3 Cough Care Findings Pharmacists Should Know

MARCH 16, 2016
Jeannette Y. Wick, RPh, MBA, FASCP
Experts around the world recently assembled at the 5th American Cough Conference to discuss the latest findings in cough care.

The journal Lung published abstracts from the June 2015 event, and the following 3 topics are of great interest to pharmacists:

·         The impact of cough and cold on children’s lives.
·         The use of extended-release (ER) guaifenesin and pseudoephedrine coupled with a “wait and see” approach to antibiotic prescribing.
·         The use of flurbiprofen lozenges.

Here’s what pharmacists should know about the latest research on these 3 topics.

1.      Surveys of mothers and school nurses suggest that colds decrease children’s quality of life and negatively impact their education.

School-aged children are prone to coughs and colds, but their experience has never been quantified. However, mothers and school nurses are positioned to gauge the emotional and physical impacts of these mild illnesses.

The researchers surveyed 1002 mothers of pre-kindergarteners through 8th-graders and 301 school nurses. The mothers reported that after developing coughs, their children's energy levels decreased (78%), sleep was disrupted (58%), and focus was adversely affected (43%). Almost all of the mothers said they recommended rest for lack of energy (95%).

A strong majority of nurses (84%) reported focus and participation issues, while 51% believed that parents wait until their children’s symptoms are too severe before contacting a physician.
These findings show that cough and colds negatively impact children’s education due to quality of life concerns.

2.      ER guaifenesin and pseudoephedrine use with a “wait and see” approach could help decrease patient demand for antibiotics.

Many patients expect antibiotic therapy upon presentation with respiratory symptoms, but antibiotic overuse and misuse (eg, for viral illnesses) drives resistance.

Deferring antibiotic therapy with ER guaifenesin and pseudoephedrine provides symptomatic relief that may reduce patients’ desire for antibiotic therapy.

The researchers enrolled 1179 patients (591 in active arm, 588 in placebo group) with chest congestion, thickened mucus, nasal congestion, runny nose, sinus headache, sinus pressure, and/or postnasal drip.

Fewer patients desired antibiotics after 7 days of active treatment (4.2%) than placebo (8%). Guaifenesin and pseudoephedrine were better tolerated than antibiotics, which tend to cause stomach upset in a large number of patients.

The researchers concluded that treatment of viral respiratory infections with guaifenesin and pseudoephedrine decreased patient demand for antibiotics and is effective and well-tolerated.

3.      Flurbiprofen lozenges may help suppress cough.

Because inflammatory mediators drive both upper respiratory tract infection-induced cough and sore throat, a local anti-inflammatory could be an effective treatment.

The researchers enrolled 101 patients in the active arm and 21 patients in the control group. All subjects had sore throat (a score of 5 or greater on the Tonsillo-Pharyngitis Assessment) and at least 1 upper respiratory tract infection symptom.

The patients received a single lozenge, which was either an 8.75 mg flurbiprofen lozenge or a visually identical placebo.

Almost half of the active arm patients with cough (11 of 24) reported absence of cough 3 hours after receiving the lozenge. No patients reported adverse effects.

The researchers concluded that the use of a flurbiprofen 8.75 mg lozenge appeared to have an antitussive effect mediated by a local anti-inflammatory effect.


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