Common Cold - Patient Education PDF

Community Pharmacy Dr. Sara Youssif MSc, PhD, BCPS 1  An upper respiratory tract infection is any infection that involves the nasal cavity, paranasal sinuses, pharynx, or larynx. It’s most often caused by an invading pathogen like a virus.  Over 200 virus strains are im...

Community Pharmacy Dr. Sara Youssif MSc, PhD, BCPS 1  An upper respiratory tract infection is any infection that involves the nasal cavity, paranasal sinuses, pharynx, or larynx. It’s most often caused by an invading pathogen like a virus.  Over 200 virus strains are implicated in causing the common cold, with rhinoviruses (30–80%), coronaviruses(≈ 15%), influenza viruses (10–15%), adenoviruses and enteroviruses being the most common.  Getting chilled or wet will not cause a cold.  Viruses cause colds, However, severe exposure leading to significant reduction of body temperature (hypothermia) may put one at a greater risk for the common cold.  Colds are more common in winter because cold temperature-induced changes in the respiratory system, decreased immune response, and low humidity causing an increase in viral transmission rates, perhaps due to dry air allowing small viral droplets to disperse farther and stay in the air longer.  Children’s noses have been called , the chief reservoirs for infectious rhinoviruses.  Preschoolers have the most colds (between 6 and 10 per year).  Normal defense mechanism of the respiratory system When you breathe in, air flows through the nostrils and enters the nasal cavity, which is lined by cells that release mucus. That mucus is salty, sticky, and contains lysozymes, which are enzymes that help kill bacteria. Nose hairs at the entrance of the nasal cavity get coated with that mucus and are able to trap large particles of dust and pollen as well as bacteria.  The nasal cavity is connected to four sinuses which are air- filled spaces inside the bones that surround the nose, there’s the frontal, ethmoid, sphenoid, and maxillary sinus (the largest one). The paranasal sinuses help the inspired air to circulate for a bit so it has time to get warm and moist. The paranasal sinuses also act like tiny echo-chambers that help amplify the sound of your voice, which is why you sound so different when they’re clogged with mucus during a cold!  At each side of the back of the throat, there is the pair of tonsils, which are small clumps of lymphoid tissue that act as the body's first line of defense that swallow viruses and bacteria that enter through the mouth or nose. The lower part of the pharynx is continuous with the larynx or the voice box. At the top of the larynx sits a spoon- shaped flap of cartilage called the epiglottis which acts like a lid that seals the airway off when you’re eating, so that the food can only go one way - down the esophagus and towards the stomach.  when an infected person How do sneezes or you get infected? How do you got infected? coughs, they spread thousands of droplets containing these pathogens into the local area, up to about two meters away. These droplets can then land in the mouths or noses of people nearby, or get inhaled into the upper airways. Most of these viruses or bacteria can also survive on surfaces for a few hours, so it’s possible to get them by touching a surface and then touching your own eyes, nose, or mouth.  Usually, even when a pathogen gets in, your body can protect itself, but sometimes, pathogen succeeds in colonizing our upper airways and when that happens - You’ve got an infection! These infectious little pathogens typically jump inside the cells lining the airways, multiply and cross over to the underlying tissue, creating an inflammatory response. When that happens, goblet cells and sub-mucosal glands in the airways start to produce a lot of mucus in order to try to trap and eventually expel these pathogens.  In severe situations, the pathogens might result in lots of white blood cells coming over to fight off these pathogens. The battle result in formation of pus (a mixture of pathogens, immune cells, and dead tissue and a whole lot of inflammatory signaling molecules, called cytokines). These cytokines can then spill into the systemic circulation and reach the brain, telling it to rise the body’s temperature in order to make it a less friendly place for those pathogens to reproduce.  