Hello, Cold and Flu Season

By Dr. Mary Parks Lamb
Medical Director
Lakeside Primary Care
1001 Waterdam Plaza Drive
McMurray, PA 15317
Office 724-969-1001

It’s that time of year again—cough and cold season is gearing up.

You get that dreaded scratchy throat, headache, fatigue, sneezing and runny nose, and you know you’re in for misery for a week or two.

But just what is the common cold and is there anything you can do to prevent it or treat it once it has taken hold?

The common cold, or upper respiratory illness, is the most frequent acute illness we experience. It is caused by more than 200 subtypes of viruses. The illness consists of variable degrees of sneezing, nasal congestion and discharge, sore throat, cough, low grade fever, headache, and malaise. Most adults experience two to three URIs per year, and most children five per seven per year.

The common cold is responsible for more lost days from work or school than any other acute medical problem.

Viruses that cause the common cold are spread by hand contact and aerosol particles. Cold viruses may remain viable on human skin for up to two hours and on surfaces for several hours. The more time you spend with an infected person and the more that virus is shed by that person, the more likely you are to get the cold.

Most of the viruses that cause colds can produce reinfection after repeat exposure. However, most infections with the same or similar viruses are usually milder and of shorter duration. Studies have shown that recirculated air on commercial airplanes and exposure to cold temperatures do not seem to increase the risk of catching a cold.

So what do you do when you have been exposed to someone who is sick? The average incubation period for a virus is 24-72 hours after exposure. Given the widespread misery that colds inflict, it is not surprising that considerable research dollars have been spent on ways to prevent and alleviate the symptoms of the common cold.

Most studies have not found consistent evidence to support that taking megadoses of vitamin C, getting extra sleep or exercise, or ingesting large amounts of zinc makes any difference in your likelihood of getting a cold. The only way to prevent a cold is with common sense and a good hand-washing technique.

Try to limit exposure to those who are sick and frequently sanitize common surfaces in the household or workplace with disinfecting spray or wipes. Wash hands or use hand sanitizer frequently, and try to avoid putting your hands to your face, nose or mouth.

Once a cold has started, symptomatic therapy remains the mainstay of treatment. Just as they do not prevent the common cold, huge doses of vitamin C, echinacea, zinc and herbal preparations do not minimize symptoms once they have begun. Antihistamines such as diphenhydramine (Benadryl) and loratidine (Claritin) have been found to have conflicting results and are not recommended for patients with the common cold.

Cough medications likewise have little effectiveness, although a few studies reported improvement of cough with guaifenesin (Mucinex). Oral or intranasal decongestants (pseudoephedrine, phenylephriene) may relieve nasal congestion but these drugs carry risks for those with medical conditions such as hypertension and have been moved to “behind-the-counter.”

Topical decongestants should never be used for more than three days in a row as rebound rhinitis can occur after 72 hours of use. Intranasal glucocorticoids (such as Flonase or Nasonex) and leukotriene receptor antagonists (Singulair) may be effective in decreasing URI symptoms in patients with asthma and allergies, but they have not been shown to be effective for patients without those conditions.

Antibiotics are not effective for the common cold. Many extensive studies have shown that giving antibiotics to patients with URIs is no more effective than giving them a placebo (sugar pill).

In other words, if you divide a group of patients six days into a cold into two groups, and one receives an antibiotic and the other a placebo, the groups will get better at the same rate—and they will attribute their recovery to the pill. The antibiotic group may suffer harmful side effects, however, including stomach upset, diarrhea, yeast infections, allergic reactions, and the development of resistance.

Many patients worry that the color and thickness of their discharge signals a bacterial infection, but we know now that colored, thick nasal discharge is a normal progression of a viral illness and does not signify bacterial involvement or the need for antibiotics.

Clearly, we have learned that antibiotics have no place in the treatment of the common cold.

So what does work then? Good evidence shows that nasal saline washes can relieve nasal congestion and drainage inexpensively and without harmful side effects. Ipatropium bromide and cromolyn prescription nasal sprays taken four times daily can also help with nasal discharge and congestion.

Heated and humidified air may also help improve symptoms of the common cold. Mild analgesics such as acetaminophen (Tylenol) and ibuprofen (Advil or Motrin) can alleviate sore throat pain, rib pain from coughing, muscle aches, and low grade fever. Short-term topical or oral decongestants and guaifenesin preparations can help with congestion and cough, respectively. Mom’s age-old advice of plenty of rest, fluids and chicken soup can, believe it or not, be beneficial.

Several over-the-counter cough and cold medications are no longer recommended in children younger than the age of six (cough suppressants such dextromethorphan or DM), cough expectorants (guaifenesin), decongestants (pseudoephedrine, phenylephrine), and antihistamines (Benadryl) because the risks of side effects outweigh the benefits of the medications.

URIs in children are best treated with a vaporizer, nasal saline, acetaminophen or ibuprofen, and watchful waiting. In the great majority of adults and children alike, upper respiratory infections resolve without treatment in 10 days.

However, not all URIs follow a benign course. Complications certainly can occur. If your symptoms do not improve in 10-14 days, if you develop a fever greater than 101.5 degrees during the course of the illness, if you are short of breath, if you experience worsening ear pain, if you see white spots on tonsils or throat, if you develop a skin rash, if your symptoms are unusually severe, or if you have other medical conditions, you should be evaluated by your health care provider.

About this column: Each week, physicians from Washington Hospital bring you news about health and wellness issues—just for women.