Respirator System

IPU Medicines Counter Assistant (MCA) Course
Topic 5 – Respiratory Conditions and Treatments
Welcome to
Topic 5:
Respiratory
Conditions and
Treatment
MCA – Topic 5: Respiratory Conditions and Treatments – 01/09/2023 1
Aim
The main aim of Topic 5: Respiratory Conditions

and Treatments is to equip you with the
knowledge and skill to demonstrate knowledge
of OTC products available for the treatment of
minor illnesses and conditions, advise on
appropriate treatment options and give practical
recommendations to manage illness and
conditions.
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This topic contains three parts:

Part 1. An Introduction to Conditions
Topic Affecting the Respiratory Tract
Part 2. The Ingredients Used in the
Content Treatment of Respiratory
Conditions
Part 3. When to Refer to a Pharmacist
Learner Objectives
The learner objectives for this topic are:

• Describe the pathophysiology of the common cold
• List the causes and symptoms of the influenza virus, cold
virus and COVID-19 (coronavirus)
• Explain how to minimise the spread of influenza, cold virus
and COVID-19
• State, when an influenza suffer, should seek medical
attention
• Describe the pathophysiology, causes and types of coughs
• List the causes, symptoms and lifestyle advice for suffers of
hay fever
• State the causes of perennial allergic rhinitis
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Learner Objectives (contd.)
The learner objectives for this topic are:

• List and describe OTC medicines for the treatment of all
respiratory conditions (including throat, nose, eyes) and
their suitable applications, dose, duration, cautions and
age restrictions
• Outline the side effects, interactions and issues from the
use of multiple ingredients in cough and cold medicines
• State and explain the codeine regulations impact, on the
supply of cough and cold remedies
• Demonstrate using the 2WHAM approach to make
appropriate recommendations for respiratory conditions
• Identify and demonstrate when to refer standard and
specific patients to a Pharmacist
Methodology
This topic is delivered using a blended format

of learning, including classroom teaching, case
studies, self-study, on-the-job coaching and
eLearning.
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Assessment
There are three assessments for this topic.
These include:
• On-line quizzes (summative test)
• Workplace assignment and skills demonstration
• Theory examination (formative test)
You are required to achieve a minimum grade of 80% for the

theory examination in order to achieve your certificate.
Successful students will receive an ATHE endorsed programme
certificate.
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1.1 The Pathophysiology of the Common

Cold, its Symptoms and the Viruses
which Cause It
1.2 The Causes and Symptoms of the
Influenza Virus and COVID-19 and
Part 1. 1.3
how they differ
How to Minimise the Spread of
An Introduction Influenza, Cold Virus and COVID-19
and Manage Its Symptoms
to Conditions 1.4 When Influenza Sufferers Should
Seek Medical Attention
Affecting the 1.5 The Pathophysiology, Causes and
Respiratory Types of Cough
1.6 The Causes and Symptoms of Hay
Tract Fever
1.7 Lifestyle Advice Recommended for
Hay Fever
1.8 The Causes of Perennial Allergic
Rhinitis
Part 1.1 The Pathophysiology of the Common Cold,

its Symptoms and the Viruses which Cause It
The Common Cold

• Viral infection of the lining of the upper respiratory tract
(mucous membrane)
• Membrane becomes swollen and inflamed leading to
congestion
• Lining produces an increased amount of secretions leading
to runny nose and watery eyes
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5

Cold Symptoms
• There are many different kinds of symptoms associated
with coughs and colds:
- Tickly throat
- Runny nose
- Watery eyes
- Nasal congestion
- Sore throat
- Cough
- Sneezing
- Headache
- Mild fever
- Fatigue
• Your customer may have all or any of these symptoms
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Cold Symptoms (contd.)

