Written by Eamonn Brady, MPSI

Eamonn is the Supervising Pharmacist and Owner of Whelehan’s Pharmacy, Pearse Street and Clonmore, Mullingar

Overview

60 Second Summary

Coughs, colds and flu remain among the most common respiratory illnesses seen in Irish pharmacies, particularly during the autumn and winter seasons. While all are viral infections and cannot be cured by antibiotics, pharmacists play a crucial role in guiding patients on effective symptom relief, self-care, and prevention. Typical cold symptoms develop gradually and are usually confined to the head and sinuses, whereas influenza strikes suddenly, causing fever, muscle pain and extreme fatigue that can confine sufferers to bed for several days.

Pharmacy advice is essential in ensuring the safe use of over-the-counter medicines. Decongestants, antihistamines, painkillers and cough preparations must be selected carefully, especially for patients with conditions such as hypertension, asthma or gastric ulcers. In children, most coughs and colds are viral and self-limiting; the HPRA recommends avoiding cough and cold preparations in under-sixes, instead focusing on fluids, rest and saline nasal drops.

Influenza continues to pose serious risks for vulnerable groups including older adults, pregnant women, those with chronic illness and children. The 2025/26 flu vaccine, incorporating updated viral strains, remains the most effective protection and is free for at-risk groups under the HSE. Vaccination uptake in Ireland has increased steadily in recent years, helping to reduce flu-related hospitalisations and deaths.

With pharmacists positioned at the forefront of winter health services, patient education, vaccination and early intervention continue to be key strategies for minimising illness and maintaining community wellbeing.

Coughs, Cold and Flu

Cold or influenza (flu) are caused by viruses so have no cure, but the symptoms can be relieved by over-the-counter remedies. These symptoms include runny/blocked nose, sneezing/coughing, aches and pains, high temperature and sore throat. The flu comes on suddenly, whereas a cold develops over several hours.

Flu is a much more “hard hitting” illness than a cold and will usually leave the sufferer confined to bed for a few days. The symptoms of a cold, while unpleasant, usually allow the sufferer to continue his or her normal daily activities. Though with COVID-19 in our community, COVID-19 must be considered a possibility too. Symptoms of a cold are generally confined to the head, while a patient with the flu will feel sick all over. The treatment for both colds and flu is similar. Colds and flu symptoms generally last a maximum of seven days and need no specific treatment other than painkillers for aches, pains and temperature and simple measures such as decongestant rubs or vaporisers. Antibiotics are of no benefit as both colds and flu are caused by viruses.

Cold and Flu Treatment

The age of the patient will influence choice of products.

• Runny nose and congestion are both treated by decongestants.
• Sneezing is treated by an antihistamine.
• Cough may be due to irritation or to post-nasal drip. An expectorant mixture can help.
• Headaches are due to inflammation of the sinuses and nasal passages, and muscular or joint pain is common – this will need a painkiller.
• Sinus pain worsens on leaning forward or lying down and may develop into an infection.
• High temperature is more common in the flu than with a cold – paracetamol is very useful to bring down high temperature.
• Sore throat is usually the first sign of a cold, and one of the common OTC sore throat lozenges will help.

Precautions

Many cold and flu remedies contain several drugs, so anyone on prescription medication should speak to the pharmacist. Anyone who is pregnant, has heart disease or lung disease or very young or old should also be seen by the pharmacist.

So, for example, if someone suffers from hypertension it is best to avoid many cold and flu remedies which contain decongestants as these products tend to raise blood pressure.

Asthmatics and people with stomach complaints such as stomach ulcers should avoid products which contain aspirin and Non-Steroidal Anti-inflammatories (NSAIDs) like ibuprofen. This is because aspirin and NSAIDs can trigger asthma attacks in some asthmatics and irritate stomach ulcers. There are vast number of preparations available for the treatment of cold and flu symptoms, some of which are combination preparations and may be capable of treating many symptoms at once.

Cough

Essentially, there are two main types of cough – dry and chesty. During a cold, a cough is often triggered by nasal drip irritating the back of the throat. Chesty coughs occur when mucus, also called phlegm or catarrh, builds up in the airways; coughing helps the body clear this mucus. Chesty cough mixtures containing expectorants such as guaifenesin or carbocisteine help to loosen and thin the mucus, making it easier to expel. Some formulations also include sedative ingredients to support sleep when coughing is troublesome at night, and sugar-free options are available for people with diabetes.

