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Coughs, blocked noses, sore throats and fevers can wreak havoc with work, school and leisure activities. Although respiratory viruses can occur at any time of the year, cases of flu and respiratory syncytial virus (RSV) usually reach peak levels in the autumn and winter months. The viruses spread easily from person to person, in tiny droplets in the air and on contaminated surfaces, with symptoms ranging from mild to severe. Staying at home when unwell and practising good hygiene can help to reduce the spread of infections and protect vulnerable people.
This year, the NHS has been preparing earlier than ever for the winter vaccinations season. Covid, flu and RSV vaccinations can help to avoid complications in high-risk groups, including young children, older people and people with weaker immune systems or other chronic illnesses such as asthma.
Understanding the different signs and symptoms of flu and RSV can help to determine which treatments and advice to offer customers and when to refer people to their GP. “‘How quickly did your symptoms come on?’ is perhaps the single most useful screening question,” says Kenny Chan, lead information pharmacist at Numark. “A response indicating symptoms appeared suddenly, within hours or overnight, strongly suggests flu, while gradual development over several days points towards a cold or RSV.”
Flu
Flu (influenza) is usually much worse than an ordinary cold and starts much more rapidly. It affects the nose, throat and lungs and can be a serious illness in vulnerable people, causing thousands of hospitalisations and deaths each winter.
“The common cold typically develops gradually over two to three days, with customers often reporting a scratchy throat on day one, followed by a blocked nose, and then sneezing and general malaise,” says Kenny. “Flu, by contrast, arrives suddenly and leaves patients feeling acutely unwell with high fever, severe body aches, chills and fatigue. If the patient describes being bedridden and unable to function, flu becomes a more likely diagnosis.”
Flu symptoms tend to last for up to five days in adults and seven days in children. They include:
- A sudden high temperature (38 degrees Celsius or above)
- Feeling tired or exhausted
- Shivering
- Headaches
- A sore throat
- Muscle aches
- A dry cough
- Difficulty sleeping
- Loss of appetite
- Digestive symptoms like diarrhoea, feeling sick, being sick and tummy pain (these are more common in young children).
“Being mindful of symptoms, such as high fever, chills, breathing difficulties or severe coughing can help pharmacy teams identify illnesses early,” says Dr Roger Henderson, NHS GP and Olbas spokesperson. “If a patient has a consistently high temperature for more than three days and feels hot and shivery – or if a cough persists for more than three weeks – they should discuss this with their doctor. They should also contact them straight away if they feel short of breath or have chest pain.”
Management
Many people with flu feel so unwell that they stay in bed until they feel better – rest, sleep and keeping warm are important for recovery. They should drink lots of water to prevent dehydration, especially if they have a high fever.
“Over-the-counter treatments can help with symptoms of flu,” says Dr Henderson. “These include vapour rubs on the back or chest, gargling with salt water, simple analgesics such as paracetamol or ibuprofen, nasal sprays and decongestants.”
Market Monitor: Product updates from Training Matters
New from Lanes Health, Olbas Pelargonium Herbal Cough & Cold Relief Tablets are a traditional herbal medicinal product used to relieve symptoms of upper respiratory tract infections, including the common cold, coughs, sore throats and blocked or runny noses, based on traditional use only. The tablets contain a medicinal extract from the roots of Pelargonium sidoides to provide naturally derived relief from within. Pelargonium sidoides is a medicinal plant native to South Africa, used traditionally to relieve respiratory complaints. Suitable for adults and children aged 12 years and over, Olbas Pelargonium complements the existing Olbas range, helping customers to breathe easier and feel more comfortable throughout their recovery, at home or on the go, says manufacturer Lanes Health.
laneshealth.com
Vocalzone Throat Pastilles help to maintain a clear voice and soothe throat irritation or dryness that may occur from talking, singing or smoking excessively, or from a cold. “The Vocalzone formula is unique and is the only pastille in the UK to contain myrrh, which is known to possess natural anti-inflammatory properties, and helps relieve excess mucus and clear congestion,” says manufacturer Kestrel Medical. “Vocalzone has been trusted by many of the world’s most iconic voices for more than a century, and is a good recommendation for customers over the age of 12 years who need to soothe an over-used voice or throat irritation.”
Kestrel Medical: 01202 658 444 / vocalzone.com
Prevention
Flu viruses are highly infectious, especially in the first three to five days of the infection, so good hygiene is important. Flu vaccinations are offered to people who are most likely to become seriously ill if they catch the infection. It’s important to stress that flu jabs are recommended for all eligible people, even if they feel healthy, rather than only for people whose underlying condition is poorly controlled.
