Common cold from the New York Times
Treatment
The following are some food and fluid recommendations. Most will not cure a cold, but they may help a person deal better with the symptoms:
* Drinking plenty of fluids and getting lots of rest when needed is still the best bit of advice to ease the discomforts of the common cold. Water is the best fluid and helps lubricate the mucous membranes. (There is no evidence that drinking milk will increase or worsen mucus, although milk is a food and should not serve as fluid replacement.)
* Chicken soup does indeed help congestion and body aches. The hot steam from the soup may be its chief advantage, although laboratory studies have actually reported that ingredients in the soup may have anti-inflammatory effects. In fact, any hot beverage may have similar soothing effects from steam. Ginger tea, fruit juice, and hot tea with honey and lemon may all be helpful.
* Spicy foods that contain hot peppers or horseradish may help clear sinuses.
* Foods rich in vitamins A and C are widely recommended. They include oranges, kiwi, and tomatoes for vitamin C, and sweet potatoes, spinach, and broccoli for vitamin A.
Vitamins
Despite a few studies that suggest that large doses of vitamin C may reduce the duration of a cold, most of the scientific evidence finds no benefit. Taking high doses of vitamin C is not recommended, for the following reasons:
* High doses of vitamin C may cause headaches, intestinal and urinary problems, and even kidney stones.
* Because vitamin C increases iron absorption, people with certain blood disorders, such as hemochromatosis, thalassemia, or sideroblastic anemia, should avoid high doses of this vitamin.
* Large doses of vitamin C can also interfere with anticoagulant medications ("blood thinners"), blood tests used in diabetes, and stool tests.
In addition, a review of evidence suggests that taking large doses of vitamin C after the onset of cold symptoms does not improve the symptoms or shortens the duration of the cold.
Zinc
Zinc appears to influence the immune system and it may have a direct effect on viruses. How it works is not entirely clear, however. Zinc preparations in lozenge or nasal gel form are now available as cold treatments. Studies are very mixed on the effects of zinc on colds. A review of available studies comparing zinc treatment to placebo ("sugar pill") found only one high-quality study, which showed that zinc nasal gels might provide a benefit. The overall benefit of zinc in the prevention of colds remains unproven. In any case, no one with an adequate diet and a healthy immune system should take zinc for prolonged periods, for the purpose of preventing colds.
Side Effects. Side effects, particularly of the lozenges form, include the following:
* Dry mouth
* Constipation
* Nausea
* Bad taste (possibly only with zinc gluconate lozenges)
* Severe vomiting, dehydration, and restlessness (signs of overdose, seek medical help)
* Allergic response (rare)
Food and Drug Interactions. Zinc may also interact with drugs or other elements:
* It may reduce absorption of certain antibiotics.
* Foods high in calcium or phosphorus may reduce zinc absorption.
* In high doses and for long periods of time, zinc can cause copper deficiencies.
Medications for Mild Pain and Fever Reduction
Many people take medications to reduce mild pain and fever. Adults most often choose aspirin, ibuprofen (Advil), or acetaminophen (Tylenol).
The following are recommendations for children:
* Acetaminophen (Tylenol) or ibuprofen (usually Advil or Motrin) are the typical pain-relievers parents give their children. Most pediatricians advise such medications for children who run fevers over 101 F. Some suggest alternating the two agents, although there is no evidence that this regimen offers any benefits, and it might be harmful.
* Aspirin and aspirin-containing products should never be used in children or adolescents. Reye syndrome, a very serious condition that can be life-threatening, has been associated with aspirin use in children who have flu symptoms or chicken pox.
Nasal Strips
Nasal strips (such as Breathe Right) are placed across the lower part of the nose and pull the nostrils open. These strips may open the nasal passages and ease congestion due to a cold, sinusitis, or hay fever. As of yet, there is no scientific evidence that they offer such benefits.
Nasal Wash
A nasal wash can be helpful for removing mucus from the nose. A saline solution can be purchased at a drug store or made at home. One study reported that neither a homemade solution (using one teaspoon of salt and one pinch of baking soda in a pint of warm water) nor a commercial hypertonic saline nasal wash had any effect on symptoms. Further, one preliminary study found that over-the-counter saline nasal sprays that contain benzalkonium chloride as a preservative may actually worsen symptoms and infection.
Some physicians, however, advocate a traditional nasal wash that has been used for centuries and is different from that used in most studies. It contains no baking soda and uses more fluid for each dose and less salt. The nasal wash should be performed several times a day.
A simple method for administering a nasal wash:
* Lean over the sink head down.
* Pour some solution into the palm of the hand and inhale it through the nose, one nostril at a time.
* Spit the remaining solution out.
