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HelixTalk Episode #47 - Self-Care of Cough and Cold

Date posted: August 2, 2016, 6:00 am

In this episode, we discuss self-care of cough and cold, including using PQRSTA or SCHOLAR-MAC to prompt relevant questions for patients, codeine, dextromethorphan, diphenhydramine, camphor, menthol, and guaifenesin.

 

Key Concepts

  1. Use a structured methodology of asking a patient questions about his or her symptoms to help direct OTC management using PQRSTA or SCHOLAR-MAC
    • PQRSTA: Provocation (what makes it worse); Quality, Remitting factors (what makes it better), Severity, Time (chronology/history of the symptoms), and Any other symptoms
    • SCHOLAR-MAC: Symptoms, Characteristics, History, Onset, Location, Aggravating factors, Remitting factors, Medications (other medications), Allergies, Conditions (medical conditions)
  2. Children less than 4 years of age are not appropriate for self-care using OTC medications
  3. OTC codeine, a systemic antitussive, is a DEA schedule C-V as long as it meets a requirement about potency (no more than 200 mg per 100 mL) and contains a non-codeine active ingredient.
  4. Dextromethorphan (Robitussin, a systemic antitussive) is available in a wide variety of dosage formulations, including an extended-release liquid (Delsym) that lasts 12 hours.
  5. Diphenhydramine (Benadryl) is FDA approved as an antitussive, although other first-generation antihistamines also likely have similar efficacy for cough.  The second-generation antihistamines (like loratadine) do not have an antitussive effect.
  6. Guaifenesin, a protussive, is available in a wide variety of dosage formulations, including an extended-release tablet (Mucinex) that lasts 12 hours.
  7. According to the 2006 ACCP guidelines, there is an overall lack of data for both adults and children regarding the efficacy of most OTC agents in treating cough.  These guidelines make the following recommendations:
    • When cough is caused by a post-nasal drip, consider a first-generation antihistamine combined with a decongestant
    • When cough is associated with bronchitis or following a resolved infection (postinfectious subacute cough), consider codeine or dextromethorphan or short-term symptomatic relief