Types of upper respiratory tract there are many different types of upper infections respiratory tract infections, depending on the part of the tract that’s involved. 1) Rhinitis, “rhino-“ means nose, so the infection is inside the nasal cavity. Usually it’s caused by viruses responsible for the common cold or flu, and the most common is rhinovirus, influenza virus, respiratory syncytial virus (RSV ), parainfluenza virus, and adenovirus. When rhinitis is caused by bacteria, like Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis, and Staphylococcus aureus. 2) These bacteria often spread to the surrounding sinuses, causing rhino sinusitis - infection in both the nose and sinuses. In individuals that are immunocompromised, like those taking chemotherapy, rhino sinusitis can be caused by fungi, like Aspergillus. 3) Pharyngitis : infection of the pharynx or throat, which can develop if a virus like rhinovirus, and coronavirus decide to move beyond the nose, and travel down into the pharynx. There are some viruses and bacteria that largely bypass the nose and just attack the pharynx as ebstein barr virus (EBV). Some bacteria, like Group A Streptococcus, can also cause pharyngitis and that’s called “strep throat”. 4) Also, if the infection spreads to involve the tonsils, it’s called tonsillitis. 5) Laryngitis, infection of the last part of the upper respiratory tract (the larynx). The most common is viral laryngitis, caused by the usual viruses that cause the common cold and flu. There’s also bacterial laryngitis, caused by Group A streptococcus, Streptococcus pneumoniae, or Haemophilus influenzae. 6) These bacteria, and particularly Haemophilus influenzae, have a special preference for the superior portion of the larynx and the epiglottis, causing epiglottitis. However, the vaccine for Haemophilus influenzae type b has made that disease much less common.  Non-specific symptoms that can go along with many of the infections include fatigue, loss of Symptoms appetite, and fevers. Rhinitis causes a runny or stuffy nose and sneezing. Rhino sinusitis causes pain or pressure on the face near the infected sinus and a change in the voice. Pharyngitis will cause a sore throat. tonsillitis will cause painful, swollen tonsils, both of which can make it hurt to swallow. Laryngitis will cause a hoarse voice and dry cough. Finally, there’s epiglottitis, which can cause trouble breathing, and it’s a serious emergency because a serious infection can block the airway.  Diagnosis of the Common Cold 1. Clinical diagnosis: Most common method; based on history, presence of symptoms, and physical examination. 2.Radiographic studies: Useful for assessing complications such as pneumonia. 3. Laboratory studies:  Rapid viral antigen tests and nasopharyngeal cultures helpful for epidemiology and diagnosis in acute cases.  1. Nature and Severity  Patients with cold may complain of nasal congestion or nasal discharge (rhinorrhoea), a sore throat, cough, headache, or other symptoms.  The color of these secretions may be helpful when other symptoms are present.  Headache or facial tenderness and aching over and under the eyes Sinusitis. 2. Onset & Duration Symptoms of common cold usually lasts about one week, may persist for 2-3 weeks. If Cough >3 weeks (without improvement) referral to exclude any chronic condition. Long-standing recurrent cough (since childhood) may indicate chronic lung disorder (e.g. Asthma /COPD). 3. Accompanying Symptoms If there is sputum, its nature may be helpful in deciding management.  Clear white sputum  allergy or viral infection.  Brown/green sputum  chest bacterial infection.  Blood-stained sputum  referral  Possible Complications 1- Colds are the most common trigger of asthma symptoms in children with asthma. 2- 2ry bacterial infection; especially in:  Extremities of age,  Immunocompromised,  Chronic heart, lung, kidney & liver patients.  2ry bacterial infections include: 1- Acute otitis media 2- Pneumonia 3- Acute Sinusitis Trigger points indicative of referral in common cold  Similarities and Differences between Flu & Common Cold Treatment  Treatment Preventive Non- measures for Pharmacological Pharmacological spreading cold Treatment Treatment  How to Prevent the Common Cold? It is impossible to completely prevent the spread of the common cold viruses. But by following these steps you can reduce your chances of becoming infected with this virus. These steps are: 1) Wash hands frequently. 