• The important thing is to find out what symptoms the
customer has
• This will help you decide whether you should refer the
customer to the pharmacist and will help you match the
treatment to your customers needs
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6

Cold Viruses
• Rhinovirus
- Most common cause of colds
- 250 different strains of virus
- Immunity would take 64 years of 4 colds per annum
- Most common in infants and young children
• Coronavirus
- Responsible for 10-20% of colds
- Particularly prevalent in late autumn, winter and early
spring
- COVID-19 is a completely new coronavirus, which causes
anything from little or no symptoms, to very severe
sometimes fatal illness
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Part 1.2 The Cause and Symptoms of the Influenza

Virus and COVID-19 and How They Differ
• Influenza is an acute, respiratory illness caused by the

influenza virus
• There are several different influenza viruses including:
- H3N2
- H1N1
- H5N1
• COVID-19 is an entirely new coronavirus which can cause

an acute respiratory illness
• As with influenza there are several different strains of
COVID-19
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• A person can become infected with COVID-19 or Influenza

when they come into close contact with someone who has
the virus
• It is spread through droplets that come from the nose and
mouth when speaking loudly, coughing or sneezing
• A person can also get it from surfaces where infected
droplets have landed. They touch the surface then touch
their eyes, nose or mouth
• COVID-19 virus can survive for up to 72 hours on some
surfaces
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Symptoms of COVID-19 include:

• A fever (high temperature of 38oC or above)
• A cough which is usually dry but can be of any kind
• Shortness of breath or breathing difficulties
• Loss or change to the sense of smell or taste
• Sore throat
• Nasal congestion
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Symptoms of Influenza include

• Sudden onset
• High fever >38oC
• Prominent headache
• Severe aches and pains
• Prolonged fatigue and weakness
• Extreme exhaustion
• Runny nose, sneezing, sore throat common
• Cough common and severe
• Vomiting and diarrhoea sometimes
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Part 1.3 How to Minimise the Spread of Influenza, Cold

Virus and COVID-19 and Manage Its Symptoms
• Wash your hands properly and often using soap and water
or an alcohol hand cleanser
• Wear a face covering on public transport, in shops and
other indoor settings
• Maintain a social distance of 2m where possible
• Avoid crowded places as much as possible
• Turn your head away from other people when coughing or
sneezing and cough or sneeze into your elbow
• Use tissues to cover your nose and mouth
• Dispose of tissues into a waste bin
• Wash your hands with soap and water or alcohol hand
cleanser after disposing of tissues
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Part 1.4 When Influenza / COVID-19 Sufferers

Should Seek Medical Attention
If you suspect a patient has Influenza / COVID-19

• Refer to the pharmacist
• At risk groups include:
- Babies and children
- Elderly
- People with underlying illnesses
- Pregnant or breastfeeding women
If a patient has Influenza or COVID-19 they should:
• Stay at home for up to 7 days or COVID negative
• Take paracetamol or ibuprofen to reduce symptoms
• Drink plenty of fluids
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Sufferers should seek medical attention if they have

any of the following:
• Shortness of breath at rest
• Painful or difficult breathing
• Coughing up bloody sputum
• Drowsiness, disorientation or confusion
• Fever for 4-5 days and not starting to get better or getting
worse
• Starting to feel better then developing high fever and
feeling unwell again
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Medical attention should be sought for a child if

they have any of the following:
• Fast breathing or trouble breathing
• Bluish skin colour
• Not drinking enough fluids
• Not waking up or not interacting
• Being so irritable that the child does not want to be held
• Influenza like symptoms improve but then return with
fever and worse cough
• Fever with rash
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Part 1.5 The Pathophysiology, Causes

and Types of Cough
• A symptoms of infection, irritation or inflammation
of the airways
• Cough is the body’s way of clearing the airways of
irritants
• Most coughs will last one to two weeks
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and Types of Cough
Causes of a Cough
• Infection • Inflammation
- Viral (most common) - Asthma
- Bacterial - Chronic Obstructive
- Fungal (rare) Pulmonary Disease (COPD)
• Irritation
- Post nasal drip • Others
- Acid reflux - Chronic medical conditions
- Environmental pollutants
- Drugs
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and Types of Cough
Cough Symptoms
• Non-productive cough
- Dry or tickly cough
- No phlegm is produced
- Usually irritation of the upper airways caused by
viral infection or post nasal drip
• Productive cough
- Phlegm or mucus is produced
- Sputum is discoloured in bacterial infection and
clear or white in viral infection
- Phlegm may not be loose enough to cough up
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Part 1.6 The Causes and Symptoms of

