Management of common cold symptoms with over-the-counter medications: clearing the confusion

The validity of single-item measures of health-related quality of life across groups differing in acute respiratory symptom severity

PURPOSE

Practical considerations precluding health-related quality of life (HRQOL) monitoring in population and clinical research have spawned development of improved items for more brief surveys of frequently measured HRQOL outcomes. The aim of this study was to validate the use of the Quality of Life General (QGEN-8), a shorter 8-item alternative to the longer 36-item short form (SF)-36 Health Survey for measuring the same eight HRQOL domains across groups of adults with varying severity of acute respiratory symptoms, such as cough and sore throat.

METHODS

National Opinion Research Center (NORC) representative probability (N = 1,648) and supplemental opt-in (N = 5,915) U.S. adult samples were surveyed cross-sectionally online in 2020. Parallel analyses compared QGEN-8 and SF-36 estimates of group means for each of eight matching profile domains and summary physical and mental scores across groups differing in severity of acute symptoms and chronic respiratory conditions using analysis of covariance (ANCOVAs) controlling for socio-demographics and presence of chronic respiratory conditions.

RESULTS

In support of discriminant validity, ANCOVA estimates of QGEN-8 means with SF-36 estimates revealed the same patterns of declining HRQOL with the presence and increasing severity of symptoms and chronic condition severity.

CONCLUSION

QGEN-8® shows satisfactory validity and warrants further testing in cross-sectional and longitudinal population and clinical survey research as a more practical method for estimating group differences in SF-36 profile and summary component HRQOL scores.

Pharmacist's recommendations of over-the-counter treatments for the common cold - analysis of prospective cases in Poland

BACKGROUND

Common cold is a frequent illness in northern hemisphere between late autumn and early spring. Patients suffering from it frequently turn to pharmacists instead of physicians in order to receive medical advice and treatment. We studied its treatment advised by pharmacists in Poland, as well as evidence for the efficacy of their recommendations by utilizing a self-developed questionnaire and a study of existing literature.

METHODS

The data were collected by 27 pharmacists who worked in four large network community pharmacies in Lodz, Poland. The study took place from December 2019 to February 2020. Data were recorded only if the patient asked for pharmacy counselling for over-the counter (OTC) products due to common cold self-diagnosis and a product was sold. Pharmacists' recommendations were compared with the results of a literature review of best evidence to determine appropriateness of the pharmacists' decisions.

RESULTS

In four out of five cases the pharmacists recommended products contained paracetamol. In addition, in one out of three patient encounters they advised nasal decongestant, inosines and/or OTC mucolytics. There was a significant relationship between fever and recommendation frequency of some analgesics, inosines, mucolytics and sore throat products (OR > 1, p < 0.05); rhinorrhea and recommendation frequency of paracetamol, inosines, anti-histamines and alpha-mimetics (OR > 1, p < 0.05); cough and recommendation frequency of paracetamol, inosines, mucolytics and sore throat products (OR > 1, p < 0.05); and fatigue and recommendation frequency of paracetamol, acetylsalicylic acid, inosines and sore throat products (OR > 1, p < 0.05). The pharmacist recommendations were based on patients' symptoms, product price, pharmaceutical company promotion and the financial incentive. In many cases their recommendations were not in line with current best practice recommendations.

CONCLUSIONS

Our study suggests that the most common rationale for pharmacist recommendation on anti-common cold treatment was to take a "shotgun" approach. Pharmacists commonly made recommendations for products that lack strong evidence for efficacy (i.e. anti-viral agents) and are potentially unnecessary, based on presentation of the symptom. Reasons for this situation include lack of training, lack of time to evaluate the patient, lack of awareness of evidence as well as drug company marketing and financial incentives (i.e. fulfilling sale plans and target sale bonuses).

TRIAL REGISTRATION

The study was a non-interventional, observational research trial. The study registration was not required.

The prevalence of serotonin syndrome in an intensive care unit: A prospective observational study

PURPOSE

In spite of life-threatening nature of serotonin syndrome (SS), it remains an under-diagnosed condition. The availability of epidemiological data about SS, especially in the ICU setting, may help physicians make early diagnoses and interventions.

MATERIALS AND METHODS

This was a 6-month prospective study in a medical ICU of a tertiary hospital to find out the prevalence of SS. All consecutive adult patients admitted to the medical ICU were evaluated to see if they fulfilled the Hunter criteria of SS. Patients who met the Hunter criteria were evaluated further for other details.

RESULTS

Overall, 309 patients were identified of which 24 (7.8%) met the Hunter criteria. The mean age was 52.4 years, and 75% were male. Most patients received two or more serotonergic drugs. Ondansetron was the most common serotonergic drug (58%), followed by tramadol (38%), and cough syrup (dextromethorphan or chlorpheniramine, 21%). None of the patients received a diagnosis of SS by the treating physicians. Chronic obstructive pulmonary disease exacerbation with respiratory failure and metabolic encephalopathy were the two most common admission diagnoses (17% each). Twenty-two patients received cyproheptadine. There were no fatalities.

