Patients with chronic refractory cough (CRC) may benefit from behavioral cough suppression therapy (BCST). In a session of the 2021 American Cough Conference, Laurie Slovarp, PhD, CCC-SLP, associate professor at the University of Montana in Missoula, said increased awareness of BCST is needed for clinicians and patients to know it as a noninvasive, efficacious, and inexpensive form of cough treatment, as well as to understand how this therapy works and how to identify eligible candidates.

According to Slovarp, BCST is known by various names, including speech pathology treatment for chronic cough, respiratory retraining, and cough-suppression physiotherapy.

“Just about every single paper refers to it by a different name,” she said. “If you see ‘speech pathology’ and ‘cough’ together, you can bet that we’re probably talking about the same therapy.”

Prior to using BCST, patients will often see multiple care providers, undergo multiple tests, and try multiple medications, she said.

However, up to 88% of patients with CRC using BCST have shown a reduction in cough severity through published studies. These reductions occurred in cough frequency and sensitivity, while also increasing quality of life for patients.

“These are all patients that have already failed just about every other medical treatment available to them,” Slovarp said.

A survey study published by Slovarp in 2021 investigated the post-BCST satisfaction of 164 patients in the United States and Australia. It found that 58% of patients reported being “quite satisfied” or “completely satisfied” following therapy. The mean change of 6.6 from the Leicester Cough Questionnaire was significant, according to Slovarp.

“There’s pretty reasonable efficacy data on BCST,” she said. “These patients are not just getting better a little bit, many of them have a pretty dramatic improvement.”

According to Slovarp, onset of CRC often occurs with a cough-inducing event, such as a respiratory virus. CRC may present itself in various ways, from a once-a-week coughing fit to a cough that induces gagging or vomiting.

“In my clinic, I see a wide variety of severity,” she said.

BCST is often determined with extensive case history, oral mechanism exam that may find muscle tension or tenderness in the neck, shoulders and suprahyoid, voice evaluation, urge-to-cough testing, and validated patient-report questionnaire.

“The biggest thing for me is the case history,” she said. “Most of the patients we see have been coughing for years.”

Treatment options may be educating patients about coughing including the safety of cough suppression, training patients to suppress coughing; increasing awareness of cough triggers and a pending cough; management of laryngopharyngeal reflux and postnasal drip, voice therapy, and, if needed, a challenge.

Cough-control breathing, relaxation, and swallowing techniques, as well as distractions, and resonant voicing are some of the methods employed in BCST.

“Over time, with suppression, you will feel a reduction in urge to cough,” she said.

Slovarp L. Issues in clinical cough management: Behavioral management of chronic refractory cough. Presented at: American Cough Conference; virtual. June 11, 2021. 

https://app.socio.events/NzMwMw/Agenda/85150/Session/385292

Articles

Noninvasive, efficacious treatment options are available to help patient outcomes and improve quality of life.  

Using Behavioral Management to Control Chronic Refractory Cough

Officials with the FDA have approved azelastine hydrochloride 0.15% (Astepro Allergy; Bayer) as an OTC product for the temporary relief of nasal congestion, runny nose, sneezing, and itchy nose associated with upper respiratory allergies such as hay fever. According to Bayer, the approval is the FDA’s first for a steroid-free, antihistamine nasal spray for allergies available OTC in the United States.

More than 50 million Americans are affected by allergies each year, according to Bayer. Azelastine hydrochloride 0.15% is indicated for adults and children 6 years of age and older. 

According to Catherine Vennat, vice president and general manager, GM Bayer Consumer Health US, azelastine HCI 0.15% addresses an unmet need for patients with allergic rhinitis. The approved OTC formulation is full prescription strength and can provide relief from allergy nasal symptoms that will last up to 24 hours.

Azelastine is currently only available with a prescription in the United States. According to Bayer, azelastine hydrochloride 0.15% is expected to become available in retail locations in early 2022.

Currently, OTC allergy medications includes 3 major classes: antihistamines, intranasal steroids, and mast cell stabilizers. Azelastine hydrochloride 0.15% will be the only OTC antihistamine nasal spray for indoor and outdoor allergy relief.

FDA Approves Astepro Allergy Nasal Spray for Over-the-Counter Use in the United States [news release]. June 17, 2021; Bayer. Accessed June 17, 2021. 

https://www.businesswire.com/news/home/20210617005872/en/FDA-Approves-Astepro%C2%AE-Allergy-Nasal-Spray-for-Over-the-Counter-Use-in-the-United-States

Astepro Allergy is the first steroid-free antihistamine of its kind to be available without a prescription.

