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Questions and Answers
What is the primary purpose of coughing?
What is the primary purpose of coughing?
How are coughs classified based on their duration?
How are coughs classified based on their duration?
What percentage of upper respiratory tract infections (URTIs) are caused by viruses?
What percentage of upper respiratory tract infections (URTIs) are caused by viruses?
Which group experiences the highest incidence of cough episodes per year?
Which group experiences the highest incidence of cough episodes per year?
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Which of the following can result in a cough reflex?
Which of the following can result in a cough reflex?
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What is a common clinical feature of acute viral cough?
What is a common clinical feature of acute viral cough?
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Which of the following bacteria is NOT typically associated with upper respiratory infections?
Which of the following bacteria is NOT typically associated with upper respiratory infections?
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What typically happens to coughs that are classified as self-limiting?
What typically happens to coughs that are classified as self-limiting?
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What is a characteristic symptom of Upper Airway Cough Syndrome (UACS)?
What is a characteristic symptom of Upper Airway Cough Syndrome (UACS)?
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Which of the following can be a cause of Upper Airway Cough Syndrome?
Which of the following can be a cause of Upper Airway Cough Syndrome?
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What is the usual duration of a cough caused by acute bronchitis?
What is the usual duration of a cough caused by acute bronchitis?
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What associated symptoms are usually present with a cough from allergies?
What associated symptoms are usually present with a cough from allergies?
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What might a cough lasting longer than 14 days suggest?
What might a cough lasting longer than 14 days suggest?
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Which statement about acute bronchitis is correct?
Which statement about acute bronchitis is correct?
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What is the typical age range most affected by laryngotracheobronchitis (croup)?
What is the typical age range most affected by laryngotracheobronchitis (croup)?
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Which symptom is typically NOT associated with acute bronchitis?
Which symptom is typically NOT associated with acute bronchitis?
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What is a common characteristic of asthma symptoms?
What is a common characteristic of asthma symptoms?
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What is the primary cause of chronic bronchitis?
What is the primary cause of chronic bronchitis?
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What is the common causative agent of community-acquired pneumonia?
What is the common causative agent of community-acquired pneumonia?
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What symptoms indicate an acute exacerbation in a patient with established COPD?
What symptoms indicate an acute exacerbation in a patient with established COPD?
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What type of cough is commonly seen in the initial stages of pneumonia?
What type of cough is commonly seen in the initial stages of pneumonia?
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Which symptom is NOT typically associated with pneumonia?
Which symptom is NOT typically associated with pneumonia?
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What is the recommended treatment for children with the specified condition?
What is the recommended treatment for children with the specified condition?
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What is a common side effect of ACE inhibitors related to respiratory symptoms?
What is a common side effect of ACE inhibitors related to respiratory symptoms?
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What is the main concern of using older antihistamines?
What is the main concern of using older antihistamines?
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What combination is suggested to provide limited benefits to adults for treating the common cold?
What combination is suggested to provide limited benefits to adults for treating the common cold?
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Which symptom is NOT associated with the anticholinergic effects of older antihistamines?
Which symptom is NOT associated with the anticholinergic effects of older antihistamines?
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What was the recommendation for the use of over-the-counter cough and cold medicines in children under 6 years old?
What was the recommendation for the use of over-the-counter cough and cold medicines in children under 6 years old?
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Which of the following is NOT a side effect of antihistamines?
Which of the following is NOT a side effect of antihistamines?
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Why are antihistamines with known sedative effects not recommended for certain individuals?
Why are antihistamines with known sedative effects not recommended for certain individuals?
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What is a common interaction risk when taking older antihistamines?
What is a common interaction risk when taking older antihistamines?
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What should parents limit in children aged between 6 and 12 years regarding cough and cold medicines?
What should parents limit in children aged between 6 and 12 years regarding cough and cold medicines?
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Why is the risk from specific ingredients reduced in children over 6 years old?
Why is the risk from specific ingredients reduced in children over 6 years old?
