With new curbs on prescribing OTC products for coughs and colds, pharmacies must be braced for this year’s winter season, says Victoria Goldman.

Last year the country experienced a particularly severe flu season, due to the outbreak of Aussie flu, with hospital admissions and GP visits rising sharply in the early months of 2018. In March 2018 NHS prescribing guidelines called on clinical commissioning groups (CCGs) to curb prescribing for coughs, colds and nasal congestion and acute sore throat, encouraging more people to visit their local pharmacy for advice. So with this year’s cold and flu season on its way, it’s likely that community pharmacists will play an increasingly important role in managing winter illnesses.

“If patients can’t obtain a prescription for medication to relieve their cold and flu symptoms, inevitably some will leave their problems untreated,” says Jillian Watt, director of marketing/NPD at The Mentholatum Company, manufacturer of Mentholatum Vapour Rub. “But we believe it is very likely that many will seek out OTC products. Pharmacies will see more patients wanting advice on how to treat coughs, colds and sore throats and the category will show growth.”

Flu vaccinations

The flu season is hard to predict, influenced by several factors including the strains in circulation, the efficacy and coverage of vaccination and even the weather. Flu vaccinations are one of the most effective ways to prevent flu outbreaks and limit complications in high-risk groups. However, the flu virus is constantly mutating, resulting in slightly different viruses, which is why it's possible to catch flu more than once. The composition of the flu vaccine is updated every year but if the virsu continues to mutate during the season it can become less effective over time. According to Public Health England (PHE), the typical effectiveness of the flu vaccine is 40-60% so it's important that pharmacy customers are also given advice on cold and flu prevention.

“It takes about six months to develop the flu vaccine,” says Dr Sarah Pitt, chief examiner on the Virology Advisory Panel at the Institute of Biomedical Science (IBMS) and a principal lecturer at Brighton University. “In the meantime, the virus has trotted off for winter somewhere in the southern hemisphere – Australia, for example - and while it’s there it’s undergoing slight little mutations.”

For the 2018/19 winter season, there is a new adjuvanted trivalent flu vaccine (aTIV) for people aged 65 years and over, as well as the quadrivalent vaccine (QIV), which is recommended for children aged from six months to two years and in adults under 65. Last year, vaccine effectiveness was 12.2% in 18 to 64-year-olds and 10.1% in the over-65s. PHE analysis found that the non- adjuvanted inactivated vaccines (including the quadrivalent vaccine) were less effective in the over-65s, so it is hoping that the new flu vaccine (aTIV) will be more effective in this age group, especially for the over-75s.

The UK flu vaccination programme is also vaccinating all children aged two and three years as well as children of reception and school years one to five (effectively all children aged two to nine years on 31 August 2018). The intranasal vaccine offered to children aged two years and over is a quadrivalent vaccine.

Prevention tactics

As people get older, their immune system becomes less effective. Washing hands regularly, or using a hand gel for convenience, is the best way to avoid the spread of colds and flu viruses.

“While people might not be able to get through the season without catching a cold or suffering from a cough, there are steps that can be taken to help improve their overall health during winter and keep their immune system strong,” says Lindsey Tier, marketing manager for Ultra Chloraseptic. “Getting enough sleep, staying active, eating a healthy, nutritious diet, washing their hands regularly and avoiding contact with people with a cold or flu are important measures that customers can take.”

In November 2017, a Euromonitor report, on Cough, Cold and Allergy (Hayfever) Remedies in the UK, revealed that herbal remedies and dietary supplements that boost the immune system have gained share versus winter remedies, with manufacturers adding preventive ingredients such as vitamins B, C and D, zinc and echinacea to their formulations.

According to Dr Jen Tan, joint managing director of herbal medicine manufacturer Bioforce UK, a recent review of the safety of echinacea preparations showed that there is no reason to curtail the use of echinacea, as some sources previously and erroneously thought.

“This misinformation was due to a misunderstanding of the mechanism of action of Echinacea purpurea,” he says. “The fresh extract of herb and root, as present in Echinaforce, has a balancing or modulating effect on immune function, improving accurate response to pathogens such as viruses and bacteria. The lack of interaction with drug medication makes it an easy option to work with, when immune function may be low (due to stress, poor sleep, poor diet, or exposure to many sources of infection such as children) or infection rife.”

There’s mounting evidence that probiotics can help to boost the immune system as well, according to Dr Richard Day MA (Oxon), MBBS, MRCPsych, medical advisor for ADM Protexin, manufacturers of Lepicol and Bio-Kult. “Multiple studies suggest that probiotics can reduce the incidence of respiratory tract infections, shorten the duration of common infections and even increase the body’s response to the flu vaccine,” he says.

“Currently there are many different probiotics available – ranging from single strain to multi-strain versions – and they are available in differing concentrations. There is no clear consensus on what the ‘right’ concentration is, but studies have found statistically significant results even when probiotics are administered at low concentrations. Furthermore multi-strain probiotics are considered to exert more positive benefits to the host.”

Management advice

Gareth Coady, area marketing manager (Cold & Flu and Allergy) at GSK, says pharmacies should encourage customers to be prepared in advance by keeping a good supply of suitable medicines in their cabinet at home, as the high incidence levels of colds and flu mean they are likely to fall victim this winter.

“GSK has been doing a lot of research this year to understand what stops people from going to a pharmacy for pharmacy- only cold and flu remedies, rather than their GP,” he says. “We have found that there are several main barriers. Many people don’t put pharmacists on a par with GPs, even though pharmacists are
the ‘masters of medicines’. They don’t understand that there are stronger Pharmacy medicines behind the counter, which means there’s a need to educate about the difference between P and GSL. Sometimes, if there’s a queue at the pharmacy counter, customers aren’t prepared to wait so if pharmacies have enough staff available, it may help to have a separate queue for those needing advice. There’s also the embarrassment factor – not everyone realises that pharmacies can offer one-to-one advice in a private setting, such as a consultation room.”

Colds and flu share many symptoms, but flu tends to be much more severe. Many people believe they have flu when they actually only have a bad cold. Customers with a cold are much more likely to have a blocked or runny nose and less likely to have a fever. 

According to a Mintel report on OTC Analgesics and Colds and Flu Remedies in the UK in July 2018, 26% of people say that they are too busy to rest when they are ill with a cold or flu, rising to 35% of employees on permanent contracts. With taking time out from work not even a consideration for many workers pharmacists may wish to emphasise the fast-acting nature of certains brands to appeal to customers who can't, or won't, slow down. "It's more important to rest if you have flu, as the virus spreads throughout your whole body, which is why you get a range of symptoms, rather than just a runny nose," says Dr Pitt. "With the common cold, you can carry on exercising if you feel well enough as the virus stays in your head and won't spread elsewhere. 

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