New OTC Nasal Spray for Allergy Relief Granted FDA Approval

The pandemic has changed life as we knew it, but COVID-19 vaccines are changing lives again, this time for the better.

Grandparents are once again able to hug their grandchildren, but those same grandchildren are still at risk for COVID-19 until we can get all of them who are medically able vaccinated. At press time, children accounted for the largest number of new cases of COVID-19, because most are still not vaccinated (AAP, 2021, April).1 Hospitalization rates for children with COVID-19 have also risen, and serious cases are being seen (AAP, 2021, June).2 From March 1, 2020, through April 30, 2021, approximately 1.5 million COVID-19 cases in individuals aged 11 to 17 years had been reported to the CDC (USFDA, 2021, May 10).3

Most children will return to classrooms for school in the fall, if they have not done so already (Parents, 2021, March).4 Although handwashing, masks, and social distancing are essential public health measures and have slowed the pandemic, the best and most long-lasting way to protect children is to vaccinate them. The number of COVID-19 cases among individuals aged 50 years and older has dropped dramatically. A large segment of this population is fully vaccinated (CDC, 2021, June 13).5 There is also a serious public health threat from other vaccine-preventable diseases, such as measles and pertussis, as the rates of routine immunizations took a precipitous drop during the pandemic (Santoli, et al. 2020).6 The CDC is recommending that children receive all regularly scheduled vaccines, along with the COVID-19 vaccine (CDC, 2021 April 6).7

The Pfizer-BioNTech COVID-19 vaccine, which is an mRNA vaccine, recently received FDA approval for adolescents aged 12 through 15 years (USFDA, 2021, May 10).3 This vaccine is administered intramuscularly as a series of 2 doses (0.3 mL each) 3 weeks apart. The most common adverse effects are chills, fever, headache, joint and muscle pain, pain and redness at the injection site, and tiredness. Aside from pain at the injection site, more adolescents reported these adverse effects after the second dose than after the first dose, so it is important to advise adolescents and parents to expect that there may be some adverse effects after either dose but even more so after the second. The adverse effects in adolescents were consistent with those reported in clinical trial participants aged 16 years and older (USFDA, 2021, May 10).3

Pfizer also said that it plans to request authorization for BioNTech COVID vaccine use in children aged 2 through 11 years in September 2021 and for children younger than aged 2 years later in 2021 (Jenco, 2021, May 6).8

Recently, there have been reports of myocarditis and pericarditis following mRNA vaccines. These events occurred mostly in male adolescents and young adults aged 16 years and older. Myocarditis and pericarditis are seen more often after getting the second dose of either Moderna or Pfizer COVID-19 vaccines than after the first dose. The symptoms typically occur within 4 days after COVID-19 vaccination. As of press time, there have been 275 cases of either myocarditis or pericarditis of more than 600,000 doses administered to adolescents and children in the United States since Pfizer received its emergency use authorization on May 10, 2021 (CDC, 2021, May 18).9 Most patients who received care responded well to rest and treatment and quickly recovered. Patients can usually return to normal daily activities after their symptoms improve, and they should speak with health care providers about returning to exercise or sports. The CDC continues to monitor the situation and recommends COVID-19 vaccinations for everyone aged 12 years and older, given the greater risk of COVID-19 illness and related, possibly severe complications (CDC, 2021, May 27).10 Getting vaccinated is the best way to help protect individuals aged 12 years and older from COVID-19 illness and potential complications.

Another COVID-19 vaccine for adolescents is also moving toward approval. Moderna reported that its COVID-19 vaccine is 96% effective for adolescents aged 12 through 17 years after at least 1 dose and has no serious safety concerns (Jenco, 2021, May 6).8 The report did not provide additional details on a projected timeline for requesting FDA approval. Moderna is also continuing to study its vaccine in children aged 6 months to 11 years (Jenco, 2021, May 6).8

