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Focus on cough and sore throat

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Focus on cough and sore throat

It’s time to make the most of the winter ailments season and ensure your customers are ready to deal with the coughs and sore throats this winter season

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. Antibiotic resistance is an increasingly serious problem in the UK, and pharmacy staff are well placed to help 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 informing 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 others.”

Pharmacy staff can help to discourage 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

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 ô€€€
  • Cough worsening after three weeks ô€€€
  • Shortness of breath ô€€€
  • Voice changes ô€€€
  • Lumps/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 is important to get a detailed overview of the patient’s symptoms,” advises Ed Round, brand manager for Covonia. “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 conditions that may affect any treatment or product you recommend.”

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 simple linctus containing glycerol or honey.

 

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 include: 􀀀

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

 

Sore throat

A typical sore throat lasts up to a week and is usually caused by a virus. Most cases will not 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 which doesn’t improve with analgesics, they have any difficulty swallowing or breathing or they are in severe pain,” says Ms Connor.

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

Research by RB found that shoppers spend longer browsing the cold/flu category than any other fixture, spending 56 seconds choosing a cough remedy, compared with just 34 seconds on 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 a Mintel 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 over 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.

Build a better cough category

Difficulty navigating the cold/flu category is the biggest obstacle to customers not purchasing (TNS Retail & Shopper survey, 2014), according to RB. Customers say that brand is crucial in shaping their decision-making 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, 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.

“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,” suggests Mr Round at Covonia. The brand currently holds 24 per cent market share.

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. When customers look at winter remedies, presence of which symptoms will be targeted 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, adds RB. “The split of cough, cold and flu into distinct subcategories helps simplify the fixture and make it easier to navigate for those who prefer to selfserve. 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 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 the customer’s eye and encourage link purchases.”

“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,” says Ms Connor. “Offer the flu vaccine in your pharmacy. Be proactive with advice and leaflets and create a lively and informative in-store display.”

Going for growth

The Winter Remedies market, including Cough, Cold and Flu, is currently worth £487 million and is running at just under 15% value growth (14.9%) following a busy winter season, according to market figures published 11 July 2015 by IRI, and shared by Omega Pharma.

Annelies Smits, senior international brand manager for Bronchostop at Omega Pharma says: “Within the winter remedies market, the cough category, which includes cough liquids and cough specific medicated confectionary, is the fastest growing segment, with a 19% year-on-year increase in units, while Cold and Flu is growing at 17.3% and Med Con is growing at 9.5%.

“Value is growing ahead of units, due to the average unit price of the Cough category having grown. Our research has shown that when people have a cough, they aren’t price sensitive, but want the best product to remedy the illness quickly. The problem they face is confusion with all the options that are available to them on the shelf. Another big trend this year is sugar-free treatments.”

Partly, the recent growth in the cough market was due largely to high incidence, and the category increased the number of units sold by 20% year-on-year, says Ms Smits. BronchoStop has sold over 2 million boxes in less than a year since launch, with a worth of £10 million, says Omega Pharma.

“The incremental growth in [category] value has in part been driven by the launch of BronchoStop in this category,” she claims. Omega Pharma offers community pharmacies mechandising advice for the cough category this winter.

For example, research has shown that offering too many products on the shelf confuses shoppers and can leads to them walking away without a purchase. “There are six types of cough, and over 100 products available on the market, she suggests.

“For pharmacists and retailers, simplicity on the shelf is key. Nearly three-quarters (69%) of consumers have had at least one cough in the last year, and there will be a high percentage of people on other medication or managing other conditions such as diabetes, who need pharmacy advice before buying a cough product.”

Omega Pharma is supporting BronchoStop in three main ways this season, says Ms Smit. “The first is with our biggest ever media spend to date, and a national TV campaign will start mid October and run all the way through the season into 2016. A trade press campaign will run alongside that, starting in November and aimed at explaining to pharmacy staff the Bronchostop USP – that it’s combination of ingredients can relieve any cough.”

Category 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 58 per cent of sufferers prefer to take their medicine hot and 62 per cent buy 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.

Lemsip Max All in One has been repackaged with a premium look to increase shelf standout and highlight the all-in-one message.

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.

In addition, Jakemans has extended its range of menthol confectionary with the addition of 10- sweet stick packs for their Throat & Chest Honey & Lemon lozenges.

 

European Antibiotic Awareness day – 18 November

Wednesday 18 November is European Antibiotic Awareness day, 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 could 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 suggested tactics for getting the messages across to the general public regarding prudent use of antibiotics, especially to people who are self-medicating with antibiotics.

Comment

Vishal Mashru, VM Pharmacy Services, Leicester “The flu jab is so important for those in the at-risk categories – it’s massive for us now – and obviously the elderly can suffer a lot more. If we can vaccinate those who are most likely to pick up coughs, chest infections or cold and flu, this will hopefully prevent some of these problems. Generally, it’s important to make patients aware of what type of cough they have – sometimes they don’t know the different coughs or how they differ. What’s the difference between a tickly or dry cough, for example? At this time of year it’s often upper respiratory, so a dry throaty cough, but once it gets into the chest, or they have a condition such as asthma, it’s harder to treat. Unfortunately, there are limited products that we can use for people who are diabetic or with high blood pressure.”

 

Rena Dadra, Village Pharmacy, Harlington “We have people with all types of cough coming in. We’ve recently received some counter training from one of our manufacturers that was really helpful – about understanding what type of cough the patient has – and our counter skills have really improved. People still assume that if they’re coughing they need antibiotics because it’s a bacterial infection, so I think that’s good that we’re educating them to know that actually antibiotics won’t work and that a cough or cold can take four to six weeks to clear up on its own. People need to understand that we can soothe the cough, but we won’t get rid of it. This really frustrates me, and there needs to be more publicity telling people not to expect to get antibiotics when they get a cough – they just won’t work.”

 

Ranjit Mann, Ringwood Pharmacy, Coventry ‘The lack of evidence on some of the preparations on the market is frustrating, especially in the children’s category. Recommendations are limited to soothers, because there’s a lack of evidence to suggest that any of the cough suppressants work in children, or indeed even for adults as well – more research needs to be done on cough medicines. Obviously, this is an important category, and one where we try to find out what sort of cough people have. Our staff are all undergoing training in the category at the moment, so they are very aware of the products that are available.”

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