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What alternative treatment can be given to children over the age of 1 year for cough relief?
What alternative treatment can be given to children over the age of 1 year for cough relief?
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Under what condition should antibacterials be considered according to NICE guidelines?
Under what condition should antibacterials be considered according to NICE guidelines?
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At what age should individuals receive an annual flu vaccination?
At what age should individuals receive an annual flu vaccination?
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Which group is NOT advised to get an annual flu vaccination?
Which group is NOT advised to get an annual flu vaccination?
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What practice is recommended to reduce the transmission of cold and flu viruses?
What practice is recommended to reduce the transmission of cold and flu viruses?
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Which type of products are contraindicated for children under 16 years?
Which type of products are contraindicated for children under 16 years?
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Which of the following conditions does NOT qualify for consideration of antibacterials?
Which of the following conditions does NOT qualify for consideration of antibacterials?
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Study Notes
Cough
- Coughing expels foreign bodies and particulate matter from airways.
- Cilia in bronchi move mucus and entrapped foreign bodies for expectoration or swallowing.
- Cough can be debilitating and disruptive.
- Most coughs are self-limiting and resolve within 3-4 weeks without antibiotics.
- Cough can be productive (with sputum) or nonproductive (dry, tight, tickly).
- Cough is classified as:
- Acute: less than 3 weeks
- Subacute: 3 to 8 weeks
- Chronic: more than 8 weeks
Epidemiology
- Community pharmacy sees high numbers of cough cases, around 24 million visits yearly.
- Schoolchildren experience more coughs than adults, with 7-10 episodes per year compared to 2-5 episodes per year for adults.
- Acute viral upper respiratory tract infections (URTIs) are more common in the winter months.
Aetiology
- 90% of URTIs are caused by viruses, including respiratory syncytial virus, rhinovirus, and viral influenza.
- Remaining 10% of infections involve bacteria like Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus, and Klebsiella pneumonia.
- The cough reflex is triggered by mechanical, irritant, or thermal stimulation, with receptors in the pharynx, larynx, trachea, and bronchi.
- Neural impulses are carried along afferent pathways to the cough centre in the medulla, then efferent fibres carry signals to the diaphragm, chest wall, and abdominal muscles, which contract and create the cough.
Clinical features of acute viral cough
- Viral coughs often have sudden onset and are accompanied by fever.
- Sputum production is minimal, and symptoms are worse in the evening.
- Associated cold symptoms last 7-10 days, with durations longer than 14 days potentially indicating postviral cough or a bacterial secondary infection.
Conditions to eliminate
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Upper airways cough syndrome (UACS): previously called postnasal drip. Characterized by sinus or nasal discharge flowing into the throat. Patients may describe something stuck in their throat.
- Common causes: allergies, vasomotor rhinitis, and postinfectious UACS.
- Allergic cough: often nonproductive and worse at night, associated with sneezing, nasal discharge, conjunctivitis, and itchy oral cavity. May exhibit seasonal variation.
- Treatment: address the cause of UACS rather than solely treating the cough.
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Acute bronchitis: most cases occur in autumn or winter, with symptoms similar to viral URTIs but also dyspnea and wheeze. Lasts 7-10 days but can persist for 3 weeks. Cause is usually viral but sometimes bacterial. Symptoms resolve without antibiotics. Referral is appropriate if the person is systemically unwell.
Unlikely causes
-
Laryngotracheobronchitis (croup): caused by parainfluenza virus, affecting infants aged 3 months to 6 years. More common in autumn and winter. Symptoms appear in the late evening and night, with a barking cough, breathlessness, and difficulty breathing. Improves during the day and recurs at night. Most cases resolve within 48 hours. Standard treatment is oral or intramuscular dexamethasone.
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Chronic obstructive pulmonary disease (COPD): characterized by destruction of lung tissue, encompassing chronic bronchitis (CB), emphysema, and chronic obstructive airways disease. Hallmarks include cough, sputum production, and increasing breathlessness. Treatable but not curable.