COVID-19 vaccines are becoming a reality for children. With the vaccines comes the return to birthday parties, in-classroom school, play dates, and sleepovers. But the COVID vaccine is not the only one children need. Routine vaccination is an essential preventive care service for adolescents, children, and adults, including pregnant women, that should not be delayed because of the COVID-19 pandemic. Parents have not been bringing their children into the offices of health care providers for well-child visits and vaccines. It is essential to assess the vaccination status of all adolescents and children at each patient visit to avoid missed opportunities for vaccination and ensure timely vaccine catch-up. All vaccines due or overdue should be administered according to the recommended CDC immunization schedules during each visit unless there is a specific contraindication. This will provide protection as soon as possible and minimize the number of health care visits needed to complete vaccination. Health care providers should identify children who have missed recommended vaccinations and/or well-child visits. Contact parents to schedule in-person appointments, starting with newborns, infants, and children up to aged 2 years, young children, and extending through adolescence. COVID-19 is still circulating, and cases among children can often be asymptomatic. Consequently, the importance of evidence-based infection prevention practices cannot be overemphasized for all patient encounters. These measures include hand and respiratory hygiene, physical distancing, source control, and surface decontamination (CDC, 2021, April 6).7

Because vaccine administration has decreased during the COVID-19 pandemic, under vaccinated or unvaccinated children are susceptible to preventable illness, such as measles, and communities are at risk for outbreaks. Strategies should be implemented to promote vaccination schedule adherence and ensure catch-up vaccination. Reminder and recall systems should be implemented to identify children who are due for or who have missed vaccine doses. Electronic health records and immunization information systems can be essential to tracking delinquent vaccine doses. In addition, the vaccination status of all children should be assessed at every health care visit to reduce missed opportunities for vaccination, including COVID-19 vaccination, and standing orders should be implemented (CDC, 2021, April 6).7

Health care providers who care for children must ensure that children receive not just COVID-19 vaccines but all age-appropriate vaccines that are due and catch up on any missed doses. It would be a travesty if children headed back to school without the vaccine-induced protection they need to stay healthy. Without all Advisory Committee on Immunization Practices (ACIP)-indicated vaccines, children could be headed back to school and out of the COVID-19 pandemic into a measles or pertussis epidemic.

1. Children and COVID-19: state data report. American Academy of Pediatrics. April 29, 2021. Accessed June 17, 2021. 

https://downloads.aap.org/AAP/PDF/AAP%20and%20CHA%20-%20Children%20and%20COVID-19%20State%20Data%20Report%204.29.21%20FINAL.pdf

2. Children and COVID-19: state data report. American Academy of Pediatrics. June 3, 2021. Accessed June 17, 2021. 

https://downloads.aap.org/AAP/PDF/AAP%20and%20CHA%20-%20Children%20and%20COVID-19%20State%20Data%20Report%206.3.21%20FINAL.pdf

3. United Stated Food and Drug Administration. (2021, May 10). Coronavirus (COVID-19) Update: FDA Authorizes Pfizer-BioNTech COVID-19 Vaccine for Emergency Use in Adolescents in Another Important Action in Fight Against Pandemic. Retrieved from 

https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-authorizes-pfizer-biontech-covid-19-vaccine-emergency-use

4. Harris N. Will kids go back to school in the fall? Here’s what experts think and what it may look like. 

https://www.parents.com/kids/education/back-to-school/will-kids-go-back-to-school-in-the-fall-heres-what-experts-think-and-what-it-may-look-like/

5. Demographic characteristics of people receiving COVID-19 vaccinations in the United States. CDC. June 16, 2021. Accessed June 17, 2021. 

https://covid.cdc.gov/covid-data-tracker/#vaccination-demographic

6. Santoli JM, Lindley MC, DeSilva MB, et al. Effects of the COVID-19 pandemic on routine pediatric vaccine ordering and administration — United States, 2020. 

 2020;69(19):591-593. doi:10.15585/mmwr.mm6919e2

7. Interim guidance for routine and influenza immunization services during the COVID-19 pandemic. CDC. April 6, 2021. Accessed June 17, 2021. 

https://www.cdc.gov/vaccines/pandemic-guidance/index.html

8. Jenco M. Moderna reports COVID-19 vaccine for teens safe, effective. 

https://www.aappublications.org/news/2021/05/06/moderna-covid-vaccine-teens-050621

9. Mendez R. CDC says 600,000 kids ages 12 to 15 have received Covid vaccine shots in last week. CDC. May 18, 2021. Accessed June 17, 2021. 

https://www.cnbc.com/2021/05/18/cdc-says-600000-kids-aged-12-to-15-have-received-covid-shots-in-last-week-.html

10. Myocarditis and pericarditis following mRNA COVID-19 vaccination. CDC. May 27, 2021. Accessed June 17, 2021. 

https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/myocarditis.html

Practitioners can help ensure that kids get these and all age-appropriate vaccinations before school starts in the fall.

