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After studying this module, assistants will:

tra

ining excellence

in association with C

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Quality Seal 2015

This module is suitable for all members of the pharmacy team who wish to increase their knowledge of common

conditions and their treatment options. This module has been endorsed with the NPA’s Training Seal as suitable

for use by pharmacy teams as part of their ongoing learning.

This module can also form part of your Team Tuesday training.

OBJECTIVES

LEARN & ADVISE

To understand how conditions affect the nose, it’s importantto know a little about its structure.

The nose is made up of a combination of bone andcartilage. At the top, around the bridge, the structure isbone. Towards the front, the nose is mostly cartilage andthis continues inside, where a cartilage called the ‘nasalseptum’ divides the nose into two halves. Air enters intoeach of these halves through the nostrils. Towards the backof the nose, the two nasal cavities join together.

The entire nasal cavity is lined with a membrane thatproduces a thin film of clear mucus. This helps humidify theair we breathe in and traps particles like allergens, bacteriaand viruses. If the inside of the nose is too dry, its variousfunctions will be impaired.

The sinuses are four pairs of air-filled cavities found in the bones ofthe face, around the nose and eyes.The mucus membrane that lines thenasal cavity also coats the inside ofthe sinuses. Mucus produced heredrains into the nose. Anything thatblocks this drainage can lead to abuild up of pressure in the sinuses,which can be felt as sinus pain or a headache. If the sinus cavitiesbecome blocked, bacteria in themucus may grow, leading to a sinusinfection.

Most of us probably don’t give our noses a second thought most of the time, but ifwe’re feeling stuffy and congested, or ifour nose just won’t stop running, itcertainly makes us feel under the weather.

Nasalconditions

• Have a basic understanding of the structure of the nose

• Be familiar with common conditions that affect the nose

• Know what treatment options are available to relieve these conditions.

THE PROFESSIONAL

ASSISTANT

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DID YOU KNOW?...Exposure to dry air can lead to stuffynoses, particularly in babies.

Rhinitis is themedical term forinflammation andswelling of themucus membraneinside the nose.This inflammationincreases the amountof mucus producedand, as a result,customers maycomplain of a runnynose, sneezing,nasal congestion anda feeling of mucusdripping or tricklingdown the back oftheir throat.

Rhinitis can be definedby the duration of symptoms – acute (short-lived) or chronic (longer-lasting). Here, we focus on acute rhinitis:

Acute allergic rhinitis Allergic rhinitis is triggered by an allergic reaction to an allergensuch as pollen, pet dander or house dust mites.

Acute non-allergic rhinitis Non-allergic rhinitis can be caused by:• A viral infection – e.g. the common cold• Environmental factors – e.g. a dry atmosphere, smoke, a change in temperature• Hormonal imbalance – e.g. during pregnancy, puberty orwhen taking oral contraceptives or hormone replacement therapy• Rebound congestion – the medical name for this is ‘rhinitismedicamentosa’ and it is caused by the overuse of nasaldecongestants. You may have heard it referred to as reboundcongestion. Anyone with repeated symptoms of congestionfollowing use of a nasal decongestant, should be referred to thepharmacist.

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Understanding the problemWhether they’re caused by an infectionor an allergy, nasal conditions such asrhinitis, nasal congestion, sinusitis andpost-nasal drip are some of the mostcommon complaints seen in pharmacy.

Many of these conditions tend to havesome degree of overlap, so it can bedifficult to distinguish between them. Forinstance, it’s possible for someone withrhinitis to also report nasal congestion, orsomeone with a stuffy nose to also sufferfrom sinus pain. It’s therefore importantto ask customers to describe theirsymptoms carefully as this will help youto offer effective treatment and advice.

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Rhinitis

Normally, all mucus secretionsfrom the nose drain to the backof the throat and are swallowedin a process we’re not usuallyaware of. However, sometimes a person may feel as if mucus isaccumulating at the back of theirthroat. This is termed ‘post-nasaldrip’. A person may describe this as a feeling of mucus dripping ortrickling down the back of theirthroat, which may trigger coughing.

