients with an antibiotic prescription are counselled and advice given.” “It’s important to educate staff about the different types of cough and there are lots of training modules available to help,” says Ms Thakerar. “Cough remedy manufacturers will have information and reps who can offer staff training.”

In the UK, we get an average of two sore throats a year and symptoms can last up to 10 days. “It’s important to reinforce the message that in most cases antibiotics aren’t needed and the best way to treat it is with OTC remedies,” reminds Ms Tier.

Which type of cough?

Traditionally, pharmacists will ask a patient whether their cough is dry/tickly or wet/chesty in order to recommend a remedy. Clinical pharmacist Alyn Morice, who has worked with cough brand UniCough, has studied European research on treating coughs and is calling for an updated approach.

Instead of asking whether a patient’s cough is dry or chesty, he proposes that the important thing is to ascertain whether a cough is acute or chronic, as well as assessing red-flag symptoms. He suggests a new treatment pathway for over-12s to work out duration of symptoms and pick up any red-flag signs. If a cough has lasted less than three weeks, with no red-flag signs, the patient can be recommended simple OTC cough remedies or home remedies. “The new trend towards cough products licensed for all coughs makes it easier for staff to help and support patients presenting with coughs but not sure what type of cough they have,” says Unicough marketing manager Bernice Simpson.

Winter illness: trends in the market

The cold and flu treatment market grew by five per cent last year, says Mintel, and growth is put down to post-Brexit job insecurity, which motivates employees to avoid taking days off sick.

Last year, the lowest number of working days were lost to sickness since records began, say Mintel. The good news for community pharmacies is that employees are looking for OTC remedies to help them manage their symptoms at work.

Mintel figures show that sales of cough liquids were up 3.3 per cent last year, worth £131 million, while medicated confectionary sales grew 3.1 per cent to £146 million.

IRI figures show sales of cough liquids and medicated confectionary start to increase rapidly from November, with sales peaking in December. Last year, sales of medicated confectionery were £14.8 million in December, while sales of cough liquids were £15.5 million. IRI also noticed a steady increase in sales of products to help prevent winter viruses – immune support products, children’s vitamins and adult multivitamins and minerals.

“The free-from market is continuing to grow and sugar-free formulations now account for 10 per cent of all cough liquid sales, a figure that is likely to grow given the alarming diabetes incidence rates,” says Ed Round, Covonia marketing manager. He says the total cough remedy market grew by 13 per cent last winter.