COVID Vaccines for Children Are Becoming a Reality

The launch of the Center for Sexual and Gender Minority Health Research (CSGMHR) has been announced by Columbia University School of Nursing.

The program plans to use innovative methods to study “health among sexual and gender minority (SGM) populations across the lifespan with an emphasis on resilience.” Further, the program will support nursing and interdisciplinary scholarly work focused on social justice and health equity with the objective to eliminate SGM-related health disparities, according to a press release from Columbia.

“While recognition of LGBTQ people’s unique needs is growing, we lack solid evidence on how marginalization, stigma, and discrimination impact health,” said CSGMHR executive director Tonda Hughes, PhD, in the press release. “The center will support rigorous interdisciplinary research on the social, political, and economic determinants of health for SGM populations, which will in turn inform practice and form a knowledge base for interventions to address health disparities.”

Previous research shows that SGM individuals experience worse physical and mental health than their heterosexual peers and face an increased risk of cardiovascular disease, certain cancers, substance abuse disorders, depression, and suicidal behavior. Prior surveys, such as the 2015 US Transgender Survey, have found that many LGBTQ individuals feel discriminated by clinicians, with this survey finding 1 in 4 people reporting not seeking necessary medical care due to this fear.

“Dr. Hughes and her colleagues are conducting ground-breaking research that will further Columbia Nursing’s commitment to health equity and social justice,” said Lorraine Frazier, PhD, the dean of Columbia University School of Nursing and the senior vice president of Columbia University Irving Medical Center, in the press release. “Under her leadership, the center will train the next generation of researchers in this vital field and educate experienced investigators on the importance of SGM status for health.”

Columbia Nursing launches center for sexual and gender minority health research. Columbia School of Nursing. Published June 15, 2021. Accessed June 16, 2021. 

https://www.nursing.columbia.edu/news/columbia-nursing-launches-center-sexual-and-gender-minority-health-research

The program plans to use innovative methods to study “health among sexual and gender minority (SGM) populations across the lifespan with an emphasis on resilience.” 

New Center for Sexual and Gender Minority Health Research Focused on LGBTQ Community Needs

interviewed Carrie Cuttler, PhD, an assistant professor in the Department of Psychology at Washington State University, on a recent study she co-authored that was published in the 

 on the use of cannabis in treating symptoms of obsessive-compulsive disorder (OCD).

 You mentioned that there may be value in investigating the treatment of compulsions, intrusions, and anxiety with pure CBD. Specifically, why might pure CBD be beneficial, and how would you define pure?

For example, there are isolate, broad spectrum, and full spectrum as common terms used for CBD products sold on the market today. Would any of these terms apply or perhaps not?

 The finding that higher levels of CBD were associated with larger symptom reduction led me to suggest that future investigations should really examine whether pure CBD effectively reduces compulsions, and by that I just meant CBD, either with no THC or with very low THC.

Really, I think all 3 products would be very interesting to investigate. The idea is really just that the intoxicating effects of cannabis, the most detrimental effects of cannabis, and the negative side effects of cannabis are really more associated to THC, so reducing or eliminating THC may be more desirable.

The other thing I wanted to mention in response to your last question was just that we really didn't have enough data on CBG, CBN, or any of the minor phytocannabinoids or terpenes to explore their potential effects, but future research should definitely do so.

Videos

Carrie Cuttler, PhD, an assistant professor in the Department of Psychology at Washington State University, discusses recent findings that pure CBD may help to reduce the symptoms of OCD for patients.

Research Finds Potential Benefit of Pure CBD for the Management of OCD Symptoms

The first step to address mild to moderately elevated blood pressure and cholesterol in otherwise healthy adults should be advising them to sit less and move more, according to a new scientific statement published in 

An estimated 21% of adults in the United States have systolic blood pressure between 120- and 139-mm Hg, or diastolic blood pressure between 80- and 89-mm Hg, according to the American Heart Association (AHA). Both of these values are abnormally high and meet the American College of Cardiology (ACC)/AHA High Blood Pressure Guideline criteria for lifestyle-only treatment for elevated blood pressure.

