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I received a great emailed question the other day about the use of Zinc for colds, and while working in the ED this week, it seems that everyone has a cold and cough! So, this week’s topic will address the “common cold and cough”  (and see below for the answer on Zinc).  With adults averaging two to three cases of the “cold” per year and preschoolers five to seven, it’s no surprise that it’s that time of the year again.  Colds account for 40% of all time lost from jobs, so getting back on your feet as quickly as possible is a huge benefit. 

Use this information below as your “Go-To Resource” for the upcoming cold and flu season.  I’ve also included at the end a couple of “cheat-sheets” for the most complicated cases, such as children, pregnant women, and adults with high blood pressure—so print it out and take it with you on your next trip to the drug store!

Treatment for the cold and flu focuses specifically on symptomatic treatment, since the vast majority of these are caused by viruses that your body will eventually conquer.  So, treatment focuses on minimizing how miserable you feel while you give your body the time to do this! Antibiotics are not effective for common cold symptoms, and are reserved for patients with bacterial conditions such as Streptococcal pharyngitis (“Strept Throat”), ear infections, pneumonia, and others.

  • The symptoms usually last for up to 7-10 days in the average healthy patient.  They last 3-4 days longer in smokers. 
  • Pain/Fever treatment:
    • Acetaminophen (Tylenol) 650mg every 4-6 hrs for pain or fever.  Do not exceed 4grams in 24hrs
    • Ibuprofen (Motrin or Advil) 600-800mg every 8-12 hrs for pain or fever
  • Nasal Pressure/Congestion: Topical therapies:
    • Saline sprays – spray ample amount into nostrils, then blow out until you are able to clear congestion
    • Neti pot—accomplishes same as saline sprays, more effective (people swear by it), but some people find it uncomfortable
    • Afrin: great for constricting the vessels in the nostrils and decreasing swelling and congestion.  Do not use for more than 72 hours, as using it longer can cause rebound nasal congestion
    • Nasal steroid sprays: [*Rx] good for people who have allergic rhinitis, or runny nose and congestion due to allergies
  • Nasal Pressure/Congestion: Decongestants:
    • Pseudoephedrine (Sudafed, in many other cold therapies) – temporarily dries/clears nasal passages.  Pseudoephedrine is now sold only “behind-the-counter” and requiring ID, but it does not require a prescription
    • Phenylephrine: this has largely replaced pseudoephedrine in many medications, but research has shown that it is LESS effective than pseudoephedrine at treating congestion symptoms
    • Patients with Heart Disease or High Blood Pressure: these medications can increase blood pressure and heart rate, and may cause anxiety or insomnia. Be cautious if you are sensitive to these medications and do not take before bed.
    • Others: Ephedrine, Naphazoline, Oxymetazoline)
  • Cough Suppressant(Anti-tussives): helpful if you have a cough that is so severe that it interferes with speaking, breathing, keeps you awake at night
    • Dextromethorphan (Delsym): affects the “cough trigger” in the brain
    • Codeine: Codeine can be added to expectorants (see below), so you get both expectorant and cough suppressant benefits.  This addition WILL make you sleepy, however, and you should avoid driving/operating machinery for at least 6-10 hours after taking it.
  • Expectorant: thin the mucus in the air passages to facilitate coughing up the mucus and clearing airways
    • Guaifenesin (Robitussin Chest Congestion, Mucinex, Diabetic Tussin, Vicks Dayquil Mucus Control)
    • Guaifenesin with Codeine (Robitussin with Codeine) [*Rx]  – especially good if your coughing is keeping you awake at night
  • Anti-histamines (useful if your symptoms are more due to allergies, or sneezing, itching/rash, watery eyes and runny nose)
    • Make you sleepy (1stgeneration antihistamine)
      • Diphenyhydramine (Benadryl)—will make you sleepy but the most effective
      • Chlorpheniramine
      • Don’t make you sleepy (2ndgeneration)
        • Loratidine (Claritin)
        • Cetirizine (Zyrtec)
      • Pepcid: the anti-histamines listed above block the 1st type of histamine receptor (H1).  Pepcid and other antacid medications block the 2nd type (H2 receptor), but there is some cross-reactivity, and some patient s find that taking both an H1 blocker and a H2 blocker can increase their symptom improvement
  • Vitamins and Herbal Remedies:
    • Zinc: This therapy has been around since the 1970s, with conflicting evidence.  A recent research paper found that if Zinc is taken within 24hrs of onset of cold symptoms, it significantly reduced the duration and severity of symptoms. Adverse effects of zinc include vomiting (so ALWAYS take these supplements with food!) as well as a bad taste.  The FDA has put a warning against the intra-nasal forms as they can cause disruption of the sense of smell, so stick to the oral versions. 
      • Since Zinc can irritate the stomach, if you find that you are particularly sensitive, take it not only with food but also with an antacid such as Pepcid or Zantac
      • Vitamin C: Once cold symptoms have started, Vitamin C has not been shown to be better than placebo for treating symptoms
      • Echinacea: no data supports its efficacy in treating the cold
  • Other treatments:
    • Humidifier: a 2004 study of 319 patients showed that inhaling warm vapor reduced symptoms by 31% and decreased nasal congestion
    • Short course of steroids[*Rx]  if there is a component of reactive airway disease (or asthma) to your disease
    • Short course of albuterol inhaler  [*Rx] (for the same reasons as the steroids)
  • Prevention:
      • Vitamin C: While Vitamin C seems to not be helpful once the symptoms have begun, some studies have shown that it MAY  be useful for preventing the cold in the first place.  Once 5-year study inJapanshowed that 500mg daily of Vitamin C significantly reduced the frequency of colds, although it had no effect once the cold symptoms had begun.