* Gently blow the nose.
The solution may also be inserted into the nose using a large rubber ear syringe, available at a pharmacy. In this case, the process is the following:
* Lean over the sink head down.
* Insert only the tip of the syringe into one nostril.
* Gently squeeze the bulb several times to wash the nasal passage.
* Then press the bulb firmly enough so that the solution passes into the mouth.
* The process should be repeated in the other nostril.
Nasal-Delivery Decongestants
Nasal-delivery decongestants are applied directly into the nasal passages with a spray, gel, drops, or vapors. Nasal forms work faster than oral decongestants and have fewer side effects. They often require frequent administration, although long-acting forms are now available. Ingredients and brands of nasal decongestants include the following:
Long Acting Nasal-Delivery Decongestants. They are effective in a few minutes and remain so for 6 - 12 hours. The primary ingredient in long-acting decongestant is:
* Oxymetazoline: Brands include Vicks Sinex (12-hour brands), Afrin (12-hour brands), Dristan 12-Hour, Good Sense, Nostrilla, Neo-Synephrine 12-Hour
* Xylometazoline: Inspire, Otrivin, Natru-vent
Short-Acting Nasal-Delivery Decongestants. The effects usually last about 4 hours. The primary ingredients in short-acing decongestants are:
* Phenylephrine: Neo-Synephrine (mild, regular, high-potency), 4-Way, Dristan Mist Spray, Vicks Sinex
* Naphazoline (Naphcon Forte, Privine)
Dependency and Rebound. The major hazard with nasal-delivery decongestants, particularly long-acting forms, is a cycle of dependency and rebound effects. The 12-hour brands pose a particular risk for this effect. This effect works in the following way:
* With prolonged use (more than 3 - 5 days), nasal decongestants lose effectiveness and even cause swelling in the nasal passages.
* The patient then increases the frequency of their dose. The congestion worsens, and the patient responds with even more frequent doses, in some cases as often as every hour.
* Individuals then become dependent on them.
Tips for Use. The following precautions are important for people taking nasal decongestants:
* When using a nasal spray, spray each nostril once. Wait a minute to allow absorption into the mucosal tissues, and then spray again.
* Keep the nasal passages moist. All forms of nasal decongestants can cause irritation and stinging. They also may dry out the affected areas and damage tissues.
* Do not share droppers and inhalators with other people.
* Use decongestants only for conditions requiring short-term use, such as before air travel or for a single-allergy attack. Do not take them more than 3 days in a row. With prolonged use, nasal decongestants become ineffective and result in the so-called rebound effect and dependence.
* Discard sprayers, inhalators, or other decongestant delivery devices when the medication is no longer needed. Over time, these devices can become reservoirs for bacteria.
* Discard the medicine if it becomes cloudy or unclear.
Oral Decongestants
Oral decongestants also come in many brands, which mainly differ in their ingredients. The most common active ingredient are pseudoephedrine (Sudafed, Actifed, Drixoral) or phenylephrine (Sudafed PE and many other cold products) .
Side Effects of Decongestants. Decongestants have certain adverse effects, which are more apt to occur in oral than nasal decongestants and include the following:
* Agitation and nervousness
* Drowsiness (particularly with oral decongestants and in combination with alcohol)
* Changes in heart rate and blood pressure
Avoid combinations of oral decongestants with alcohol or certain drugs, including monoamine oxidase inhibitors (MAOI) and sedatives
Individuals at Risk for Complications from Decongestants. People who may be at higher risk for complications are those with certain medical conditions, including disorders that make blood vessels highly susceptible to contraction. Such conditions include the following:
* Heart disease
* High blood pressure
* Thyroid disease
* Diabetes
* Prostate problems that cause urinary difficulties
* Migraines
* Raynaud's phenomenon
* High sensitivity to cold
* Emphysema or chronic bronchitis
Anyone with the above conditions should not use either oral or nasal decongestants without a doctor's guidance. In addition, people taking medications that increase serotonin levels, such as certain antidepressants, anti-migraine agents, diet pills, St. John's wort, and methamphetamine, should avoid decongestants. The combinations can cause blood vessels in the brain to narrow suddenly, causing severe headaches and even stroke.
Others who should use these drugs with caution are the following (consult your health care provider):
* Anyone who is pregnant.
* Children: Children appear to metabolize decongestants differently than adults. Decongestants should not be used at all in infants and small children under the age of 4, according to new recommendations. Young children are at particular risk for side effects that depress the central nervous system. Such symptoms cause changes in blood pressure, drowsiness, deep sleep, and, rarely, coma. Studies have also shown that these cough and cold products generally are not effective in the treatment of children under 6 years of age.