Hay Fever
• Hay fever is very common and about 1 in 10 people suffer
from it. That means that there are about 400,000 hay fever
sufferers throughout the country. The majority of those
people (about 80%) will not visit their GP with symptoms of
hay fever but instead will come directly to their pharmacy.
• Hay fever is caused by an allergy to pollen from grasses and
trees
• Pollen is known as a allergen
• Grass pollen is the most common allergen in hay fever
• The main hay fever season is from the middle of May to the
end of July although for some sufferers it can start as early
as April and for some continues to the end of August.
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Hay Fever
• Allergy can be inherited and is often associated with
asthma or eczema
• These conditions often affect other members of the family
• Hay fever runs in families as does asthma and eczema.
These three conditions are linked and sometimes present
in the one family. There may be one parent who is
asthmatic, one child who had eczema as a child and
another who gets hay fever.
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Hay Fever
Symptoms of Hay Fever
• Hay fever affects the eyes, nose, throat, mouth and ears
• It can also cause headaches
• Pollen is floating around in the air and is breathed in
through the nose and it also lands on the surface of the
eyes
• It is not surprising that the eyes and nose are the site of
the main hay fever symptoms
• The pollen causes inflammation of the tissues lining the
nose and on the surface of the eyes
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Hay Fever
Symptoms of Hay Fever (contd.)
• Eyes
- Watery
- Streaming
- Itchy
- Irritated
- Conjunctivitis
• The eyes feel itchy and irritated and become watery. This is thought to
be due to congestion of the tear ducts as well as pollen getting into
the eye and irritating the cornea. Nasal irritation also contributes to
eye symptoms.
• Sometimes the eyes become infected and become painful and gritty,
with sticky yellow matter in the eye. If this happens then you should
refer the patient to the pharmacist.
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Hay Fever
• Nose
- Runny
- Congested
- Sneezing
• The nose is usually very runny (rhinorrhoea); up to an egg-
cupful of clear watery fluid every hour!
• Sometimes the inflammation causes nasal congestion.
Severe congestion may result in headache and occasionally
earache
• Sneezing is a common and troublesome feature of hay
fever
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Hay Fever
• Throat, Mouth, Ears
- Itching
- Photophobia
- Headaches
• Other symptoms can include itching of the throat,
roof of the mouth, and in the ears
• Some sufferers complain of headaches due to
congestion or repeated sneezing
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Part 1.7 Lifestyle Advice Recommended

for Hay Fever
You can also give your customers some very useful practical
advice on how to minimise the symptoms of hay fever:
• First, the symptoms are likely to be worst in the morning
because that is when the pollen is released into the air by
the grasses and trees
• During the day as the temperature rises the pollen rises
high into the air and is carried around by the wind
• Hay fever sufferers often find their symptoms become
worse again in the evening as the temperature drops and
the pollen settles again
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for Hay Fever
• Wearing sunglasses can reduce the amount of pollen
getting into the eye, and can protect irritated eyes from
bright light
• Activities like gardening and mowing the lawn will release
lots of pollen and can precipitate severe hay fever
symptoms
• Driving with the window open exposes drivers to 10 times
more pollen that with the window closed
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for Hay Fever
• Remain indoors, if possible, with the building or car
windows closed while pollen count is at its highest
• Close bedroom windows at night
• Frequent damp dusting and daily vacuuming will reduce
pollen levels at home
• If outdoors avoid fields, newly mowed grass, picking fruit
and flowers and touching animals that may have pollen on
their coats
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for Hay Fever
• Choose a car with air conditioning
• Plan holidays to hot dry destinations preferably seaside,
mountains or moorland
• A small amount of Vaseline applied to the inside of the
nostrils will reduce the amount of pollen you inhale
• Don’t dry clothes on the clothes line if the pollen count is
high
• Avoid air pollution and tobacco smoke
• Follow pollen count reports
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for Hay Fever
• So, as you can see, there is lots of good advice you can give
your customers about reducing their hay fever symptoms
• Remember, it is not just about selling them an OTC
medicine, it is also about giving good advice about
customers complaints wherever possible
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Part 1.8 The Causes of Perennial Allergic