The free seasonal flu vaccine on the NHS is available to those:
- Aged 65 or older
- Who are pregnant
- With a heart problem, respiratory problem (including asthma, bronchitis or emphysema), kidney disease or liver disease
- With diabetes or a neurological condition (such as multiple sclerosis or cerebral palsy)
- With lowered immunity due to disease or treatment (such as steroid medicines or cancer treatment)
- Who have had a stroke or a transient ischaemic attack
- Who have a problem with their spleen (such as sickle cell disease) or have had their spleen removed
- Living in a residential or nursing home
- Who are the main carer of an older or disabled person
- Working in frontline health or social care
- Who are a close contact of people with lowered immunity
- Who are rough sleepers or using homeless hostels or night-shelters and are aged 16 years and over.
Coping with an ongoing cough
Most virus-triggered coughs clear up without any specific treatment within two to three weeks, but sometimes they can linger once all of the other symptoms have cleared up. A persistent cough can be distracting and annoying, and can cause significant distress for the affected person and their families, including sleepless nights. Coughs are more likely to linger in chronic smokers.
Cough medicines such as syrups may help to some degree but won’t stop a cough completely. There are several other self-help measures that customers can try, including:
- Drinking lots of water to loosen and dilute any mucus and make it easier to cough up – sipping water will also help to moisten the throat
- Drinking a soothing hot lemon and honey drink (not suitable for babies under one year)
- Gargling with warm salty water if the cough is making the throat sore (adults only)
- Blowing the nose regularly and inhaling steam to clear excess mucus
- Propping the head up while sleeping using extra pillows, to make breathing easier and clear the chest of mucus
- Using a humidifier in the bedroom to combat dry air, which can irritate the throat.
If someone has had a cough for more than three weeks, has other symptoms such as shortness of breath, is coughing up blood or blood-stained mucus, is losing weight for no known reason or has a weakened immune system (due to diabetes or chemotherapy, for example), they should be referred.
Respiratory syncytial virus (RSV)
The respiratory syncytial virus (RSV) usually spreads more quickly from October to March each year in the UK. Up to nine in 10 children will get RSV before they turn two, and around 175,000 people over the age of 65 go to their GP about RSV each year.
The RSV infection isn’t serious in most people, but it is still a major cause of breathing difficulties due to complications like bronchiolitis, bronchitis and pneumonia. People most at risk of complications include babies under one year (especially those under six months), children who were born prematurely or have an underlying lung disease, and older people with weakened immune systems or long-term lung or heart conditions. Children who breathe in cigarette smoke are more likely to get serious RSV infections. Babies born in late summer or the autumn are most likely to be admitted to hospital with RSV.
When it comes to symptoms, they are usually similar to a cold. They include:
- A runny or blocked nose
- Sneezing
- Coughing
- A high temperature (fever)
- Difficulty feeding in babies and children
- Tiredness
- Wheezing
- Breathlessness.
“Pharmacy teams should specifically ask about respiratory symptoms,” says Kenny. “‘Have you noticed any wheezing, shortness of breath, or difficulty breathing?’ is particularly important for identifying RSV and for recognising red flags requiring urgent referral. RSV will develop gradually but will often present with wheezing or high-pitched whistling when breathing, which distinguishes it from other respiratory viruses.”
If babies have fast or noisy breathing and are particularly unsettled or difficult to comfort or feed, it’s important that they are assessed by a GP.
Older adults should see a doctor if they have any breathing problems with cold-like symptoms or notice colour changes around their lips, mouth or fingernails
with a bluish tint.
“Up to nine in 10 children in the UK will get RSV before they turn two”
Market Monitor: Product updates from Training Matters
Established in 1907, Jakemans prides itself on remaining the UK’s number one cough/throat lozenge brand. “Marvellous moments require marvellous voices, that’s why each tasty lozenge is carefully blended with menthol, an ingredient that releases natural vapours to soothe the symptoms of a sore or tickly throat and keep airways clear,” says manufacturer Lanes Health. Made with natural ingredients, Jakemans lozenges contain no artificial colours or flavours and are suitable for vegetarians. The existing flavour line-up has now been joined by new permanent flavour Blood Orange & Warm Spice, which is available in 73g and 160g bags.