Dry cough mixtures, on the other hand, often include soothing or cough-suppressant ingredients such as dextromethorphan or codeine derivatives and are available in both drowsy and non-drowsy forms.

In addition to these conventional preparations, some patients may prefer herbal or medical-device-based remedies that act by coating and soothing the throat and upper airways, providing relief from both dry and chesty coughs irrespective of cause. These products work through physical or demulcent mechanisms rather than pharmacological suppression and can be suitable for adults and children seeking a more natural approach.

When to see the doctor?

Patients should see their GP if they experience any of the following symptoms with cough as it can be a sign of more serious conditions such as COPD or cancer:

• Phlegm which is green, yellow, or rusty colour*
• Coughing up blood
• Cough lasting longer than two weeks
• Shortness of breath
• Chest pain on breathing or coughing
• Unexpected loss of weight
• Regular nighttime cough
• Harsh barking cough in children (croup)
• Whooping sound when breathing in after a fit of coughing (whooping cough)

*The meaning of different colours of phlegm: green phlegm means a bacterial infection; yellow phlegm means a viral infection; brown or reddish phlegm can mean the presence of blood and is a serious sign; clear phlegm means no infection.

Self Help for coughs

Stop smoking

If determined to continue smoking, at least stop for the duration of the cough. This gives the lungs an opportunity to try to clear the infection. When stopping smoking, coughing more for a few weeks is common as the lungs clear the tar that coated the lungs while smoking.

Steam inhalations

Steam inhalations can be useful, particularly in productive or chesty coughs. Simply putting hot steaming water, not boiling, in a basin, putting a towel over one’s head and inhaling the steam can accelerate the clearing of catarrh. The steam helps to liquefy lung secretions, and the warm, moist air is comforting. Adding a little eucalyptus to the steaming water is a favourite of some people.

Increase fluid intake

Maintaining a good fluid intake helps to hydrate the lungs. Hot drinks like hot lemon and honey provide a soothing and comforting effect.

Could the cough be due to blood pressure medication?

A type of blood pressure medication can cause a persistent dry cough in some people. The class of drug that causes this cough is ACE inhibitors. Examples include ramipril, perindopril and lisinopril. About 10 to 15% of people who use this class of blood pressure medication experience a dry cough. The incidence of cough appears to be higher in women. It is a persistent dry cough which is worse when lying down and generally does not start for 24 hours after starting an ACE inhibitor. If their dry cough occurs, the doctor will need to change to another drug, for example to an angiotensin II inhibitor. The cough will subside once the ACE inhibitor is stopped.

Coughs in children

Coughs are more common during school term and are caused by common viruses which are commonly passed from child to child in school. While rarely serious, coughs and colds are an inconvenience and lead to many missed school days. Some prevention tips help prevent coughs and colds. Examples include ensuring children wash their hands regularly and properly, especially after touching their nose or mouth and before handling food. Teach them to always sneeze and cough into tissues to prevent spreading infection. Sharing cups and utensils is a common way to spread colds and flu. Chesty coughs are especially common during school term. Antibiotics are rarely needed. Only 20% of chest infections are bacterial, so antibiotics are ineffective in most cases.

Guidelines for coughs and colds remedies for children

Guidelines introduced by the Health Products Regulatory Authority (HPRA) in 2011 restrict the sale of pharmacological cough and cold medicines, those containing ingredients such as cough suppressants, decongestants, or antihistamines, for children under six years of age.

This decision was not based on specific safety concerns, but on the recognition that most coughs and colds in young children are self-limiting and that there is limited evidence of benefit from these active medicines in this age group.

As a result, pharmacies should not recommend or sell traditional cough suppressants, decongestants, or antihistamines to children under six.

For these children, supportive measures remain first line – rest, plenty of fluids, and simple comfort strategies such as saline nasal drops or sprays, and paracetamol or ibuprofen liquids when required for fever or discomfort.

However, non-pharmacological cough remedies such as medical-device-based or demulcent preparations, indicated from one year of age, may also be considered.

These products act by coating and soothing the throat and upper airways, helping to reduce irritation and ease coughing without relying on systemic drug action.

They can provide gentle symptomatic relief where appropriate parental reassurance and advice are also given.

For children aged six years and over, a range of over-the-counter (OTC) options are available, but no single product has proven superior. Pharmacists should always check age-appropriate doses and advise parents that most coughs and colds resolve within one to two weeks without antibiotics, since over 80% are viral in origin.