Rhinitis
• Perennial allergic rhinitis refers to all year round allergy
• It produces the same symptoms as hay fever
• The allergens are present all year unlike hay fever caused
by pollen during the summer
• The most common causes of year round allergy are dust
and pets
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Part 1.8 The Causes of Perennial Allergic

Rhinitis
Symptoms
• All year round allergy produces the same symptoms as hay
fever
• Because these symptoms are often present during the
winter months, all year round allergy is often mistaken for
a common cold
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2.1 The Role, Actions and Side Effects of

Antihistamines in the Management of
Respiratory Conditions
2.2 The Role, Actions, Administration, Side Effects
and Interactions of Decongestants in the
Management of Respiratory Conditions
Part 2. 2.3 The Issues Arising from the Use of Multiple
Ingredients in Cough and Cold Medicines
Ingredients 2.4 The Medicines Used to Treat Cough, Their
Indications and Side Effects Specifically
Used in the 2.5 The Codeine Regulations Impact on the Supply
of Cough and Cold Remedies
Treatment of 2.6 The Use of Inhalational Products for the
Management of Cold Symptoms
Respiratory 2.7 Medicines Used to Treat Sore Throat, their
Ingredients, Use and Cautions When
Conditions 2.8
Recommending
The Role of Eye Drops in the Management of
Ocular Hay Fever Symptoms
2.9 The Role, Action, Dose, Duration, Age
Restrictions and Advice of Nasal Corticosteroids
in the Management of Hay Fever
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Part 2.1 The Role, Actions and Side Effects of Antihistamines

in the Management of Respiratory Conditions
The Role of Antihistamines

• Actions:
- Stop running nose
- Dry secretions
- Stop sneezing
- Stop watery eyes
- Causes drowsiness / aid restful sleep (older antihistamines)
- Can cause congestion so may be best combined with a
decongestant
• Always alert a patient if the product may make them drowsy
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• Older antihistamines cause drowsiness

- Triprolidine – Actifed Syrup and Tablets, Benylin
Children’s Coughs and Colds
- Chlorphenamine – Piriton
- Brompheniramine – Ilvico
- Diphenhydramine – Benylin Dry Cough Drowsy,
Benylin Day & Night, Benylin 4 Flu, Uniflu, Benylin
Original
- Promethazine – Night Nurse, Phenergan
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• Newer antihistamines are non-drowsy

- Loratidine - Clarytin, Clareze, Lorat
- Cetirizine - Zirtek, Anti Hist, Cetrine
- Fexofenadine - Telfast
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• Antihistamines are ideal for treating the two main

symptoms of hay fever; eye irritation and a runny nose
• In hay fever, antihistamines work best if taken before
symptoms occur
• Customers who suffer from hay fever regularly should be
advised to watch out for pollen counts in newspapers or
on TV and consider taking their antihistamine on the
morning or days where a high pollen count has been
forecast
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• Antihistamines also act as cough suppressants and can

help a dry cough, particularly where it is associated with a
runny nose (post nasal drip)
• They should not be recommended for a productive cough
• Antihistamines don’t help if the nose is stuffy or blocked
• ALWAYS remember to ask if your customer is driving, if not
too young to drive
• Warn that medicines with antihistamines, might make
them feel drowsy and loose concentration
• Customers operating machinery should be warned also
43

• Many products contain an antihistamine to ‘aid restful

sleep’, thus the manufacturers are using the side effect of
drowsiness as an advantage for customers who find that
their symptoms are disrupting their sleep
• Nevertheless you must always warn customers that the
product may make them drowsy
• The newer antihistamines such as Zirtek and Clarytin rarely
cause drowsiness, however they are less effective at drying
up a runny nose
• All the cough and cold remedies use older antihistamines
where drowsiness is a much more common side effect
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Part 2.2 The Role, Actions, Administration, Side Effects and

Interactions of Decongestants in the Management
of Respiratory Conditions
The Role of Decongestants
• Constrict the blood vessels lining the nasal passages
• Dilate the airways
• Unblock stuffy, blocked nose
45

