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Whatever the severity of the impending cold and flu season, it is important to be ready with the right products and self-care advice.

The cold and flu season can vary from year to year but pharmacy teams need to ensure that they are forearmed with the right products and advice to help customers seeking relief from winter ailment symptoms and reinforce self-care messages. Nikki Banwell, brand manager for Olbas, stresses the need to continually stock a wide range of winter remedy products throughout the season to keep up with demand.

“As the NHS gears up for the unpredictable cold and flu season, we feel it is more important than ever for pharmacists to stock a range of products that offer relief from cold and flu symptoms, limiting the need for unnecessary GP visits,” she says. “By nature, winter remedies are often a distress purchase bought when consumers are already feeling ill and looking for fast and effective relief.”

Colds

The common cold is a regular winter affliction, with most people in the UK suffering an average of two to four each year.⁷ Characteristic symptoms include a sore throat; nasal irritation, congestion and discharge; sneezing; hoarse voice; cough; and a general feeling of malaise and ill health. In adults and older children, symptoms typically last around a week, although a residual cough may linger for up to three weeks.⁷

In younger children, the symptom duration is longer – 10-14 days on average.⁷ NICE Clinical Knowledge Summaries (CKS) recommend comfort measures and rest as the mainstay of cold management. OTC analgesia can be recommended for headache or muscle pain, with CKS guidelines suggesting either paracetamol or ibuprofen as suitable first-line options for most people.

Non-pharmacological relief options include steam inhalation to help ease general cold-related congestion, vapour rubs for respiratory symptoms, gargling with salt water or sucking menthol sweets to help with sore throat pain, and nasal saline drops for nasal congestion. A range of specialist combination cold and flu remedies are also available OTC, typically containing a decongestant ingredient, caffeine and/or an expectorant. Some products also include an antihistamine agent to dry up nasal congestion and promote sleep.

Decongestant nasal sprays are available OTC but should not be used for longer than seven days as rebound congestion can occur. Cold sufferers should also be advised to maintain an adequate fluid intake, eat nutritious foods and take adequate rest. In reinforcement of new NICE guidelines on appropriate antibiotic prescribing, it is important to reiterate to all customers that antibiotics are ineffective against cold viruses and may cause unwanted adverse effects of their own.⁷

Flu

Unlike its benign winter cousin the common cold, influenza is a more severe acute respiratory infection and more likely to cause adverse complications. Flu symptoms appear abruptly, typically two to three days after exposure to the causative RNA virus, and include severe sore throat, headache, weakness, fatigue, muscle aches, loss of appetite, insomnia and a dry unproductive cough.⁸

Mirroring the symptoms of the infection itself, flu-related complications are usually respiratory in nature and include acute bronchitis, pneumonia, asthma/COPD exacerbations, otitis media and sinusitis. It is important to clarify to customers that, although antibiotics may sometimes be prescribed in the case of flu complications such as a bacterial chest infection, they remain ineffective against the influenza virus itself. The worst symptoms of flu usually resolve in around a week but residual symptoms can persist for significantly longer.

CKS-recommended self-care options for flu include paracetamol and ibuprofen to lower temperature and relieve muscle aches. Pharmacists should advise any customer in a recognised ‘at risk’ group (i.e. those eligible for the annual NHS flu vaccination) to consult their GP if they present with symptoms suggestive of flu. Due to the poorer prognosis for these patients, antiviral drugs are recommended if national surveillance schemes confirm that the virus is circulating and antiviral therapy (oseltamivir or zanamivir) can be initiated within 48 hours of symptom onset.⁸

Sore throat

Sore throat is a hallmark symptom of both viral and bacterial infections of the upper respiratory tract. Sore throat is a selflimiting complaint, resolving within three days in 40 per cent of sufferers and within one week in 85 per cent of people - even in those cases with a bacterial aetiology.⁹ The key symptom of sore throat is pain at the back of the mouth, which can vary from localised mild discomfort to intense pain on swallowing.

For sore throat sufferers presenting in pharmacy, regular use of paracetamol or ibuprofen-based products can be recommended to relieve pain (soluble analgesics can be gargled to provide targeted pain relief). Customers can also be advised to use simple mouthwashes at frequent intervals (e.g. warm, salty water) until the discomfort and swelling subsides. Sucking pastilles or lozenges stimulates saliva secretion, which lubricates the throat, and many throat sweets also contain soothing ingredients, such as glycerine and honey, to help relieve irritation.

Antiseptic lozenges or throat sprays containing specific antimicrobial agents are available from the pharmacy and are often formulated in combination with local anaesthetic ingredients to ease pain and difficulty in swallowing.

 Winter remedies are often a distress purchase