Similarly, the scientific statement authors estimated that 28% of adults in the United States have an LDL cholesterol score above 70 mg/dL and otherwise meet criteria for low risk of heart disease or stroke. This patient population would meet the 2018 ACC/AHA Cholesterol Treatment Guidelines criteria for lifestyle-only treatment, which includes increased physical activity, weight loss, improving diet, smoking cessation, and moderating alcohol intake.

“The current American Heart Association guidelines for diagnosing high blood pressure and cholesterol recognize that otherwise healthy individuals with mildly or moderately elevated levels of these cardiovascular risk factors should actively attempt to reduce these risks,” said Bethany Barone Gibbs, PhD, FAHA, chair of the statement writing group, in a press release. “The first treatment strategy for many of these patients should be healthy lifestyle changes beginning with increasing physical activity.”

Increasing physical activity has been shown to result in clinically meaningful reductions in both systolic and diastolic blood pressure, typically with an average reduction of 3- or 4-mm Hg. Similar improvements have been seen with blood cholesterol, according to the press release. The statement emphasized research demonstrating that physically active people have a 21% lower risk of developing cardiovascular disease and a 36% lower risk of death from cardiovascular diseases compared to those who are not physically active.

According to the AHA, a “prescription” for increased exercise includes several steps. Health care providers should screen patients about their physical activity at every interaction, whether by asking a few questions or by having patients use a wearable device. Health professionals should also provide ideas and resources for supporting patients to improve and sustain regular physical activity.

Importantly, providers should help patients find activities that they enjoy and should provide ideas for early success in order to optimize the patient’s chances of implementing a life-long change. Similarly, encouraging and celebrating small improvements and increases in physical activity, such as walking more or taking the stairs, can keep patients motivated.

“Even small initial increases of 5 to 10 minutes a day can yield health benefits,” Gibbs said in the press release.

To improve overall health, the US Department of Health and Human Services 2018 Physical Activity Guidelines for Americans recommend that individuals participate in either a cumulative 150 minutes of moderate intensity aerobic exercise or 75 minutes of vigorous aerobic activity weekly, in addition to 2 or more strength training sessions each week.

“In our world where physical activity is increasingly engineered out of our lives and the overwhelming default is to sit—and even more so now as the nation and the world is practicing quarantine and isolation to reduce the spread of coronavirus—the message that we must be relentless in our pursuit to ‘sit less and move more’ throughout the day is more important than ever,” Gibbs concluded.

“Prescription” to sit less, move more advised for mildly high blood pressure & cholesterol [news release]. American Heart Association; June 2, 2021. 

https://newsroom.heart.org/news/prescription-to-sit-less-move-more-advised-for-mildly-high-blood-pressure-cholesterol?preview=9fe0

Health care professionals can help patients improve mild to moderate hypertension and elevated cholesterol by encouraging them to find activities they enjoy and celebrating small improvements.

Improving Blood Pressure, Cholesterol With Increased Physical Activity

The COVID-19 pandemic negatively impacted the pediatric-focused advanced practice registered nursing (APRN) workforce, which could create long-term barriers to pediatric care, according to a study conducted by the National Association of Pediatric Nurse Practitioners (NAPNAP). The study, published in the 

, surveyed almost 900 pediatric-focused APRNs.

According to the investigators, more than one-third of respondents reported moderate or extreme concern for feeling professionally burned out, while one-quarter reported anxiety. Seventy-three percent of respondents reported increased presentations of child mental or behavioral health concerns throughout the pandemic.

“This problem is, of course, multifactorial, with isolation, loss of safety net services, family stressors and trauma, and deferred care and services all compounding this issue across communities worldwide,” said Jennifer Sonney, PhD, APRN, PPCNP-BC, FAANP, NAPNAP secretary, in a press release.

The investigators said that the rapidly evolving policy changes and the constant struggle to respond to disinformation is likely to be responsible for the professional burnout.

“The sustained professional and personal impacts of the pandemic are placing pediatric APRNs at high risk for moral distress and burnout,” said NAPNAP President Jessica Peck, DNP, APRN, CPNP-PC, CNE, CNL, FAANP, FAAN, in the press release. “In addition to practicing clinicians feeling anxious or burned out, 70% of educator respondents in the study reported moderate or extreme concern with clinical training site availability, delaying the pipeline of new pediatric nurse practitioner graduates from entering the workforce to increase patient access to care.”

