Management of cold and flu symptoms 

Introduction

Upper respiratory tract infections are among the most common health problems encountered in the UK, often labelled interchangeably by patients as ‘cold’ or ‘flu’. The common cold is a self-limiting viral illness of the upper airways, whereas influenza (flu) is a systemic viral infection caused by influenza viruses, which is associated with more severe symptoms and potentially serious complications^​1​. Both conditions can result in patients seeking advice and treatment in settings such as accident and emergency (A&E) and general practice — although most cases require only supportive management.

In the UK, adults experience two to three colds annually, while children may experience up to eight^​2​. Flu remains a seasonal burden, with annual epidemics contributing to significant morbidity, hospital admissions and winter mortality^​3​. During the 2022–2023 flu season, the UK Health Security Agency (UKHSA) reported excess mortality linked to flu and other respiratory viruses^​4​.

Since the COVID-19 pandemic, public awareness of respiratory symptoms and infection prevention has increased. The Propriety Association of Great Britain’s ‘The self-care census 2025’ report, published in July 2025, highlighted that the general population said they wanted to take ownership of their health and wellbeing when it came to the management of ‘common conditions’, with 84% of adults agreeing that they would choose self-care as their first option for healthcare^​5​. However, while the desire to self-care appears to be strong, there has been a decline in the past three years in consumers’ confidence in self-care for nearly all the self-treatable conditions surveyed. Even though most people felt confident self-treating cold or flu, respondents’ confidence in providing self-care for the condition fell by 18% in just three years — from 81% in 2023 to 63% in 2025. 

The NHS and public health agencies continue to emphasise self-care, hygiene and vaccination, where available, as first-line strategies for managing minor viral illnesses^​6​. At the same time, pressure on primary care has led to reforms in service delivery and the better use of the expertise available via community pharmacy.

The Pharmacy First service was introduced in England in January 2024, building on existing services already available in Scotland, Wales and Northern Ireland. This service allows community pharmacists to manage minor conditions, including respiratory symptoms, and supply certain prescription-only medicines under patient group directions^​7​. As such, community pharmacy has become a central access point for patients with cold and flu symptoms, reducing GP workload and enhancing patient convenience. The importance of access to such services from community pharmacy has been underlined in the NHS ten-year health plan for England, which will endeavour to deliver a seismic shift of care from hospital to community, focusing on prevention^​8​.

This article outlines the management of cold and flu symptoms in the UK, with emphasis on evidence-based pharmacological and non-pharmacological strategies, the role of pharmacy teams, and the integration of current UK services and guidelines.

Where patients present and opportunities for pharmacy engagement

Patients with cold and flu symptoms may present across different healthcare settings:

• Community pharmacies: Community pharmacy teams, which are the most accessible healthcare providers, see a high volume of patients seeking advice or symptom relief. The advent of Pharmacy First in England reinforces this role, positioning pharmacists to assess, triage and advise, while ensuring safe use of over-the-counter (OTC) medicines^​7​;
• GP practices: Patients may still attend GPs, often seeking reassurance or treatment, usually in the form of antibiotics. The National Institute for Health and Care Excellence (NICE) emphasises that most uncomplicated cases should not be managed with antibiotics^​9​. Pharmacists play an important role in redirecting such demand through effective communication and antimicrobial stewardship;
• NHS 111: Patients may contact NHS 111 for advice. Under the new integrated pathways, patients can be referred directly to community pharmacies for assessment and management^​10​;
• Urgent and emergency care: Attendance here usually signals severe symptoms, rapid deterioration or complications (e.g. pneumonia, dehydration, acute asthma exacerbation). 

It is critical that patients understand how to access the care they need and understand their symptoms and their severity. NHS 111 is a crucial enabler for this; however, there are still patients who present at A&E departments, which can compound operational pressures experienced by hospitals.

Pharmacy engagement opportunities include:

• Identifying red-flag symptoms for referral;
• Advising on safe and effective use of OTC treatments and providing safety netting advice;
• Reinforcing antimicrobial stewardship messages;
• Promoting vaccination to eligible patient groups (e.g. influenza, COVID-19 and respiratory syncytial virus);
• Identifying and referring high-risk groups (e.g. older people, pregnant, immunocompromised, children aged under five years) that require closer monitoring;
• Signposting to NHS services or other parts of the healthcare system, where appropriate.

Why supporting patients with self-care matters

Empowering patients to self-manage reduces unnecessary GP and A&E attendances, preserving capacity for more serious conditions. In 2022, NHS England reported that up to 40% of GP appointments involve conditions that are manageable in pharmacy^​11​.

Antimicrobial resistance (AMR) puts many of the gains of modern medicine at risk, while misconceptions around antibiotics for viral infections persist. NICE guidance, published in 2019, emphasises the role of pharmacists in reducing inappropriate prescribing and supply^​9​. 

Although self-limiting, cold and flu cause discomfort, lost productivity and missed days at school or work. Effective symptom management improves recovery and wellbeing^​12​.

Signs and symptoms

An overview of cold and flu symptoms and their typical duration can be seen in Table 1^​1,3​.

Table 1: Typical symptoms of cold versus flu in adults and older children

Presentation of cold and flu-like illness can look different in younger children and infants. Pharmacists should seek a comprehensive assessment of symptom history to ensure that the child gets the most appropriate advice, treatment and/or referral in a timely manner. Patients should also be assessed for underlying pathology (e.g. meningitis, acute otitis media), as necessary. There is additional NICE guidance, published in 2023, for the risk assessment and management of feverish children, which pharmacists should be familiar with when assessing a child^​13​. 

