Colds and flu-Module 146
With the number of people suffering from colds and flu peaking over the winter season, brush up your knowledge before you need it
• learn how to tell the difference between colds and flu
• find out which patients need to be referred to the pharmacist
• improve your knowledge of what treatments patients can use to reduce symptoms
Download a pdf version of this module here
Download the Test Your Knowledge questions here
Colds and influenza (flu) are two distinct illnesses, caused by different viruses. Flu is more serious than a cold, with patients often left weak and unable to get out of bed, and is potentially fatal.
Adults usually catch two to four colds a year, and children three to eight. It is thought that a person becomes contagious two to three days before their symptoms begin, and remains contagious until their symptoms have passed.
Colds and flu are spread by inhaling droplets of fluid containing viruses that are coughed and sneezed out by those who are infected. People can be infected by getting viruses on their hands from something touched by an infected person, or contaminated with virus-containing droplets. The hands then touch the face or eyes, transmitting the virus.
To limit the spread of colds or flu, people should catch coughs and sneezes in a paper tissue, bin the tissue and wash their hands with soap and water. Surfaces and objects handled by lots of people should be cleaned regularly.
Symptoms
Cold symptoms develop over one or two days, becoming more intense, and then gradually improve. The average length of illness is 10 days. Cigarette smokers can have more severe symptoms, especially coughs, than non-smokers. Infants may be irritable, have difficulty feeding, and have diarrhoea. Infants and young children often develop higher temperatures than adults.
Other possible causes of cold-like symptoms include allergies, hayfever or a throat infection. If a child has only one affected nostril and the discharge from it contains pus and blood and is smelly, they may have a foreign body in their nose.
Flu usually comes on more quickly than a cold and symptoms typically last for four to five days, but cough and fatigue may last for one or two weeks. Patients are infectious for five days after the onset of flu, although children can remain infectious for two weeks and those with weakened immune systems even longer.
Older patients may not develop a fever, and some people have gastrointestinal upsets. Babies and infants with flu can be drowsy, feed poorly, and have ear infections.
See OTC's symptom checker on p14-15 for a full list of possible cold and flu symptoms.
Treating colds
Treatment helps to relieve cold symptoms. Antibiotics will not help because colds are viral infections, although if someone has a bacterial infection at the same time they may need antibiotics.
Patients with a cold should have plenty of fluids to replace those lost in sweating and nasal discharge, rest as much as possible, and eat healthily. Children may lose their appetite when they have a cold, and only need to eat when they are hungry. It helps to keep the air moist, and raising the pillow at night can make breathing easier if the patient is congested – the end of a cot can be raised up for a baby. Inhaling steam may help to loosen and clear mucus. Menthol, eucalyptus, camphor, thymol or pine oil can be added to the water. Patients should close their eyes when inhaling steam, and young children for whom the hot water is a risk can sit in a steamy bathroom.
Gargling with salt water (saline) can help a sore throat and nasal congestion. The salt reduces inflammation and draws out excess fluid that can contribute to the congestion. Nasal saline drops or sprays can relieve nasal congestion in babies and young children.
Vapour rubs can be used from three months of age, and are applied to the chest and back. Always check the packaging to make sure it is suitable to the patient's age. Rubs should not be applied to the nostrils because this causes pain and breathing difficulties.
Decongestants reduce swelling in the nasal passages, but should not be used for more than five to seven days because they can make congestion worse with prolonged use. Decongestants are available in tablet and liquid forms, and as nasal sprays and drops. They should not be used at bedtime because they can make it difficult to get to sleep. Patients with high blood pressure, heart problems, glaucoma, or who take antidepressants or beta blockers should be referred to the pharmacist.
Paracetamol can reduce a fever and relieve aches and pains. Up to eight paracetamol tablets can be taken in 24 hours by those over 12 years old, with intervals of four to six hours between doses. Children's doses depend on the age of the child. Many cold remedies contain paracetamol, and patients should be warned not to take additional paracetamol if they are using these. For more information, see last month's module on pain relief (OTC, September 2011).