CONCLUSION

SS is not uncommon in the ICU setting. There is a need to increase awareness among physicians.

Application of derivative emission fluorescence spectroscopy for determination of ibuprofen and phenylephrine simultaneously in tablets and biological fluids

Two sensitive, rapid, and accurate derivative emission spectrofluorimetric methods applying zero crossing techniques were developed for simultaneous determination of binary mixtures of ibuprofen (IBU) and phenylephrine hydrochloride (PHE) in pure powder, synthetic mixture and combined tablets. The proposed methods were performed via measuring the intersected drug derivative amplitude of one drug at the zero crossing points for the other one and vice versa. The two methods rely on the measurement of the combined drugs native fluorescence after excitation at 270 nm in methanol directly, followed by differentiation using first (D₁) and second derivative (D₂) techniques. Applying the D₁, IBU was measured quantitatively at 293.1 nm at zero crossing of PHE, on the other side; PHE was measured quantitatively at 300.7 nm at zero crossing of IBU. By the same way, applying the D₂, the wavelengths selected were 303.5 nm for IBU and 312.9 nm for PHE. The concentration plots of derivative fluorescence intensity were rectilinear over the range of 0.5-10 μg/mL and 0.025-0.5 μg/mL for IBU and PHE, respectively. The results obtained with average % recoveries ± RSD are 99.73 ± 0.72 (IBU, D₁), 99.49 ± 0.95 (PHE, D₁), 99.79 ± 0.47 (IBU, D₂), and 99.88 ± 0.34 (PHE, D₂) were in good agreement with the comparison method. The proposed methods offer high sensitivity that enable direct analysis of IBU and PHE in spiked human plasma. The proposed methods were entirely validated in terms of ICH guidelines.

[Combination drugs in the therapy of acute respiratory viral infections: Evaluation of clinical and economic effectiveness]

AIM

To make a comparative clinical and economic evaluation of the use of the combination drug Influnet in the treatment of acute respiratory viral infections (ARVI).

SUBJECTS AND METHODS

A total of 103 medical records of outpatients with uncomplicated mild and moderate ARVI were studied. There were three groups: 1) 35 patients who received therapy with Influnet; 2) 31 patients who took Rinza; 3) 34 patients who were on treatment without the combination drug.

RESULTS

Analysis of comparative clinical effectiveness of the drugs revealed that the use of Influnet was accompanied by the rapider alleviation of fever and other ARVI symptoms and by its shorter treatment duration (4.5 ± 0.5 days) versus that of Rinza (5.5 ± 1.4 days) and monocomponent drugs (5.6 ± 1.2 days). Economic analysis showed that in terms of indirect costs associated with shorter temporary disability in patients with ARVI, Influnet therapy was more economically sound for them.

CONCLUSION

The results demonstrate the higher clinical and economic feasibility of Influnet therapy for ARVI versus its alternative therapy. Combination drugs cause fewer adverse reactions than a combination of monocomponent drugs used to treat ARVI and are more cost- effective for the patient.

Consumer attitudes on cough and cold: US (ACHOO) survey results

OBJECTIVE

The Attitudes of Consumers Toward Health, Cough, and Cold (ACHOO) survey was developed to better inform health care providers on the natural history and impact of common cold and cough, and related consumer experience and behaviors.

RESEARCH DESIGN AND METHODS

Randomly selected US Internet/mobile device users were invited to participate in an online survey (N = 3333) in October 2012. Response quotas modeled upon 2010 US Census data ensured a demographically representative sample. To reduce potential bias from the quota design, 75% of the completed surveys were randomly selected as the primary analysis pool.

MAIN OUTCOME MEASURES

Survey questions assessed participant demographics, frequency and duration of cough/cold symptoms, impact of symptoms on daily life, treatment preferences, and knowledge about cough/cold pathophysiology.

RESULTS

In the past year, 84.6% of respondents had experienced at least one cold. Colds typically started with sore/scratchy throat (39.2%), nasal congestion (9.8%), and runny nose (9.3%) and lasted 3-7 days. Cough, the most common cold symptom (73.1%), had a delayed onset (typically 1-5 days after cold onset) and a long duration (>6 days in 35.2%). Nasal congestion and cough were the most bothersome symptoms. Many respondents waited until symptoms were 'bad enough' (42.6%) or multiple symptoms were present (20.2%) before using nonprescription medications. Drivers of choice included effectiveness in relieving symptoms, safety, and past experience. Respondents rarely consulted clinicians regarding treatment, and more than three-quarters had never received instructions from a clinician on how to choose a nonprescription cough/cold medication. Misperceptions regarding etiology and treatment of the common cold were prevalent. The main limitation is potential recall bias, since respondents had to recall cough/cold episodes over the prior year.

CONCLUSIONS

The ACHOO survey confirms that cold is a common, bothersome experience and that there are gaps in consumers' knowledge of pathophysiology and appropriate management of cough/cold.