2) Disinfect contaminated objects and surfaces. 3) Avoid touching your face. 4) Always cover mouth & nose when sneezing or coughing. 5) Isolate yourself until symptoms have passed. 1-Nonpharmacological treatment  Home remedies 1) Steam inhalation 2) Warm salt water gargle 3) Peppermint or ginger tea 4) Honey + fresh ginger 5) Vegetable or chicken soup 6) Adequate rest / sleep 7) Hot bath 2- Pharmacological Treatment  2- Pharmacological Treatment  Most episodes are self- limited, resolve without prescription drugs.  Antibacterial therapy is ONLY appropriate for bacterial complications as bacterial sinusitis or otitis media. 2- Pharmacological Treatment OTC medications include 1-Decongestants 2-Anti-histamines 3-Analgesic , antipyretics  1- Decongestants (sympathomimetics)  Indication: nasal congestion.  Dosage form: oral, topical (drops, spray & inhalers).  Mechanism of action: α-adrenergic stimulation leading to vasoconstriction of blood vessels in nasal mucosa resulting in: 1- Decrease blood flow to nasal mucosa thus decrease mucosal edema. 2- Widen up narrowed nasal passages with improved drainage & air circulation.  Examples of decongestants  Topical: - Phenylephrine (Vibrocil) - Xylometazoline (Otrivin drops & spray ) or - Oxymetazoline (Afrin drops & spray) both with longer lasting effect (>6 hrs) than Phenylephrine.  Sprays are preferable over drops in adults & children >6 yrs as they carry smaller droplets that can reach a larger surface area & also drops are easily swallowed with higher risk of adverse effects.  Oral: - Phenylephrine (Rhinopro syrup). - Pseudoephedrine with longer duration of action (Sudophine syrup & decongess cap). Adverse effects of decongestants CNS: anxiety , insomnia, nervousness, tension & tremors. CVS: tachycardia & raised B.P. Local: burning of nasal mucosa only from drops & spray, managed by normal saline irrigation. Pseudoephedrine is a stereoisomer of ephedrine that is less potent in producing CVS & CNS adverse events.  Decongestants use with caution Oral forms are used with great caution in patients with: 1) HTN. 2) Prostatic enlargement: may cause or worsen urination difficulty due to Smooth muscle contraction in bladder neck via stimulation of α-1 receptors. 3) DM: Increase glycogenolysis in liver, stimulate glucagon release. Decrease insulin release. Dose of insulin may have to be increased. 4) Active hyperthyroidism: exaggerated restlessness and stimulation of the heart rate.  Contraindications of decongestants Oral forms are contraindicated in patients: 1- taking drugs that inhibit monoamine oxidase enzyme inhibitors (MAOIs),( e.g., selegiline, moclobemide: ;prescribed for Parkinson’s & depression disease ). Sympathomimetics + MAOIs: hypertensive crisis & death (up to 2 wks of stopping MAOIs) 2- With uncontrolled HTN or ischemic heart disease. 3-Taking nonselective β blockers (e.g., propranolol, used for ttt of HTN): as β blockers enhance effect of oral decongestants lead to severe HTN and cerebral hemorrhage.  Alternative in these kind of patients  Saline nasal drops.  Levomethamphetamine (Vicks Vapor Inhaler)  Local decongestants.  2- Antihistamines Mechanism of action: H1-R blockers, however used mainly for their week anticholinergic action. Indications:  Rhinorrhea, sneezing, nonproductive cough.  Only 1st generation members (as chlorpheniramine & diphenhydramine) are appropriate for management of these symptoms, as 2nd generation members (as loratidine, fexofenadine, cetirizine) have very limited anticholinergic activity.  2- Antihistamines side effects (children & geriatrics are more susceptible)  Anticholinergic: dry (cotton) mouth (Xerostomia), difficulty in urination, constipation, blurred vision, irritability, dizziness (not observed with 2nd generation).  CNS: Sedative (chlorpheniramine is the least sedative among 1st generation), dizziness, tinnitus, incoordination, fatigue, euphoria, nervousness, and tremors (CNS effects are less common with 2nd generation which don’t readily enter CNS)  GIT: loss of appetite, nausea, vomiting, epigastric distress that is reduced by taking the drug with meals.  2- Antihistamines- contraindications  +MAOIs: can exacerbate anticholinergic effects of antihistamines.  