Prevention

As so many different viruses can cause the common cold, there is no vaccination against it. Some prevention tips are:

• Wash hands regularly and properly, most importantly after touching nose or mouth and before handling food.
• Always sneeze and cough into tissues to prevent spreading infection.
• Do not share cups or kitchen utensils with others. Use own cup, plates and cutlery.

Influenza (Flu)

Influenza (flu) is a highly infectious acute respiratory illness caused by the influenza virus. It can affect people of any age. The seasonal flu vaccine, or flu jab, protects against a number of strains of flu virus.

According to the World Health Organisation (WHO) recommendations for the 2025/26 Northern Hemisphere influenza season, the following strains are included in the vaccines distributed in Ireland and across Europe. These updates aim to provide optimal protection against the influenza viruses expected to circulate during the 2025/26 flu season.

The recommended strains for the 2025/26 vaccine are

• A/Victoria/4897/2022 (H1N1) pdm09-like virus for egg-based vaccines.
• A/Wisconsin/67/2022 (H1N1) pdm09-like virus for cell culture- or recombinant-based vaccines.
• A/Croatia/10136RV/2023 (H3N2) like virus for egg-based vaccines.
• A/District of Columbia/27/2023 (H3N2) like virus for cell culture- or recombinant-based vaccines.
• B/Austria/1359417/2021 (B/Victoria lineage) like virus for both vaccine types.
• B/Phuket/3073/2013 (B/Yamagata lineage) like virus – included only in quadrivalent vaccines, though many programmes now use trivalent formulations due to low B/Yamagata circulation.

Source: World Health Organisation (WHO). Recommended composition of influenza virus vaccines for use in the 2025-2026 Northern Hemisphere influenza season, published February 2025. These recommendations are adopted by the European Medicines Agency (EMA) and the Health Service Executive (HSE) in Ireland.

Flu vaccination is available through GP surgeries, local pharmacies and some workplaces.

Symptoms of Flu

Symptoms of flu include sudden fever, chills, headache, muscle pain, sore throat, non-productive dry cough, exhaustion, and weakness. Flu characteristically causes a temperature of 38 to 40°C that lasts three to four days.

Table 1 – Differences between common cold, influenza and COVID-19

Side-by-side comparison of the three most common viral respiratory illnesses seen in community pharmacy settings. It highlights how onset, symptoms, and duration differ among the common cold, influenza, and COVID-19.

Difference between cold and flu?

A cold will develop slowly over a few days with symptoms like a sore throat and a blocked or runny nose. The symptoms of flu hit suddenly and severely with symptoms like fever and muscle aches. Flu hits like a brick. Often people suffering from a bad cold wrongly believe they have flu. Flu causes extreme exhaustion, muscle aches, severe sweats and leaves the person so weak they will not be able to get out of bed. Work and other normal routines are not possible with flu.

Complications of flu

Most people recover from flu in 2-7 days, but in some it can last for up to two or three weeks. Flu can be severe and can cause serious illness and death, especially in the very young and in the elderly. Serious respiratory complications can develop, including pneumonia and bronchitis. Older people and those with certain chronic medical conditions are at particular risk of these complications. Pregnant women and women up to six weeks after giving birth have also been found to be at increased risk of the complications of flu. Up to 90% of reported deaths from influenza occur in the elderly, mainly from bacterial pneumonia, but also from the underlying disease.

Those considered more “at-risk” from flu:

Some people are more at risk of getting complications if they catch flu. People can get the HSE flu vaccine for free if:

• 60 years of age and over
• a healthcare worker
• pregnant at any stage of pregnancy
• children aged 2 to 17 years
• adult or child aged 6 months or older at increased risk for flu-related complications including those with long-term conditions such as chronic heart disease including acute coronary syndrome, chronic liver disease, chronic renal failure, chronic respiratory disease including COPD, cystic fibrosis, moderate or severe asthma, and bronchopulmonary dysplasia, chronic neurological disease including multiple sclerosis, hereditary and degenerative disorders of the central nervous system, diabetes mellitus and other metabolic disorders including inherited metabolic disorders, and haemoglobinopathies
• body mass index (BMI) ≥ 40 kg/m2, morbid obesity
• immunosuppression due to disease or treatment including treatment for cancer
• children with moderate to severe neurodevelopmental disorders such as cerebral palsy
• children on long-term aspirin therapy
• those with any condition that can compromise respiratory function, for example spinal cord injury, seizure disorder or other neuromuscular disorder, especially those attending special schools or day centres
• children or adults with Down syndrome
• people who live in a nursing home or other long-term care facility
• people in regular contact with pigs, poultry or waterfowl

Table 2 – Impact of flu vaccination in Ireland (2019-2025)

How influenza vaccination rates in Ireland have improved since 2019, alongside reductions in flu-related hospitalisations and deaths. It also highlights the growing impact of public health initiatives such as pharmacy vaccination programmes and nasal spray use in children.