Red-flag symptoms that require referral include:

• Severe systemic illness or rapid deterioration;
• Shortness of breath or chest pain;
• Confusion, especially in older adults;
• Haemoptysis (i.e. blood in sputum);
• Persistent fever lasting more than three to five days;
• Persistent cough lasting more than three weeks;
• Dehydration or inability to keep fluids down;
• Severe ear pain or sinus pain or headache;
• A bulging fontanelle in children, with high-pitched crying, listlessness and reduced fluid intake^​7,14​.

These symptoms could indicate more serious underlying pathology (e.g. severe lower respiratory infection, such as pneumonia, bronchitis, gastrointestinal bleed, sepsis) and the patient requires referral for further assessment. 

In community settings, signs and symptoms of sepsis can be challenging to recognise owing to their similarity to other conditions. However, pharmacy teams should be vigilant for:

• Shortness of breath: This can be a sign of respiratory distress;
• Rapid heart rate: An unusually fast heart rate may be a sign of sepsis;
• Blue, grey, pale, or blotchy skin, lips or tongue: A sign of cyanosis owing to poor circulation that occurs during sepsis — on brown or black skin, this may be easier to see on the palms of the hands or soles of the feet;
• Mental confusion: Confusion or altered mental state can indicate sepsis;
• Rash: A rash that does not fade when pressed may be a sign of sepsis;
• Low or high body temperature: Sepsis can cause fluctuations in body temperature;
• Severe vomiting or diarrhoea: These can be symptoms of sepsis, especially if accompanied by other signs^​15​.

If any of these symptoms are observed, it is crucial for patients to seek immediate medical attention via 999 or go directly to A&E. Early recognition and treatment are crucial in improving outcomes for individuals with sepsis. It is also important to note that signs and symptoms of sepsis in infants and young children can look different, including weak, high-pitched cry, being sleepier than usual, not responding like normal and grunting noises when breathing.

Extra care should be taken with certain patient groups, including infants, older people, pregnant people, immunocompromised individuals and those with chronic disease (e.g. those with congestive heart failure, asthma, chronic obstructive pulmonary disease, sickle-cell disease, kidney disease and diabetes). Complications may be more common in these patient groups^​16​. Pharmacists should be alert for the exacerbation of any underlying medical conditions in patients who have cold or flu-like illness.

Referral should be made to a GP, NHS 111 or urgent/emergency care, depending on severity and availability. Those with symptoms of complicated influenza will typically require hospitalisation; therefore, these patients should be referred appropriately to get the hospital care required. Pharmacists should document advice and referrals, where appropriate.

Management strategies

Pharmacological management (over-the-counter medicines)

Pharmacists should tailor OTC advice based on symptoms, comorbidities, contraindications and patient preference (see Table 2^{​9,17–20​}).

Table 2 is not intended to be exhaustive. Pharmacy teams should carefully check the summary of product characteristics or product pack for information concerning indication, dosage, contraindications, cautions and drug interactions. This is particularly important when considering the suitability of medication for children aged under 12 years. Many management options are unsuitable for children aged under 12 years; however, some may be suitable for 6–12-year-olds when a pharmacy medicine form is available. 

Pharmacists should advise on the use of paracetamol or ibuprofen as an antipyretic and/or analgesic in the following cases:

• Adults and children aged five years and over, if the person has a headache, muscle pain or fever;
• Children aged under five years, if the child has a fever and appears distressed:
  • Continue only as long as the child appears distressed;
  • Consider changing to the other agent if the child’s distress is not alleviated;
  • Only consider alternating these agents if the distress persists or recurs before the next dose is due.

For adults and children aged six years and older, certain OTC treatments may relieve some symptoms. Patients should be aware of their limited benefit and potential for adverse effects before using them.

For children aged under six years, OTC cough and cold products should not be used owing to the overall balance of benefits versus risks have not been shown to demonstrate a clear advantage.

Non-pharmacological and self-care measures

Guidance emphasises simple self-care strategies to manage the symptoms of cold and flu:

• Hydration and rest: Prevents dehydration and aids recovery. Warm honey and water can be soothing for cough or sore throat in adults and children aged one year and over. This is not suitable for infants aged under 12 months owing to botulism risk;
• Nutrition: Eat healthy food and have regular light meals. If appetite is poor, small frequent meals are recommended. It is also common for children to lose their appetite for a few days when they have a cold;
• Good hygiene: Handwashing, use of tissues and staying home when unwell reduce transmission;
• Relieve congestion: Saline nasal sprays or drops, particularly in children. Steam inhalation provides temporary relief, but caution is needed to avoid burn;
• Warm saltwater gargles: Helpful for sore throat and nasal congestion relief;
• Avoidance of smoking and irritants: Prevents symptom exacerbation^​5,21​.

If symptoms do not improve

Patients should be advised to seek further care if:

• Symptoms persist >ten days without improvement;
• Symptoms worsen after first improvement (i.e. a possible secondary bacterial infection);
• Red-flag symptoms develop^​22​.

Patient counselling and support

Conclusion

Cold and flu symptoms are among the most common reasons for patients to seek healthcare advice in the UK. While generally self-limiting, effective support can improve patient experience, reduce unnecessary GP visits and safeguard antimicrobial stewardship.

Pharmacists and their teams play a pivotal role in frontline management, especially with the availability of Pharmacy First services. By applying national guidance, assessing symptoms systematically, advising on management and OTC treatments, as well as delivering strong patient counselling, pharmacists enhance both individual patient care and public health outcomes.