Types of Decongestants
• Oral Decongestants
• Topical Decongestants
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Types of Decongestants – Oral Decongestants
• Oral decongestants such as tablets, capsules or liquids
• Oral decongestants pass into the bloodstream and have
effects throughout the body
• Oral Decongestant Ingredients:
- Pseudoepherine (Sudafed, Actifed, 4 Flu, Benylin Day &
Night)
- Phenylephrine (Uniflu, Lemsip Multi Relief Capsules,
Paralief Cold and Flu)
- Methoxyphenamine (Casacol)
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Types of Decongestants – Oral Decongestants
• Side Effects of Oral Decongestants:
- Increase blood pressure
- Increase heart rate
- Increase blood sugar levels
- Worsen glaucoma
- Sleeplessness
• Oral decongestants should be avoided if the patient has:
- Heart disease
- High blood pressure
- Diabetes
- Glaucoma
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Types of Decongestants – Topical Decongestants
• Topical decongestants such as sprays and drops
• Topical decongestants only enter the bloodstream in tiny
amounts and their effects are generally limited to the
nasal passages
• Topical Decongestants Ingredients:
- Xylometazoline (Otrivine Nasal Spray and Drops, Sudafed Nasal
Spray)
- Oxymetazoline (Vicks Sinex Nasal Spray)
• Do not use for more than 7 days
- Rebound nasal congestion
- Congestion ‘rebounds’ when spray or drops are stopped
- Leads to prolonged use of decongestant spray or drop
49

• Both oral and topical decongestants can interact with
other prescription medicines
• These interactions can be serious
• Always check if the patient is taking other medicines
• If the patient is taking other medicines, then check with
the pharmacist before recommending a decongestant
product
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Part 2.3 The Issues Arising from the Use of Multiple

Ingredients in Cough and Cold Medicines
• Decongestant plus antihistamine

• Decongestant plus paracetamol
- Paracetamol is found in many different cold remedies
- It is possible that your customer may be taking
paracetamol already (for example Lemsip)
- If you are recommending a cold and flu remedy
containing paracetamol remind the customer not to
take any other products with paracetamol
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Part 2.4 The Medicines Used to Treat Cough, Their

Cough Suppressants
• Examples
- Dextromethorphan (Benylin Dry Cough)
- Codeine (Codinex)
• Action
- Stop dry coughs
- Suppress the cough reflex, reducing the urge to cough
• Care
- Remember codeine regulations
- Codeine is constipating and can cause drowsiness
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Expectorants
• Examples
- Guaiphenesin (Benylin Chesty, Robitussin Chesty, Casacol)
- Thyme extract (Bronchostop)
• Action
- Help clear chesty coughs by increasing the volume of
water in the secretions making them thinner and more
‘watery’
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Mucolytics
• Examples
- Carbocysteine (Exputex, Viscolex)
• Action
- Thins the mucus
- Take with or after food
• Care
- Stomach ulcer
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Cough Soothers
• Sometimes known as demulcents

• Demulcents form a thin film over the lining of the airways
to sooth irritation
• Examples
- Glycerine lemon and honey
- Glycerin and lemon (Pharmony)
- Marshmallow extract (Bronchostop)
- Avoid honey in children under 1 year due to risk of
botulinum toxin infection
55
Part 2.5 The Codeine Regulations Impact on the

Supply of Cough and Cold Remedies
• Codeine containing products can only be sold by the

pharmacist
• This applies to cough and cold remedies containing
codeine
- Codinex
• These products must not be in view of the customers

• Requests for these products must be referred to the
pharmacist
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Part 2.6 The Use of Inhalational Products for the

Inhalers and Inhalations

• These are useful to clear stuffy, blocked noses
• Steam inhalations help to loosen phlegm and soothe the air
passages in the chest and lungs in chesty coughs
• Can be a useful addition to an expectorant cough medicine
• Inhalations can be used when the customer is taking other
medicines, but always check with the pharmacist first
• Always remember to remind customers to be careful when
using steam inhalations to keep hot water away from children
• Examples: Menthol and eucalyptus
• Advantage: Safe for use in patients taking other medicines
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Part 2.6 The Use of Inhalational Products for the

How to Use Inhalations

• It is important to explain how to use a steam inhalation
• Put one teaspoonful in a bowl
• Boil a pint of water and leave to cool for 1-2 minutes before
pouring into the bowl
• The water must not be boiling – this would make the
medicaments evaporate too quickly and they would be lost
• The customer should drape a towel over their head and the
basin to trap the steam, then inhale deeply
• Care - children
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Part 2.7 Medicines Used to Treat Sore Throat, their Ingredients,