laneshealth.com
Founded in Fleetwood, Lancashire, in 1865, Fisherman’s Friend has a long-standing reputation for providing relief from symptoms commonly associated with colds, flu and hay fever, thanks to its high menthol content. “It’s this year-round relevance that sets the brand apart,” says Ceuta Healthcare. Fisherman’s Friend Original Extra Strong remains the brand’s best-seller, driving 55 per cent of sales in the year to July 2026, making it a key line for pharmacies. “At an RRP of 99p each, Fisherman’s Friend standard 25g packs offer great value and a high number of individual lozenges in each pack, offering relief for longer,” says Ceuta Healthcare.
fishermansfriend.com
Management
RSV usually gets better on its own in one to two weeks without any specific treatment, but self-help measures can make the symptoms more bearable. Pharmacy teams can suggest taking paracetamol or ibuprofen to lower a fever (but not aspirin for the under-16s), and staying upright as much as possible while awake to make it easier to breathe. A blocked nose can be treated using salt water (saline) nasal sprays or solutions.
Sufferers should drink plenty of fluids (babies with RSV should have smaller feeds more often) and customers should be reminded not to try lower the patient’s body temperature by sponging with cool water or taking off clothes.
Sponging with cool water or stripping clothes is counterproductive: it causes rapid cooling of the skin, which the brain perceives as a threat and triggers shivering to raise the core body temperature even higher. It also constricts the blood vessels, trapping heat deep inside the body instead of letting it radiate out safely.
“A humidifier can ease congestion and coughing, as can elevating the patient’s head, particularly at night,” says Kenny. “Honey-based products can relieve throat discomfort, although these should only be used in children over one year. Saline nasal sprays can manage congestion.”
Asthma alert
Flu and other respiratory infections are common asthma triggers, so patients should take extra care to keep their asthma under control during the cold and flu season. This includes taking their usual asthma medicines as prescribed and following their action plan or self-management plan.
Patients should speak to their GP, asthma nurse or consultant if their asthma symptoms suddenly get worse – such as shortness of breath, coughing, wheezing and a tight chest – especially if their reliever medicine isn’t helping. People with asthma are more prone to developing chest infections after a cold, flu or Covid infection. Some cold and flu medicines (such as ibuprofen and aspirin) can trigger asthma symptoms in susceptible people, so it’s important to check product labels for these ingredients before recommending them to pharmacy customers.
“Flu and other respiratory infections are common asthma triggers”
Prevention
The RSV virus can survive on surfaces or objects for four to seven hours, so good hygiene is important to prevent passing it to other people. The incubation period is only around three to five days. Getting the RSV vaccine is the best way to protect children and vulnerable adults from catching the infection. It is available for free on the NHS for people who:
- Are over 75
- Live in a care home for older adults
- Are 28 or more weeks pregnant (to help protect babies in the first few months after birth)
- Are aged 65 to 74 with a weakened immune system or a long-term lung condition (excluding well-controlled asthma).
The RSV vaccination is given all year round, with only one dose needed to provide protection for several years. It can be given with other vaccines in pregnancy, such as whooping cough and flu, but isn’t usually given in the same appointment as flu vaccines in older people, unless advised by a doctor. It may be given at the same time as other vaccines for older people, such as Covid-19, shingles and pneumococcal jabs.
Encouraging vaccine uptake
Highlighting vaccination benefits can help to tackle hesitancy and misconceptions, and signposting patients to credible and reliable information resources can help to build trust. “Vaccination isn’t purely self-protective – it protects those around you,” says Kenny Chan, lead information pharmacist at Numark. “This framing can help those who are vaccine-hesitant to see the vaccination as meaningful for their loved ones, not just themselves.”
One of the more common worries is that vaccines may cause people to develop the illnesses themselves. “Providing clear explanation of the facts – that the vaccines are incapable of causing flu – may be all that’s needed to tackle this,” says Kenny. “Concerns about side effects should be addressed with honest and proportionate information that serious side effects from these vaccines are extremely rare. The vast majority of patients will experience mild local reactions such as a sore arm, which is vastly better than catching flu or RSV.”
Pharmacy teams should also address the specific question of whether annual vaccination is necessary. “For flu, the answer is unequivocally yes, as the influenza virus mutates year on year, and this year’s vaccine provides protection against current circulating strains,” says Kenny. “For RSV, a single dose in older adults provides protection for at least two seasons, so pharmacy teams should check vaccination records to confirm the patient hasn’t already received a dose.”
For more on vaccines, look out for our vaccinations feature in the November issue of Training Matters.
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