Narrow/closed angle glaucoma: increase intraocular pressure.  Prostatic hypertrophy: cause urinary retention.  + Alcohol or other CNS depressants as benzodiazepines, barbiturates (used as anxiolytics & antiepileptics): additive CNs suppression effect. 2- Antihistamines in pregnancy & lactation  1st generation has possible teratogenic effects on fetus & symptomatic effects on infants owing to secretion into breast milk.  Of 1st generation: diphenhydramine can be used safely in pregnant (but not breast-feeding).  Cetirizine and loratadine are safe in pregnancy & lactation.  2- Antihistamines drug interactions  Many 1st generation antihistamines are metabolized by CYP enzymes.  Thus, inhibitors of CYP activity as macrolide antibiotics (e.g., azithromycin) or imidazole antifungals (e.g., ketoconazole) can increase antihistamine levels, leading to toxicity.  Many newer antihistamines, as cetirizine, fexofenadine, levocabastine, and acrivastine, are not subjected to these drug interactions.  3- Analgesics  Indication: sore throat, myalgia, headache.  e.g. acetaminophen, ibuprofen, naproxen.  Patients with aspirin allergy and those with active ulcers may not be candidates for aspirin or related nonsteroidal anti- inflammatory drugs (NSAIDs).  Acetaminophen is generally preferred.  4- Complementary therapy 1 - Zinc: (weak evidence) If Taken for > 5 days in a season: may reduce risk of catching common cold. If Taken within 24-48 hrs of 1st feel sick: may make cold symptoms less severe and help them go away faster. 2- Vitamin C: (week evidence) A popular remedy for common cold. Research shows it does not prevent colds, but people who take vitamin C regularly may have slightly shorter colds and milder symptoms.  Major Counseling points Topical decongestant should be taken only for 3-5 days as it may cause rebound congestion due to: 1. Receptor desensitization. 2. Damage to the nasal mucosa : local endothelial α2 Rs stimulation may mediate contraction of arterioles that supply nutrition to nasal mucosa causing their death (rhinitis medicamentosa).  Major Counseling points  Selective α1 agonists (phenylephrine) are less likely to induce mucosal damage.  Management of rhinitis medicamentosa  slowly withdraw topical decongestant & use saline nasal drops, Vicks Vapor Inhaler or an oral decongestant if tolerable.  With antihistamines, avoid driving or operating heavy machinery until one can identify how he/she will react (administrated at night).  Common Cold Patient Education  Common cold in pediatrics The Food and Drug Administration (FDA) doesn’t recommend OTC medications for cough and cold symptoms in children younger than 2 years because these medications could cause serious and potentially life threatening side effects. You may be able to help ease a child’s cold symptoms with these home remedies: 1) Rest: Children who have a cold may be more tired and irritable than normal. If possible, let them stay home from school and rest until the cold has covered. 2) Hydration: It’s very important that children with a cold get plenty of fluids. Colds can dehydrate them quickly. Water and warm drinks like tea is great. 3) Food: Kids with a cold may not feel as hungry as usual, so look for ways to give them calories and fluids. Smoothies and soups are two good options.  Common cold in pediatrics  Decongestant, antihistamines are not recommended under 6 yrs.  Drops are preferred over spray as nostrils are not sufficiently wide enough for effective use of sprays.  Bulb syringe: Nasal suctioning with a bulb syringe works well to clear babies‘ nasal passages.  Common cold in pediatrics When to refer ? 1) Infant < 9 months. 2) Those who cannot feed or refuse to eat because of severe nasal congestion. 3) Vomiting, breathing difficulty, noisy breathing or ear ache. 4) Symptoms of a cold after receiving immunization. 5) Persistent night-time cough.  Flu vaccination Pharmacists should encourage those in at-risk groups to have an annual flu vaccination. Vaccination should be given to: - All patients over 65 years. - Chronic respiratory disease (including asthma), - Chronic heart disease - Chronic renal failure - Patients with diabetes mellitus - Immunosuppression due to disease or treatment. It's usually best for people to get the flu vaccine in September and October.