A common sense approach to the treatment of the common cold

It’s that time of the year, when watery eyes or a tickle in the throat can signal the onset of a cold. Some people prefer to ride out a cold with little more than some old-fashioned remedies and a box of tissues. For others, nothing less than a full pharmaceutical assault on the symptoms will do. Either way, there’s plenty you can do to weather the common cold.

Know The Enemy

Contrary to popular belief, colds are not caused by cold weather or by getting wet or chilled. They are caused by germs – almost always viruses. It’s not entirely clear why colds are more frequent at this time of the year. But it may be because people spend more time indoors and in closer proximity to one another, especially during the holidays. In addition, low humidity appears to help viruses thrive. Lower humidity also dries out nasal passages, making them more vulnerable to infection.

Because the vast majority of colds are caused by viruses, not bacteria, antibiotics are not helpful. Unless you have a chronic medical condition, such as chronic bronchitis or sinus infections, that makes you susceptible to developing a bacterial infection along with a cold, don’t pressure your doctor for an antibiotic. Ditto for taking any leftover antibiotics in your medicine cabinet. It won’t do you any good, and inappropriate use of these medications contributes to the growing problem of antibiotic-resistant bacteria. The burden of killing the virus falls to your immune system. You can help by getting plenty of rest and drinking lots of fluids.

Preventing Colds

Efforts to prevent colds focus on keeping your immune system strong and on using good hygiene to thwart viruses. Two of the most important preventive steps are to wash your hands often and to avoid touching your face, especially when you sneeze or cough. Keeping your hands away from your face is critical because the eyes, nose, and mouth are entry points for viruses.

You should also drink plenty of fluids and do whatever you can to boost your immunity. This includes eating right, exercising regularly, getting sufficient sleep, reducing alcohol consumption, managing stress, and not smoking. Adequate fluid intake can help keep mucus membranes moist and better able to defend against viruses. Some cold experts also recommend using a humidifier for the same reason.

What about herbal and nutritional supplements? Available research suggests that neither vitamin C nor echinacea prevents colds. Zinc preparations, while potentially helpful in treating colds, are not appropriate for prevention. That’s because extended use may suppress the immune system and lower the level of HDL cholesterol.

To avoid spreading colds to family members or co-workers, sneeze and cough into a tissue and immediately dispose of it. Use separate hand towels for sick and well family members and consider using a virus-killing disinfectant on surfaces such as doorknobs, toilet handles, faucets, and telephones.

Taming Cold Symptoms

Treatment focuses on helping the immune system do its job and on relieving symptoms. Many time-honored home remedies do work. Gargling with warm salt water can soothe a sore throat. Chicken soup or other hot liquids can open nasal passages, as can taking a steamy shower or using a cool-mist humidifier. Drinking plenty of water, juice, or other caffeine-free beverages will help loosen mucus. But limit alcohol and caffeine intake because they have a dehydrating effect.

What about all those cold remedies lining the drugstore shelves? It is well to note that people have differing tolerances for cold symptoms and that it’s fine to turn to some over-the-counter cold medicines if cold symptoms are making you miserable. Cold drug remedies include the following:

• Decongestant: oxymetazoline (Drixine spray); pseudoephedrine (Sudafed).

What it does: Opens nasal passages.

Precautions: Can raise blood pressure and cause nervousness or insomnia. Don’t use sprays more than five days.

• Antihistamine: diphenhydramine (Benadryl); brompheniramine (Dimetapp).

What it does: Stops runny nose, sneezing.

Precautions: May cause drowsiness and impair driving ability. Can increase risk of falls in the elderly. May cause dry eyes and dry mouth.

• Expectorant: guaifenesin (Robitussin).

What it does: Breaks up mucus so you can cough it up.

Precautions: High doses may cause nausea, vomiting, abdominal pain, dizziness, headache or rash.

• Cough suppressant: dextromethorphan

What it does: Quiets a cough.

Precautions: May cause nervousness, irritability, or confusion.

• Pain reliever: acetaminophen (Tylenol).

What it does: Relieves headache, muscle aches. Reduces fever.

Comments: Safe for short-term use in otherwise healthy people.

The choice of a single-agent medicine versus a combination product depends on your symptoms. If you have itchy eyes, a runny nose, lots of congestion, and muscle aches, then a combination medication would be quite good. But if you have a runny nose and watery eyes, an antihistamine would be a better choice. Clearly, if your symptoms are mostly sinus pressure and congestion without the itchy eyes and runny nose, a nasal decongestant like Sudafed or Drixine would be better. Decongestant sprays should not be taken for more than five days, and it’s important to drink plenty of water while taking these products.

Herbal And Dietary Supplements

As for herbal and dietary supplements, the jury is still out. Vitamin C, echinacea, and zinc have all shown some ability to reduce symptom duration and severity. But in each case, not all studies have supported a benefit. Zinc has the most research behind it and experts say that if you decide to try an alternative product, zinc is the one to try.

Results with zinc are mixed, but a study reported in the August 15, 2000 issue of the Annals of Internal Medicine found that people who took zinc acetate lozenges had a modest reduction in symptom severity and a shorter duration of cold symptoms (4.5 days versus 8.1 days) compared to people taking an inactive substance. An article in the January 2003 issue of the Quarterly Journal of Medicine found that a zinc gluconate nasal gel product reduced symptom severity (mostly nasal congestion and drainage, hoarseness, and sore throat) and symptom duration (4.3 days versus 6 days). The key point about zinc products is that they need to be started within the first 24 to 48 hours of the first cold symptom.

Warning Signs

No matter how you choose to handle a cold, it’s important to heed the warning signs of a more serious infection. Call your doctor if you experience any of the following:

• Chest pain or difficulty of breathing.

• Persistent fever for more than 48 to 72 hours, despite taking acetaminophen.

• Vomiting or inability to keep fluids down.

• Severe sore throat with difficulty in swallowing.

• Persistent coughing that keeps you awake at night.

• Persistent headache or congestion despite medications.

The good news is that colds are less common with age. People over age 60 tend to have one cold or less per year compared to two to four colds for younger adults. The reason for the drop-off may be that when it comes to fighting viruses, older people’s immune systems have been there, done that – and built up immunity to many of the cold viruses floating around.