For Children:

**Caution for medications in children: in 2008, the FDA placed a warning to avoid using cough and cold medications for children under the age of 2 due to risk of death and serious harm. An FDA advisory panel also suggested placing the same restrictions for children up to the age of 5.  These medications include decongestants, cough suppressants, and expectorants.

  • Keep children well-hydrated.  You can tell this by their urine output, if they have sunken eyes, and if their tongue or eyes appear more dry, instead of a moist sheen
  • For coughing
    • Honey: ½ tsp of honey to children ages 2-5, 1 tsp for 6-11, and 2tsp for >12yrs.  Don’t give to infants younger than 1 year
    • Avoid anyone smoking near the child, avoid wood-burning fires
    • If the child seems to have trouble breathing, has a barking cough, or has many, severe coughing spasms with vomiting after the cough, follow-up with your child’s doctor to have them evaluated for a more serious condition
    • For scratchy throat:
      • Soft foods, such as pudding, popsicles, chicken soup, jello, and ice cream
      • Congestion:
        • For infants, saline nasal drops and nasal suctioning can be extremely helpful and is the most beneficial intervention.  You can also do this in order children, or just use saline nasal sprays and then have them blow their nose
        • Cool mist Humidifier in the room. Do not use hot water in vaporizer, and make sure to empty the water after every use to avoid growing mold, which would only worsen their breathing.
        • Remember, babies are often nose breathers.  Unlike adults, who recognize that they should breathe through their mouth when their nose if clogged, babies don’t understand this, so can have more difficulties from a stuffed nose, making it even more important to try to suction out the mucus from their nose when possible. 

 

 

 

For Pregnant Women:

  • Pregnancy can add a challenging wrinkle to many therapies that we typically use to treat colds and the flu.  Patients and physicians must weigh the risks and benefits, and in many of the therapies, conclusive evidence is simply lacking in human models. 
  • Since most of the above therapies do not shortenthe duration of the illness, but simply help symptoms, it’s best for pregnant women to simply stick to those therapies that have the greatest safety data. 
    • Heated humidified air for congestion
    • Acetaminophen (Tylenol) for sore throat, headaches, and fever
    • Other therapies, such as Ipratroprium bromide nasal spray have reassuring data in animals, but not specifically in humans, and should only be taken after a discussion with your physician.  Zinc and Vitamin C are not advised to be taken in pregnancy as they have been shown to have detrimental effects on the fetus at high doses. 

 

 

 

For people with High Blood Pressure or Heart Disease

  • Decongestants (Pseudoephedrine, Ephedrine, Phenylephrine, Naphazoline, Oxymetazoline) are the medications that are most worrisome in people with high  blood pressure—they reach their benefit by constricting blood vessels in the nose, thus reducing swelling.  Unfortunately, they also constrict blood vessels elsewhere in the body, causing an increase in blood pressure. 
  • To avoid this, stay away from over-the-counter decongestants or multiple-medication products that contain these
  • Choose cold medications designated for people with high blood pressure
    • Coricidin HBP, for instance, has no decongestants
    • Pain Relief:
      • Take Tylenol or Aspirin to relieve fevers, sore throat, headache, and body aches
      • Nasal Sprays: saline nasal sprays can be helpful to flush out your nasal cavity and sinuses
      • Sore Throat: your grandmother’s remedy of gargling with warm salt water or warm water with lemon juice and honey still work and are a great alternative
      • Humidifiers: increasing the humidity level with a cool-mist humidifier can help coughing, sore/dry throat and congestion
      • And as always, drink plenty of fluids (thins the phlegm and congestion too) and get plenty of rest!

 

 

 

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2 Comments

  1. Susan

    This is very helpful, Dr. Gillespie. It’s amazing how we get sick every year but still don’t know what to do when a cold strikes! Your advice is very helpful this year and for years to come – thank you!

  2. Leon Adelman

    This is such great advice. Way more efficient than going to the ER for my cold!

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