NAPNAP stated that they were committed to supporting a high-quality, accessible, and affordable care continuum for pediatric patients while protecting and supporting the pediatric workforce pipeline. According to the organization, NAPNAP has commenced efforts to direct resources and advocacy tools to best support the critical needs of the pediatric-focused APRN workforce.

COVID-19 Study Reveals Significant Risk for Pediatric-focused APRN Workforce [news release]. NAPNAP; June 8, 2021. Accessed June 9, 2021. 

https://www.napnap.org/covid-19-study-reveals-significant-risk-for-pediatric-focused-aprn-workforce/

According to the investigators, more than one-third of respondents reported moderate or extreme concern for feeling professionally burned out, while one-quarter reported anxiety. 

Study: Pediatric-Focused APRN Workforce Experienced Increased Burnout, Anxiety During COVID-19 Pandemic

Starting that fateful week in March 2020 when everyone’s life changed, health care settings closed their doors en masse.

From primary care to ambulatory surgery, physical therapy to massage therapy, nearly every setting of care suspended operations, except for emergency departments connected to hospitals and pharmacies. Yes, pharmacies. More than 60,000 remained open to patients, and most pharmacists continued their role as a source for OTC products and the free-of-charge counseling that often goes with them.

Telemedicine grew at an unprecedented rate starting in April 2020, but it did not entirely fill the health care void. Individuals needing acute medications, dose adjustments, or treatment for chronic diseases lost direct access to practitioners, but pharmacies remaining open meant patients could still receive their lifesaving medications. Of course, foot traffic slowed, and the flu was practically nonexistent in 2020, but hundreds of millions of Americans had access to basic triage, care delivery, medications, and testing supplies.

More than 80% of adults use OTC products as first-line treatment for common ailments. With Americans making approximately 3 billion trips to purchase OTC products annually and 60 million Americans using them who would otherwise not seek treatment, patient access to these products is essential to a well-functioning health care system. It is inconceivable these days to schedule an office visit, procure a prescription, and have it adjudicated by insurance just to get ibuprofen for an ankle sprain. A prescription for loratadine? Laughable. Yet less than 2 decades ago, nonsedating antihistamines were deemed too unsafe to be sold over the counter.

Making products available without a prescription does not have to mean patients go without care. Pharmacists and other health care professionals can counsel patients on all types of accessible and affordable OTC products. Does an Apple Watch’s electrocardiograph or pulse oximetry app keep patients from seeing their cardiologists? Do pregnancy tests keep women from visiting their gynecologists? Do wetting drops prevent patients from going to their ophthalmologists?

Do niacin or omega oils keep patients from getting their cholesterol checked? The answer to all these questions is no. Pharmacists have multiple encounters with patients every day, and most are just as meaningful to a patient’s care as billable encounters.

Expanding Access Through OTCs and Testing

COVID-19 self-administered testing is approved and available. Health plans have picked up on the power of patient convenience. Waning resistance against self-empowerment, which the pandemic necessitated, has enlisted a host of home-based diagnostics providing accessible and affordable screening and rescreening directly to health plan members—without a prescription. Need to improve A1c testing and reporting? Why not look to pharmacies or even send the tests directly to patients’ residences?

Postpandemic Self-Care and OTC Product Use

We are only a summer away from what will likely be the first widely prevalent cough and cold season of asthma flare ups, influenza, middle-ear infections, and rhinovirus in nearly 2 years. As social distancing and masking disappear, we will again share microbes. Disease surveillance and patient care will still have a prime spot in the consciousness of the frontline pharmacist’s mind in all seasons. Education, triage, testing, and counseling have a greater meaning and purpose than ever before, and much of this purpose is enabled by access to OTC products.

Click here to view the OTC products that pharmacists recommend the most to their patients

is vice president of pharmacy provider partnerships for Community Care of North Carolina, which works collaboratively with more than 2000 medical practices to serve more than 1.6 million Medicaid, Medicare, commercially insured, and uninsured patients. He received his PharmD and MBA degrees from Drake University and a PhD in pharmaceutical outcomes and policy from the University of North Carolina. He also serves on the board of directors of the American Pharmacists Association Foundation and the Pharmacy Quality Alliance.

OTC use statistics. Consumer Healthcare Products Association. Accessed May 24, 2021. https://www.chpa.org/about-consumer-healthcare/research-data/otc-use-statistics.