Use and Cautions When Recommending
• Sore throats occur commonly in association with cough

and cold symptoms
• Most sore throats are caused by a viral infection and will
clear up in a short period of time without any treatment
• Some sore throats (approximately 10%) are caused by
bacteria and will need antibiotic treatment
• There are some cases where a sore throat will need
referral to the pharmacist, so it is always important to go
through your 2WHAM questions even if the customer has
only a sore throat and no other symptoms
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Effects of Lozenges:
• Lozenges generally have three effects:
- Soothing - Demulcents soothe the throat by increasing
saliva production, which also washes infecting organisms
off the throat. Examples are Glycerine and Throat Sweets
- Anaesthetic - numb the pain associated with an inflamed
throat. Examples: Lidocaine (Strepsils Plus)
- Antibacterial agents help to fight the infection causing the
sore throat. Examples include Amylmetacresol (Strepsils),
Cetylpyridinium (Septabene)
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Flurbiprofen
• Flurbiprofen is an anti-inflammatory ingredient similar to
ibuprofen
• It is used in:
- Strepsils Intensive Lozenge
- Strepsils Intensive Throat Spray
• The lozenges are only for use in adults and children over
12 years of age
• The throat spray is only for use in adults 18 years and over
• It should not be used by people allergic to aspirin,
asthmatics or people with stomach ulcers
• Maximum of five lozenges in 24 hours
61

Benzydamine
• Non aspirin like anti-inflammatory agent with slight local
anaesthetic properties
• It is used in:
- Difflam Throat Spray - Can be used by children under 6
with the pharmacists guidance
- Septabene - Only for children over 6
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Part 2.8 The Role of Eye Drops in the Management

of Ocular Hay Fever Symptoms
• Eye drops can ease the discomfort caused by itchy,

irritated watery eyes
• Anti Allergy Eye Drops (Otrivine Antistin) contain an
antihistamine (antazoline) to help deal with the allergy
plus an ingredient called a vasoconstrictor (in this case
xylometazoline) which reduces discomfort and redness
- Antihistamine - antazoline
- Vasoconstrictor – xylometazoline
63

• Sodium Cromoglicate (Opticrom, Vividrin) acts quickly and

can help prevent the symptoms of hay fever
• When this is present in the eye before the allergens
presents, it can help prevent the inflammatory watery
response namely redness, itchiness, watering and so on
• It should be stressed that these are preventative and
therefore must be used before the hay fever starts
• This means that these medications must be used regularly,
even when there are no symptoms – use four times a day
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• Other products which can sooth irritated eyes include

Murine, Optrex, Clearine, and Optrex eye drops.
• Many of these eye drops contain a preservative called
benzalkonium chloride as a preservative. This is absorbed
into soft contact lenses and released into the cornea
during wear, causing inflammation and irritation. Contact
lenses should therefore be removed while using these
products. These products can, if used for a prolonged
period, raise the pressure within the eye. Only recommend
these products for short term use.
65

• A word of caution with products containing

vasoconstrictors because they can occasionally cause
problems if used when a patient has an eye infection or
glaucoma
• So you should check whether your customer has any other
eye problems
• Eye drops should only be used on the recommendation of
your pharmacist
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Part 2.9 The Role, Action, Dose, Duration, Age Restrictions