Ibuprofen can also be used. It should be taken with food, and should not be taken by patients with a history of stomach ulcer, indigestion, asthma or kidney disease. It comes as tablets or a syrup and can be taken up to three times a day. Again, children's doses depend on age. It is a best to take the lowest dose that is effective at relieving symptoms.
Ibuprofen and paracetamol can be taken alternately over the course of a day as long as the maximum dose for each medicine is not exceeded. The exception is children under five years of age, who must not be given both ibuprofen and paracetamol – if one does not relieve symptoms, the other can be tried instead. Paracetamol will also relieve fever.
A recent review found that taking zinc supplements within a few days of the onset of a cold may speed recovery and reduce the severity of symptoms. However, the dose needed is not yet clear and long-term use of zinc supplements is not recommended as it can cause side effects. Echinacea may help relieve cold symptoms and is available in several forms. There is also some evidence that vitamin C slightly reduces the duration of cold symptoms.
Flu treatment and prevention
Someone with flu should rest, stay warm, drink plenty of fluids, and take paracetamol or ibuprofen to reduce their temperature and relieve aches. Pregnant women, people aged 65 years or older, and those with long-term health problems or a weakened immune system may need antiviral medication to reduce the severity of their symptoms and the length of the illness. Treatment needs to start within 48 hours in adults and 36 hours in children to be effective.
Antibiotics are not effective against flu viruses, but may be needed if the patient has other infections at the same time as flu.
At-risk groups are offered flu vaccination through a national programme starting in the autumn. These people could become seriously ill if they caught flu and suffer complications. A vaccination is needed each year because the vaccine is changed annually to one that is effective against the strains of flu prevalent at the time – in recent years the vaccine has included the H1N1, or swine flu, strain.
The jab is offered to pregnant women, those aged 65 or older, those in residential or nursing homes, and those with serious medical conditions. It is also offered to healthcare professionals and care workers.
The vaccine should not be used for patients who have had a prior allergic reaction to the jab or people who are allergic to hen's eggs, as these are used in the vaccine's production.
The flu vaccine does not contain an active virus and cannot give patients flu. It will not stop people from catching a cold, as colds are caused by different viruses to flu. While no vaccine is 100 per cent effective, vaccinated people are less likely to get flu, and if they do it will probably be milder than if they had not had a flu jab.
After vaccination, patients may have a temperature and aching muscles for a couple of days and the injection site may feel sore; this can be treated with over the counter pain relief treatments. Patients can be reassured that severe reactions to vaccines are rare.
Refer to the pharmacist anyone with symptoms of cold or flu who:
• is pregnant
• is 65 years or over and has flu symptoms
• has a long-term condition such as asthma or diabetes
• is a child who has stopped drinking and is unusually lethargic
• is a very young baby
• has symptoms that have become worse or are prolonged
• has had a cough for more than two weeks
• is coughing up thick, coloured or blood-stained mucus
• has flu and has had a high temperature for more than 48 hours
• is short of breath or has severe chest pain when they breathe or cough
• has a sore throat or hoarseness that is not improving after a week
• has a rash, stiff neck or difficulty swallowing
• has earache
Key points
• Colds are much more common than flu and much less severe; in flu, patients may be unable to get out of bed and it can be fatal
• Antibiotics do not work against colds or flu as they are both caused by viruses, not bacteria – but antibiotics may be used to treat secondary infections
• Women who are pregnant, people over 65 and those with serious conditions should receive a flu vaccination in the autumn – this is done with different strains of flu each year, so needs to be repeated. The vaccine does not use a live virus and cannot cause flu, although patients may have a raised temperature and ache for a few days
Evaluation
• Can you tell the difference between a cold and flu? Do you know how long patients are infectious, and the best ways to stop the spread of infection?
• What advice would you give to:
• a mother whose five-year-old child has a cold?
• a 70-year-old man who says he doesn't trust the flu vaccine?
• a 27-year-old woman with flu who phones for advice?