COVID-19 permanently changed how pharmacists recommend and sell nonprescription options.

OTC Products Are Accessible When Traditional Health Care Delivery Is Not

interviewed Bethany Hall, the owner of Healing Connection, on the role nurse practitioners have in understanding and approaching care for children with complex developmental trauma (CDT).

In this discussion, Hall explains why training on the recognition of symptoms of CDT in children can be essential in supporting their identification by nurse practitioners in order to best approach care for that child.

Without this training, would nurse practitioners be able to recognize the symptoms of CDT in children?

So, I can speak for myself as a nurse practitioner—I didn't know anything about it.

So, there were often times where I had this little feeling in my chest when we'd interact with the child that had come in and had a suicide attempt like I just feel like the way we're doing this isn't the best.

This child is being shut down, clearly doesn't feel safe in this environment. We bring them in the emergency department, and we strip them down for safety reasons. They're put in basically just a nightgown, so if you can imagine a child that's experienced sexual trauma, then being asked to completely disrobe in a very cold sterile environment with a security guard standing outside the door.

I just remember feeling like this just feels really wrong to me and I don't know how to do things differently or why this isn't right, but I just feel like it's not right.

So, I think probably any nurse practitioner that's encountered a child that has gone through severe neglect, abuse, childhood dysfunction in their home, there may be something that goes this just doesn't feel right. I feel like heavily medicating this 5-year-old until they can't even really cry when they're hurt kind of a thing feels unnatural to us.

I think as nurses we're often very perceptive to that, and you may feel that there should be more we're doing. I can say, in my experience, 100% I did not receive any education in this, and I wouldn't have had the tools to diagnose this, to recognize it, and much more.

I would definitely not have had the tools necessary to be a part of the solution. So, I think it's really important that, as the CDC just came out with a report on Adverse Childhood Experiences scores, and I think as there's this increasing awareness in the mental health and psychology counterparts that we really need to jump on that train and understand what we can. How can I educate myself, how can I get the tools necessary to be a part of the solution, not only to recognize the problem but to do something about it.

Bethany Hall, MSN, the owner of Healing Connection, discusses the importance of training nurse practitioners on how to identify signs and symptoms of complex developmental trauma in pediatric populations.

Training Nurse Practitioners on Symptoms of Complex Developmental Trauma in Children is Critical as a Part of the Solution

Daily use of probiotics was associated with reduced upper respiratory symptoms in overweight and older people, in a recent study, suggesting that probiotics could help to prevent respiratory infections. Results of the study were presented at Digestive Disease Week 2021.

"This is not necessarily the most intuitive idea, that putting bacteria into your gut might reduce your risk of respiratory infection," said Benjamin Mullish, MD, a lead researcher on the study and clinical lecturer in the Division of Digestive Diseases, Imperial College London, England, in a press release. "It's further evidence that the gut microbiome has a complex relationship with our various organ systems. It doesn't just affect how our gut works or how our liver works, it affects aspects of how our whole body works."

The researchers examined daily diaries of 220 patients who participated in a prior double-blind placebo-controlled study examining probiotics and weight loss. An analysis of the common symptoms of upper respiratory infection, including cough, sore throat, and wheezing, showed that individuals who took probiotics during the 6-month study period had a 27% lower overall incidence of upper respiratory tract symptoms compared with the placebo group. This effect was found to be greatest among individuals who were 45 years of age and older, as well as those with obesity, according to the current study.

Previous research indicates that probiotics decrease upper respiratory infections in healthy adults and children, but limited data exist on this vulnerable population of older, overweight, and people with obesity, according to the current study.

"These findings add to growing interest in the gut-lung axis—how the gut and the lungs communicate with each other," Mullish said in the press release. "It's not just the gut sending out signals that affect how the lungs work. It works in both directions. It adds to the story that changes in the gut microbiome can affect large aspects of our health."

The research team did not evaluate immune response, only respiratory symptoms, and future randomized clinical trials could help identify the mechanisms related to decreased respiratory symptoms and explore the possible impact of probiotics on the immune system.

Probiotics associated with fewer respiratory symptoms in overweight and older people. EurekAlert! Published May 14, 2021. Accessed May 17, 2021. 

https://www.eurekalert.org/pub_releases/2021-05/ddw-paw051221.php

Previous research indicates that probiotics decrease upper respiratory infections in healthy adults and children, but limited data exist on older, overweight, and people with obesity.

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