and Advice of Nasal Corticosteroids in the
Management of Hay Fever
Topical Steroid Nasal Spray
• Steroid nasal sprays are particularly effective in treating all of the
symptoms of hay fever
• This is because steroids are anti-inflammatory agents and
inflammation of the lining of the nose and the surface of the eye is the
cause of all of the symptoms of hay fever
• However steroid nasal sprays are a preventative treatment and must
be used regularly to get the most benefit
• Ideally they should be started before the onset of the hay fever season
and used regularly throughout the season
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Topical Steroid Nasal Spray (contd.)
• Beclomethasone (Beconase Hayfever)
• Fluticasone (Flixonase Allergy Relief)
• Triamcinalone (Nasocort Allergy)
• Mometasone (Rhinex Relief)
Preventative treatment:
• Use regularly during the hay fever season
• They take 2-3 days to become effective
• It may be several weeks before the full benefit of
intranasal corticosteroids is obtained
• Ideally begin using one week before the likely onset of
symptoms
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Topical Steroid Nasal Spray - Beclomethasone
• Beconase Hay Fever
- Only licensed for the treatment of hayfever
- Only licensed for use in over 18s
- Two sprays into both nostrils twice daily
• Beconase Hay Fever can only be recommended for hay
fever
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Topical Steroid Nasal Spray - Fluticasone
• Flixonase
- Can be used for the treatment of all year-round allergy
- Maximum duration of treatment is 6 months
- Only licensed for use in over 18s
- Two sprays into both nostrils once daily dose
- Prime the spray by pumping several times until a fine
mist is achieved
• Flixonase is used once daily and can be used from 18 years
of age
• It can be used to treat hay fever and all year round
(perennial) nasal allergy
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Topical Steroid Nasal Spray - Triamcinalone
• Nasacort Allergy
- For the treatment of hay fever
- Prime 5 times until fine spray achieved
- Two sprays into each nostril once daily
- Once symptoms improve reduce to one spray into each
nostril daily
- Over 18 only
- Maximum 3 months
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Topical Steroid Nasal Spray - Mometasone
• Rhinex Relief
- For the treatment of hay fever diagnosed by a doctor
- Prime 10 times until fine spray achieved
- Two sprays into each nostril once daily
- Once symptoms improve reduce to one spray into each
nostril daily
- Over 18 only
- Maximum 3 months
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Topical Steroid Nasal Spray (contd.)
• If the symptoms persist longer than 14 days without any relief
then the customer should be referred to the pharmacist
• Remember to tell the customer that the spray takes a few
days to become effective and may take a few weeks before
the full benefit is felt
• It is important to use the sprays every day to get the full
benefit
• This is important as customers may think that the product
does not work as they may be expecting a speed of effect
similar to the decongestant nasal sprays
73
3.1 Standard Referral Criteria

3.2 Condition-Specific Referral
Part 3. Criteria for Cough and Cold
When to Refer 3.3 Condition-Specific Referral
to a Pharmacist for Sore Throats
3.4 Condition-Specific Referral
Criteria for Hay Fever
74
37
Part 3.1 Standard Referral Criteria
Refer to a pharmacist if the customer:

• Is on other medication
• Has already tried a treatment
• Is pregnant or breastfeeding
• Has persistent or recurrent symptoms
75
Part 3.2 Condition-Specific Referral

Criteria for Cough and Cold
All the symptoms below suggest a more serious problem. If
any customer has any of these symptoms, they MUST be seen
by the pharmacist:
• If you or the customer suspect they have either influenza or COVID-19
• Yellow, green or brown phlegm (may have a chest infection)
• Pain on breathing or coughing (may have a serious condition like
pneumonia or pleurisy)
• Earache which is very painful
• Fever
• Wheezing or breathlessness
76
38

Criteria for Cough and Cold (contd.)
All the symptoms below suggest a more serious problem. If

any customer has any of these symptoms, they MUST be seen
by the pharmacist.
• If the cough has lasted longer than 2 weeks
• Used OTC treatments without success
• If the customer is pregnant
• Children under 6 years
• Taking other medicines
• If you suspect the customer is abusing the medicine
But of course you should not alarm the customer
77
Part 3.3 Condition-Specific Referral Criteria

Sore Throat
• Severe sore throat particularly in the absence of cough or cold
symptoms
• Difficulty swallowing as distinct from merely discomfort swallowing
• Babies or small children presenting with fever and sore throats
especially if they are having difficulty swallowing and may be drooling
• White spots present in the throat this may indicate a bacterial or
fungal infection in the throat
• Sore throat lasting longer than a week or recurrent sore throats
78
39

Criteria for Hay Fever
• Eyes
- Sticky
- Yellow pus
• Wheezy or short of breath
• Fever
• Symptoms of sinusitis
• Pregnant women - OTC hay fever treatments should not be taken by
expectant mothers
• If the customer has not had hay fever before - to confirm the diagnosis of
hay fever before any treatment is recommended
• As always, if the customer is taking any other medicines, either on
prescription or OTC, you must check with the pharmacist before making
any recommendations
79
Part 1. An Introduction to Conditions