In October 2007, drug manufacturers voluntarily withdrew from the market all oral cough and cold products, including decongestants, aimed at children under 2, due to potential harm from misuse. In late 2008, the Consumer Healthcare Products Association, which represents most of the US makers of nonprescription over-the-counter cough and cold medicines in children, began voluntarily modifying its products' labels to read "Do Not Use in Children Under 4." This action is supported by the FDA. Note that no products are being removed from the shelves this time. Therefore, there may be a transition period in which the instructions for use on different bottles of the same medicine may be different -- some may read "Do not Use" under age 2, while others will have the new recommendation of age 4. The FDA recommends parents follow the instructions on the bottle they bought.
Under no circumstances should children be given adult medicines, including over-the-counter medications.
Cough Remedies
Major studies have indicated that over-the-counter cough medicines are not very effective, but they are also not harmful.
* For thick phlegm, patients may try cough medications that contain guaifenesin (Robitussin, Scot-Tussin Expectorant), which loosens mucus. Patients should not suppress coughs that produce mucus and phlegm. It is important to expel this substance. To loosen phlegm, patients should drink plenty of fluids and use a humidifier or steamer.
* For patients with a dry cough, a suppressant may be useful, such as one that contains dextromethorphan (Drixoral Cough, Robitussin Maximum Strength Cough Suppressant).
Medications that contain both a cough suppressant and an expectorant are not useful and should be avoided. Medicated cough drops that contain dextromethorphan are not very useful. A patient is just as likely to find relief from hard candy or lozenges.
Prescription cough medications with small doses of narcotics are available. They are usually reserved for lower respiratory infections with significant coughs.
Remedies for Sore Throat Associated with Colds
Sore throats that are associated with colds are generally mild. The following may be helpful:
* Cough drops, throat sprays, or gargling warm salt water may help relieve sore throat and reduce coughing.
* Throat sprays that contain phenol (for example, Vicks Chloraseptic) may be particularly helpful. Phenol has antibacterial properties. In one study, patients with sore throat who used the spray experienced faster resolution of the cold itself, including fever, headache, and other symptoms compared to a placebo. The patients were not taking antibiotics.
* Cough drops that contain menthol and mild anesthetics, such as benzocaine, hexylresorcinol, phenol, and dyclonine (the most potent), may soothe a mild sore throat.
* People with sore throats from postnasal drip might try taking a teaspoon of liquid antacid. They shouldn't drink anything afterward, since the intention is to coat the throat and help neutralize the acid in the mucus that might be causing pain.
If soreness in the throat is very severe and does not respond to mild treatments, the patient or parent should check with the physician to see if a strep throat is present, which would require antibiotics.
Combination Cold and Flu Remedies and Antihistamines
Dozens of remedies are available that combine ingredients aimed at more than one cold or flu symptom. In general, they do no harm, but they have the following problems:
* Some ingredients may produce side effects without even helping a cold.
* In some cases, the ingredients conflict (such as a cough expectorant and a cough suppressant).
* In other cases, a patient may wish to increase the dosage to improve one symptom, which serves to increase other ingredients that do no good and, in higher doses, may cause side effects.
Note on Antihistamines. Many combination remedies contain antihistamines. Antihistamines are used for allergies and are not generally recommended to relieve the symptoms of the common cold. Some evidence suggests, however, that they may have some value.
First-generation antihistamines may reduce cold symptoms. Their benefits for the cold are likely to be due to the drowsiness they cause. Such antihistamines include Benadryl, Tavist, and Chlor-Trimeton. The newer, second-generation antihistamines (Claritin, Allegra, Zyrtec) do not have these effects and also appear to have no benefits against colds.
Herbs and Supplements
Herbal remedies and dietary supplements are not regulated by the FDA. This means that manufacturers and distributors do not need FDA approval to sell their products. In addition, any substance that affects the body's chemistry can, like any drug, produce side effects that may be harmful. There have been numerous reported cases of serious and even deadly side effects from herbal products.
The following are special concerns for people taking natural remedies for colds or influenza:
* Echinacea is commonly taken to prevent onset and ease symptoms of colds or flu. High quality studies have failed to show that this herb helps prevent or treat colds. In addition, some people are allergic to echinacea. People who have autoimmune diseases or plant allergies should avoid it. There have been a few reports of people experiencing a skin reaction to this herb called erythema nodosum, which is characterized by tender, red nodules under the skin.
* Chinese herbal cold and allergy products can contain trace amounts of aristolochic acid, a chemical that causes kidney damage and cancer. Many herbal remedies imported from Asia may contain potent pharmaceuticals, such as phenacetin and steroids, as well as toxic metals.
