The Common Cold: An Uncommon Level of Care

Pharmacist recommendations and intervention can positively impact outcomes for cold patients.

The average American adult will experience 2 to 4 common colds each year, and the common cold remains the number 1 reason for a physician office visit. These office visits correlate to $17 billion in direct medical costs. Indirectly, the common cold accounts for roughly $22.5 billion lost due to 189 million and 70 million missed school days and work days, respectively.

The high prevalence level of the common cold directly relates to the mode of transmission. The virus is transmitted by direct contact with the airborne virus after an infected person sneezes or coughs; however, the virus can also survive on inanimate objects for a few hours. For this reason, the virus can be transmitted from a person who comes in contact with the contaminated object. When that individual touches his or her eye or mouth, he or she may become infected. Once a person is infected, the average incubation period is 2 days. Symptoms usually peak and are most contagious during days 3 to 5. Although a cough may persist for 2 weeks or more, the other cold symptoms generally resolve spontaneously in about 4 to 9 days.

Pharmacists are often sought for advice and counseling by patients who are ideal candidates for self-treatment. Patient education is essential—patients need to understand that a cold is caused by a virus, most commonly the rhinovirus, and not bacteria, so it does not require the use of an antibiotic. The typical presentation will consist of rhinorrhea and nasal obstruction, frequently accompanied by sneezing, sore throat, and cough. Usually, the common cold is not associated with a fever or systemic manifestations.

Unfortunately, there is no cure or vaccine available, as of yet, to offer to patients. Because the common cold is a self-limiting upper respiratory tract infection, treatment includes supportive care such as plenty of fluids and rest. The standard of care is symptomatic relief—and, in fact, patients purchase $4.2 billion in OTC medications each year.

Cold Symptoms

Common

• Runny or stuffy nose
• Sore throat
• Sneezing
• Cough

Sometimes

• Fatigue
• General body ache

Rare

• Fever
• Itchy eyes

OTC Medications

If a patient is younger than 2 years of age or presents with a severe headache, airway obstruction, chronic respiratory disease, immune-compromised conditions, or is insulin dependent, then the patient should either be referred to their primary care physician, an urgent care clinic, or the emergency department, depending on the severity of their symptoms.

As pharmacists, it is our duty to utilize clinical judgment when recommending OTC medications. In a recently published study, the level of patient adherence to self-care advice was evaluated.¹ During the initial consultation, pharmacists or 4th-year pharmacy students provided detailed patient counseling with regard to OTC medications. The patients were then provided with a point-of-care survey. The pharmacists documented all potential medication-related problems within an OTC intervention document.

To determine patient adherence and symptom improvement, the patients were offered a follow-up telephone call in which the follow-up survey was given. A total of 83 out of 207 patients accepted the follow-up phone call; of those patients, 38 (82.6%) reported complete adherence to pharmacist self-care advice. Moreover, 75% of these patients classified the follow-up as “very helpful.” According to the patient survey, these patients revealed that the pharmacist’s recommendations during the initial consultation led to greater symptom improvement. More importantly, the study proved that patients not only appreciated the service, but desired to have the same level of care in the future.

Even though this study had a relatively small sample size and did not only evaluate the individual symptoms presented, the results may still be extrapolated to other community pharmacies and patient populations that experience the common cold. Pharmacists are the most widely accessible health care professional, with the preeminent pharmaceutical knowledge to make OTC medication recommendations to patients that are dealing with the common cold. Pharmacists may want to use an OTC documentation worksheet, similar to the one in the study, or an electronic documentation note. This would assist in proper documentation at point of care and also for the follow-up telephone call or visit.

OTC Medications for the Common Cold

Indication

Side Effects

Contraindications

Decongestants

Nasal congestion

Insomnia, dizziness, tremor, headache, tachycardia, and elevated blood pressure

Uncontrolled hypertension, CAD, MAOIs

Antihistamines

Rhinorrhea or sneezing

Drowsiness, dry mouth, nervousness, and dizziness

Lactation

Dextromethorphan

Nonproductive cough

Drowsiness, dry mouth, nervousness, and dizziness

MAOIs use or within 2 weeks of discontinuing

Guaifenesin

Productive cough

Nausea, vomiting, dizziness, headache, and rash

Persistent, nonproductive cough (asthmatics or smokers)

CAD = coronary artery disease; MAOIs = monoamine oxidase inhibitors.

Due to the frequency of patients coming in with common cold symptoms, such documentation may be beneficial for future recommendations. A pharmacist would be able to reference the documentation of recommended medications that worked for the patient’s last common cold and potentially recommend those medications again. This process would create a level of continuity of care for these patients who are suffering from the common cold.

In the future, there is also the potential for more studies to reveal not only the patient perceived benefit, but also the economic benefit to health care as well as objective patient common cold symptoms findings. It is still safe to assume that pharmacists can and should make a great impact on the common cold when making OTC medication and other supportive care recommendations. This study reaffirms that a pharmacist who provides OTC recommendations, counsels on proper use of medication, and offers follow-up care may lead to improved outcomes for patients. This level of patient care is what patients expect each and every visit to the pharmacy—even if it is just for the common cold.

Empathy and the Common Cold

Further literature review demonstrates the effect of the patient-practitioner interaction on the severity and duration of the common cold. A randomized controlled trial of 719 patients with new onset of a cold was randomized into 3 treatment groups: no patient—practitioner interaction, “standard” interaction, and an “enhanced” interaction.² Patients who rated the encounter with a perfect score reported that the practitioner empathized with their condition. Accordingly, these patients have reduced severity of symptoms and reduced duration of the cold, as compared with the others who had lower perception scores.

Patient perception to treatment seems to have impact on duration and symptomatic improvement with regard to the common cold. For this reason, it is imperative that the pharmacist provide empathy—along with therapeutic recommendations—in the treatment of the common cold. Both studies support the fact that the pharmacist provided a much-needed patient care service that patients value and expect.

As a result of the pharmacist—patient relationship developed through OTC recommendations, patients may also perceive other benefits that a pharmacist may provide. This would lead to further opportunities in preventative care such as immunizations, health screenings, and medication therapy management services. Pharmacists must be able to recognize the signs and symptoms of the common cold and offer OTC recommendations and follow-up counseling in an emphatic manner in order to solidify the patient–pharmacist trust relationship.

Kara Ross, PharmD, is a community pharmacist for Jewel-Osco Pharmacy in Chicago, Illinois, and is also adjunct faculty at Midwestern Chicago School of Pharmacy.

References

1. Bosse N, Machado M, Mistry A. Efficacy of an over-the-counter intervention follow-up program in community pharmacies. J Am Pharm Assoc. 2012;52:535-540.

2. Rakel DP, Hoeft TJ, Barrett BP, Chewning BA, Craig BM, Niu M. Practitioner empathy and the duration of the common cold. Fam Med. 2009;41(7):494—501.