Post-nasal drip may occur when a person is suffering from a cold or an allergy.

Post-nasal drip

The term sinusitis simply meansthat the sinuses are inflamed, andthis is usually caused by aninfection or an allergy.

Normally, mucus drains through smallchannels into the nose. However, ifthese channels get blocked, thesinuses can become congested andinflamed.

Sinusitis is often acute (lasting two to three weeks). However, it can bechronic (lasting up to 12 weeks).Symptoms may include:• Pain or tenderness in the forehead,cheeks or around the eyes, which isworse on stooping down• Headache• Fever• A blocked orrunny nose• Cough• Loss of smell or taste• Bad breath.

In addition, nasalsecretions may bethick and range incolour from whiteto yellow/green oreven tinged withblood. This mayindicate aninfection, so referthese customers tothe pharmacist.

Sinusitis

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Added advicePass on the following advice to helpcustomers stay congestion-free andbreathing easy:

• Keep nasal passages moist by usingsea water or saline sprays or washes

• Drink plenty of fluids

• Use steam inhalation. A hot steamy

shower or a vaporiser may help

• Do not smoke and avoid smokyatmospheres

• Be scrupulous about personalhygiene. Cover the nose and mouthwhen sneezing; wash hands regularly;discard used tissues immediately

• Raise the head of the bed a fewinches or use extra pillows to easeany breathing difficulties.

When to referYou should refer a customer to thepharmacist if they:

• Have symptoms which are severe or last longer than 10 days

• Have a fever lasting for more thanthree days

• Produce nasal discharge that isyellow/green and accompanied bysinus pain or pressure

• Have blood in their nasal dischargeor a persistent clear discharge after ahead injury

• Notice a change in vision orswelling around their eyes

• Are a baby with nasal congestionthat is causing feeding difficulties

• Are a child who may have a foreignobject inside their nose

• Have symptoms that initiallyimprove but then worsen

• Are taking prescribed medicationfor a long-term medical condition

• Have symptoms that persist despitethe use of appropriate OTCmedication.

DID YOU KNOW?...Allergic rhinitis affects around one in every five people in the UK.

For more information,you can:

SIGNPOSTING

• Use your Counter IntelligencePlus training guide

• Visit Allergy UK at: www.allergyuk.org or call: 01322 619898

• Visit Action Against Allergy at:www.actionagainstallergy.co.uk orcall: 020 8892 2711

! Don’t forget...Nasal decongestantssuch as oxymetazolineand xylometazolineshould only be used by adults as instructed.Prolonged use cancause symptoms toreappear after stop-ping. This is known as‘rebound congestion’.

The treatment of choice will depend on an individual’s symptoms andtheir cause, although this may not always be obvious. Ask the WWHAMquestions and refer to your pharmacist when necessary.

Sea water and saline nasal spraysNasal sprays based on natural ingredients such as sea water or salinecan provide relief from a number of nasal conditions.

Products containing sea water (e.g. Stérimar Nasal Hygiene) work bywashing away allergens and rebalancing nasal functions. Some haveadditional ingredients such as manganese, calcium and purified water(e.g. Stérimar Stop & Protect Allergy Response) to deactivate allergensin the nose and form a barrier to prevent allergens from irritating thenasal mucosa. These products can be used alone or alongsidemedication and are suitable for pregnant women, babies and thosewho cannot take medicated treatments.

DecongestantsDecongestants work by constrictingthe blood vessels in the lining of thenose, reducing swelling andopening up the nasal passages. Decongestants are not usuallyrecommended for children under12, breastfeeding women orthose who have certain healthconditions, such as high bloodpressure. They should also beavoided by anyone takingantidepressants called monoamineoxidase inhibitors.Decongestants are available as: • Tablets – useful for people who want a convenient, long-lastingtreatment. Examples include phenylephrine (e.g. Non-Drowsy SudafedCongestion & Headache Relief Capsules) and pseudoephedrine (e.g.Contac Non Drowsy 12 Hour Relief)• Nasal sprays or drops – useful for people who want immediaterelief. Examples include xylometazoline (e.g. Otrivine Nasal Sprayrange) and oxymetazoline (e.g. Vicks Sinex Decongestant Nasal Spray),which are effective for eight to 12 hours. Also available are shorter-acting ingredients such as ephedrine and phenylephrine (e.g. FenoxNasal Drops).