Affecting the Respiratory Tract
Topic Part 2. The Ingredients Used in the
Treatment of Respiratory
Recall Conditions
Part 3. When to Refer to a Pharmacist
80
40

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IPU Medicines Counter Assistant (MCA) Course

Topic 5 – Respiratory Conditions and Treatments

MCA – Topic 5: Respiratory Conditions and Treatments – 01/09/2023 1

The main aim of Topic 5: Respiratory Conditions

MCA – Topic 5: Respiratory Conditions and Treatments – 01/09/2023 2

This topic contains three parts:

MCA – Topic 5: Respiratory Conditions and Treatments – 01/09/2023 3

The learner objectives for this topic are:

MCA – Topic 5: Respiratory Conditions and Treatments – 01/09/2023 4

Learner Objectives (contd.)

The learner objectives for this topic are:

This topic is delivered using a blended format

MCA – Topic 5: Respiratory Conditions and Treatments – 01/09/2023 6

You are required to achieve a minimum grade of 80% for the

MCA – Topic 5: Respiratory Conditions and Treatments – 01/09/2023 7

MCA – Topic 5: Respiratory Conditions and Treatments – 01/09/2023 8

1.1 The Pathophysiology of the Common

MCA – Topic 5: Respiratory Conditions and Treatments – 01/09/2023 9

Part 1.1 The Pathophysiology of the Common Cold,

The Common Cold

MCA – Topic 5: Respiratory Conditions and Treatments – 01/09/2023 10

Part 1.1 The Pathophysiology of the Common Cold,

MCA – Topic 5: Respiratory Conditions and Treatments – 01/09/2023 11

Part 1.1 The Pathophysiology of the Common Cold,

Cold Symptoms (contd.)

MCA – Topic 5: Respiratory Conditions and Treatments – 01/09/2023 12

Part 1.1 The Pathophysiology of the Common Cold,

Part 1.2 The Cause and Symptoms of the Influenza

• Influenza is an acute, respiratory illness caused by the

• COVID-19 is an entirely new coronavirus which can cause

MCA – Topic 5: Respiratory Conditions and Treatments – 01/09/2023 14

Part 1.2 The Cause and Symptoms of the Influenza

• A person can become infected with COVID-19 or Influenza

MCA – Topic 5: Respiratory Conditions and Treatments – 01/09/2023 15

Part 1.2 The Cause and Symptoms of the Influenza

Symptoms of COVID-19 include:

MCA – Topic 5: Respiratory Conditions and Treatments – 01/09/2023 16

Part 1.2 The Cause and Symptoms of the Influenza

Symptoms of Influenza include

MCA – Topic 5: Respiratory Conditions and Treatments – 01/09/2023 17

Part 1.3 How to Minimise the Spread of Influenza, Cold

Part 1.4 When Influenza / COVID-19 Sufferers

If you suspect a patient has Influenza / COVID-19

MCA – Topic 5: Respiratory Conditions and Treatments – 01/09/2023 19

Part 1.4 When Influenza / COVID-19 Sufferers

Sufferers should seek medical attention if they have

MCA – Topic 5: Respiratory Conditions and Treatments – 01/09/2023 20

Part 1.4 When Influenza / COVID-19 Sufferers

Medical attention should be sought for a child if

MCA – Topic 5: Respiratory Conditions and Treatments – 01/09/2023 21

Part 1.5 The Pathophysiology, Causes

MCA – Topic 5: Respiratory Conditions and Treatments – 01/09/2023 22

Part 1.5 The Pathophysiology, Causes

MCA – Topic 5: Respiratory Conditions and Treatments – 01/09/2023 23

Part 1.5 The Pathophysiology, Causes

MCA – Topic 5: Respiratory Conditions and Treatments – 01/09/2023 24

Part 1.6 The Causes and Symptoms of

MCA – Topic 5: Respiratory Conditions and Treatments – 01/09/2023 25

Part 1.6 The Causes and Symptoms of