- Typical symptoms: chronic cough, breathlessness, wheezing, and recurrent chest infections.
- Diagnosis confirmed by spirometry testing.
- Acute exacerbations require referral to the GP for potential antibiotics and steroid therapy.
- Smoking is the primary cause of CB.
-
Asthma: chronic inflammatory airways condition, characterized by coughing, wheezing, chest tightness, and shortness of breath. Symptoms vary in intensity, are intermittent, worse at night, and triggered by allergens, infections, and irritants.
- Can present as nonproductive cough, especially in young children, often worse at night and recurrent.
-
Pneumonia (community-acquired): bacterial infection, commonly caused by S. pneumoniae (80% of cases).
- Initial cough: nonproductive and painful (first 24-48 hours), becoming productive with red-stained sputum.
- Worsens at night.
- Patient is unwell with high fever (>38°C), malaise, headache, breathlessness, and pleuritic pain.
- Older patients may be afebrile and present with confusion.
Medicine-induced cough or wheeze
- Several medicines can cause bronchoconstriction, leading to coughing or wheezing.
- Angiotensin-converting enzyme (ACE) inhibitors are commonly associated with cough, with an incidence as high as 16%. Time to onset varies from hours to over a year after treatment initiation.
Interactions
- Antihistamines:
- Studies suggest that alone, they do not benefit the common cold, but limited benefit might be seen in combination with decongestants analgesics, and cough suppressants for adults.
- Side effects: drowsiness, especially when combined with alcohol, benzodiazepines, or phenothiazines (drugs causing drowsiness or CNS depression). Older antihistamines can also have similar side effects as anticholinergics (dry mouth, blurred vision, constipation, urinary retention). These effects are amplified when combined with anticholinergics or drugs with anticholinergic actions like tricyclic antidepressants or bladder antispasmodics.
Interactions
- Alcohol
- Hypnotics
- Sedatives
- Betahistine
- Anticholinergics
Side effects
- Drowsiness (driving, occupational hazard)
- Constipation
- Blurred vision
- Urinary symptoms
- Confusion
Cautions
- Closed-angle glaucoma
- Lower urinary tract symptoms (LUTS) in men
- Epilepsy
- Liver disease
Children under 6 years old
- MHRA (Medicines and Healthcare products Regulatory Agency) recommends against OTC cough and cold medicines for children under 6 years old.
- Lack of evidence for effectiveness.
- Potential for side effects like allergic reactions, sleep disruption, and hallucinations.
- Risks of side effects are reduced in older children due to higher weight, fewer colds, and ability to communicate if the medicine is working.
- Licensed remedies for children: simple cough remedies with glycerine, honey, or lemon.
- Warm honey and lemon drink can be given to children over 1 year old.
- Aspirin-containing products are contraindicated in children under 16 years old.
- NICE guidelines suggest considering antibacterial therapy if the person:
- Is very unwell systemically.
- Has a high risk of serious complications due to pre-existing conditions like heart, lung, kidney, liver, or neuromuscular disease, or immunosuppression.
- Is over 65 years old with 2 or more of the following, or over 80 years old with one or more of the following: hospital admission in the previous year, Type 1 or 2 diabetes mellitus, known congestive heart failure, use of oral corticosteroids.
Prevention of colds and flu
- Pharmacists should encourage those at risk to receive an annual flu vaccination.
- The UK health service provides vaccinations to:
- Patients over 65 years old.
- Those under 65 years old with chronic respiratory disease (including asthma), chronic heart disease, chronic renal failure, chronic neurological disease, diabetes mellitus, or immunosuppression.
- Pregnant women.
- People living in long-stay residential care.
- Reducing flu transmission is crucial, along with colds.
- Routine handwashing with soap and water for at least 20 seconds reduces the spread of cold and flu viruses.
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Description
This quiz covers the basics of cough including its types, causes, and the impact of coughing on communities, especially in schoolchildren. Learn about the epidemiology and aetiology of coughs and how they relate to upper respiratory infections. Test your knowledge on this common health issue!
