Sorting Through Respiratory Illness Symptoms

This year, it seems more than ever that patients are walking into pharmacies with coughs, congestion, and fatigue, and pharmacists are increasingly on the front lines of helping distinguish between common respiratory illnesses.

With overlapping symptoms among the cold, flu, COVID-19, respiratory syncytial virus (RSV), and seasonal allergies, identifying the likely cause at the point of care has become both more challenging and more critical.

“In the pharmacy setting, the most common symptoms patients present with include cough, congestion, sore throat, fatigue, fever, and body aches,” said Reshma Kapadia Patel, PharmD, founder of WiseMedRx in the Dallas, Texas, area. “Where I see the most confusion is that many of these symptoms overlap across conditions like the common cold, flu, COVID-19, and RSV.”

What Are the Differences?

That overlap is exactly what makes the pharmacist’s role so essential. Although patients often assume all respiratory illnesses are similar, subtle differences in symptom patterns and timing can provide important clues.

“Patients often assume all respiratory symptoms are the same, but timing and symptom patterns matter,” Patel said. “For example, allergies typically present with itchy eyes, sneezing, and clear nasal drainage without fever, whereas flu or COVID-19 are more likely to include fever, body aches, and significant fatigue.”

At the counter, pharmacists rely heavily on targeted questioning to guide their assessment. Understanding when symptoms began, how quickly they developed, and whether a fever is present can help narrow the possibilities.

“I focus on a few key questions: when symptoms started, how quickly they came on, whether there is a fever, and the presence of body aches or fatigue,” Patel said. “In the absence of testing, asking the right questions is our most valuable diagnostic tool.”

Individualizing Care for the Patient

Becky Snead, RPh, senior director of strategic initiatives at the National Community Pharmacists Association, noted pharmacists must also consider what’s happening beyond the individual patient.

“Most respiratory-type conditions present very, very similarly,” she said. “They present with cough and congestion and often fatigue, sore throat, and sometimes headache. It’s often taking a lot of other relationships—what’s happening in the environment, what’s happening with other patients in the community—that really helps the pharmacist determine what might be going on.”

This broader awareness can be particularly helpful during seasonal spikes or localized outbreaks. Pharmacists may factor in allergy surges, flu waves, or COVID-19 trends when assessing symptoms.

Another complicating factor is how patients approach care, as many wait a bit before seeking professional advice.

“Many patients will self-treat until the self-treatment doesn’t seem to work, and then they’ll seek advice,” Snead said. “So, it’s really important that the pharmacist ask some key questions and try to engage the patient whenever there’s an opportunity.”

Asking whether symptoms persist despite medication or worsen over time can offer additional insight into whether a condition is allergic, viral, or something more serious.

Point-of-Care Testing

In recent years, the rise of rapid testing has added another layer to the pharmacist’s role.

“Many patients now expect access to rapid testing, including COVID/flu combination tests, and they often come in asking specifically for confirmation of what they have,” Patel said. “This has shifted the pharmacist’s role toward not only symptom assessment but also helping patients decide when testing is appropriate.”

Snead noted that point-of-care testing has become a critical next step when symptoms suggest a viral infection.

“Pharmacists are armed in many states with the ability to do point-of-care testing, and that is a critical next step once they’ve asked those key questions, and it’s warranted,” she said.

Still, even with testing, many respiratory illnesses are managed with supportive care, making OTC recommendations a cornerstone of treatment.

“When a definitive diagnosis isn’t possible, OTC medications play an important role in symptom management,” Patel said. “More medication isn’t always better; choosing the right medication for the right symptom is what truly improves outcomes.”

Pharmacists must also recognize when symptoms go beyond what can be managed at the counter. Certain warning signs require referral to a physician.

“Red flags that prompt referral include high or persistent fever, shortness of breath, chest pain, confusion, or symptoms that worsen or don’t improve as expected,” Patel said.

Barriers For Implementation

Despite their growing clinical role, pharmacists still face barriers, particularly in reimbursement for services such as testing and consultation.

“Pharmacists are not considered in most states as providers that can bill patients’ insurance,” Snead said, noting that expanding coverage for services such as point-of-care testing could significantly improve access and efficiency.

Still, pharmacists are well-positioned to play an even larger role in managing respiratory illnesses, provided they have the right tools.

“Access to standardized clinical protocols, expanded point-of-care testing, and ongoing training in symptom assessment would be highly valuable,” Patel said. “Pharmacists are well-positioned to triage and guide care. We just need the right tools and frameworks to do it consistently and confidently.”