Household contacts and eligibility

Not all household contacts are eligible for the free flu vaccine. The National Immunisation Advisory Committee (NIAC) recommends the flu vaccine only for household contacts of people with certain long-term medical conditions or of people with Down syndrome.

The following household contacts are not recommended for the free flu vaccine through the HSE programme unless they are in a risk group themselves:

• Household contacts of people aged 60 years and over
• Household contacts of pregnant women
• Household contacts of children aged 2 to 17 years
• Household contacts of healthcare workers
• Household contacts of carers

If a household contact is not in a recommended risk group themselves, they cannot avail of the free flu vaccine via the HSE programme and would need to source the flu vaccine privately if they choose to get vaccinated. The flu vaccine is not free for medical card or doctor visit card holders unless they are part of the at-risk groups above.

Flu vaccines available for the 2025/26 season

This season, there are two different types of flu vaccine being offered to different groups:

• Live Attenuated Influenza Vaccine (LAIV) – nasal spray for children aged 2 to 17 years.
• Inactivated Influenza Vaccine (IIV) – injectable vaccine for all other eligible groups, including children aged 2 to 17 with contraindications to LAIV.

Brands available

• Fluenz (live attenuated nasal spray) – AstraZeneca Pharmaceuticals (Ireland) DAC
• Influvac Tetra – Viatris
• Vaxigrip Tetra – Sanofi Pasteur

Pharmacies must buy vaccines privately for those who pay. The earlier a patient gets vaccinated, the better, as it takes about two weeks to achieve full protection.

Flu vaccine side effects

There may be a mild fever and aching muscles for a couple of days after having the vaccine. The arm where the vaccine was given may also be a bit sore. Serious side-effects of the flu vaccine are very rare.

For children receiving the nasal spray

• The vaccine is given as a spray in each nostril – not by injection.
• Most children need only one dose each year.
• Some children with chronic heart or lung conditions may need two doses, four weeks apart, if they have never had a flu vaccine before.
• Common side effects such as runny or blocked nose, headache, muscle aches and mild fever can be treated with paracetamol or ibuprofen.
• Aspirin or any medicine containing aspirin should never be given to children unless prescribed by a doctor due to the risk of Reye syndrome.
• There is no risk of catching flu from the nasal spray – the virus is too weak to cause infection.

Flu vaccine and COVID-19 booster

The flu vaccine and the COVID-19 booster are separate vaccines. Both can be administered at the same time if eligible for a COVID-19 booster dose.

Flu vaccine for children

Children are more likely than adults to get severe complications of flu. Children who are sick with flu miss days in crèche, childcare and school. They also miss out on their usual activities such as hobbies and sports. Children aged 2 to 17 can now get the nasal flu vaccine for free. The flu vaccine will help protect a child against flu and reduce the spread of flu to others. For example, their brothers, sisters, parents, and grandparents.

The vaccine is given as a single spray in each nostril of the child’s nose. The child can breathe normally while getting the vaccine. There is no need to take a deep breath or sniff. The vaccine is not painful and is absorbed quickly. It will work even if the child has a runny nose, sneezes, or blows their nose after the vaccination. Most children need only one dose of the vaccine each year. Some children with chronic health conditions like chronic heart or lung conditions may need two doses. The doses are given four weeks apart for these high-risk children if they never had a flu vaccine before.

Side effects of the nasal flu vaccine

The most common side effects are mild and include:

• a runny or blocked nose
• headache
• muscle aches

Some children get a fever after the vaccine. It is usually mild and goes away on its own. If the child has a fever or a headache, paracetamol or ibuprofen can help. Aspirin, or any medicines that contain aspirin, should never be given to children unless prescribed by a doctor due to the risk of Reye syndrome. This is especially important in the four weeks after getting the flu vaccine. Serious side effects such as severe allergic reaction are rare. There is no evidence of catching flu from the nasal flu spray.

References available on request