Corticosteroids Corticosteroids are anti-inflammatory drugs available as nasal spraysfor allergic rhinitis. Examples include beclometasone (e.g. BeconaseHayfever) and fluticasone (e.g. Pirinase Hayfever).

Treatment options

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Warning: The content contained in this module is the copyright of Groupe Eurocom Ltd © 2015 and cannot be reproduced without permission in the form of a valid writtenlicence granted after July 1, 2011. Unbranded pictures copyright Photodisc/Digital Stock/iStockphoto. Published under licence by Communications International Group Ltd, 162-168 Regent Street, London W1B 5TB. Tel: 020 7434 1530. Email: TM@1530.com

TESTYOURSELFGOOD PRACTICE KNOWLEDGE IS IMPORTANT WHEN ADVISING CUSTOMERS

Questions

1) Which of the following statementsis TRUE?a) The nasal cavity is lined with a

membrane that produces a thinfilm of clear mucus

b) This mucus helps to dry the air webreathe in

c) If the inside of the nose is toomoist, its functions will be impaired

d) The sinuses are made up of twopairs of cavities in the bones of the face

2) What can cause rhinitis?a) An allergen (e.g. pollen)b) A coldc) Hormonal imbalanced) All of the above

3) Who would you refer to thepharmacist? A customer who has:a) Symptoms lasting longer

than seven daysb) A fever lasting less than three daysc) Blood in their nasal discharged) Clear discharge

following a cold

4) How do sea water nasal spraysrelieve congestion?a) By washing away allergens and

rebalancing nasal functions b) By constricting blood vessels in

the lining of the nosec) By opening up the nasal passagesd) None of the above

5) What other advice could you offeryour customer?a) Drink plenty of fluids b) Use steam inhalationc) Don’t smoked) All of the above

6) Which of the following statementsis TRUE?a) Sea water nasal sprays can provide

relief from nasal congestionb) There are no limitations on the

duration of treatment with OTCdecongestant sprays

c) Allowing the nasal passages to dry out is a good thing

d) None of the above

Scenario

Go to www.tmmagazine.co.uk to submit your answers to these questions. When

you pass, you’ll be able to print out a certificate to showcase your learning. You

can also add this to your online, personalised learning log.

www.tmmagazine.co.uk

What would you recommend?

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For each part of this scenario, think about the decision you would make and,importantly, why you would choose that option. In addition, for each decision that

you make, think about how you would talk to the customer and provide thenecessary advice. You can discuss this with your team and pharmacist.

Yes. Peter can use the same product.

1No. Peter would benefit from a

different product.

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Refer to the pharmacist and, followingthis discussion, recommend a nasal spray

based on natural sea water, which issuitable for John to take alongside his

blood pressure medication.

1Suggest various options that are

available OTC, such as oraldecongestants, topical decongestants

and natural nasal sprays.

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What if?John tells you that he has a

nine-year-old son, Peter, who also suffers from hayfever. He asks whether

the sea water nasal spray would be suitable for him.

What if?John has nasal discharge that has

changed in colour and is accompanied by sinus pain or pressure.

Recommend a topicaldecongestant and tellJohn to return if hissymptoms have not

improved in two weeks.

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Refer John to A&E.

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Refer John to the pharmacist for

further advice.

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John is a regular customer at your pharmacy. Hementions that he can’t stop sneezing and his nosefeels stuffy. He tells you that he often gets hayfeverat this time of year. After asking the WWHAM questions,you establish that John has high blood pressure that is undercontrol and he would prefer a nasal spray as he dislikes taking tablets.

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