Upper Respiratory Infections

The "Common Cold"

Revised 1/9/2000

Charles Booras M.D.

by Charles H. Booras, MD

Description

The common cold, known medically as a URI, is caused by a viral infection of the upper respiratory tract. It causes irritation and drainage in any or all of the airways including the nose, sinuses, throat, voice box, and often the bronchial tubes.

Most colds last about 5 to 14 days and will gradually disappear without any specific treatment. The majority (75%) of sufferers are better within the first week. Well over 100 different types of cold viruses are known and each virus may have a slightly different pattern of symptoms and severity.

Excessive fatigue, emotional stress and other factors that weaken the body's immune defenses will predispose us to infection upon exposure to the virus.

Electron micrograph of the Rhinovirus

Rhinovirus. An electron micrograph.

Symptoms and Signs

Colds usually begin abruptly. Throat discomfort is often first, followed by sneezing, runny nose, nasal congestion and a decreased energy level. Fever is usually absent or low grade (101 or less), although children and infants may have fever up to 102 degrees. Chest symptoms are variable, and when they are present it is commonly referred to (by non-physicians) as a "chest cold".

Mucous can become thick and coughing, if present, can last two to four weeks. Discolored sputum and nasal secretions are normal and can last 7-10 days. Discolored mucus is caused by your body's dead white blood cells and simply indicates that your immune system is fighting the infection for you. This symptom does not require treatment with an antibiotic! (More on proper use of antibiotics later.)

Treatment and Prevention

There is no treatment to cure viral infections, including the common cold. Only the symptoms can be treated. Colds are most contagious for about the first four days of symptoms, but could persist longer. The virus can be transmitted by airborne saliva and is easily spread when groups of people are together in enclosed areas, so be sure to cover your mouth when you cough or sneeze. The virus also can be physically transmitted from one person to another, so hand washing is the most important way to limit the spread of the virus.

Non-prescription medications such as decongestants (Sudafed®, and others), cough syrups and aspirin substitutes (such as ibuprofen or acetaminophen or naproxen or ketoprofen) can provide relief for the symptoms produced by the infection, but should be used judiciously and according to package instructions. You need to check with your doctor if you have any medical problems listed on the medication bottle as a warning.

Listed below are self-care suggestions to help you be more comfortable during a cold and for preventing the onset of more serious complications.

  • Rest and stay warm; increase your hours of sleep.
  • Sniff; don't blow, when you have a Cold. Researchers have found that blowing your nose creates enough pressure to propel mucus into your sinuses. This could worsen congestion in the sinuses and contribute to making you feel lousy when you have a cold. The normal mucus flow is from the front of the nose to the back, and with nose blowing you reverse that.
  • A salt-water (saline) nasal spray (AYR®, and others) may be used to keep nasal passages moist and clean.
  • A nasal decongestant spray can be helpful. Afrin® should never be used longer than 3 days, but Neo-Synephrine® can be used for up to 2 weeks in a row. (Be sure to use this with Sudafed® before flying or diving since the change in atmospheric pressure can cause a painful blockage in your middle ear.)
  • Increase your intake of fluids (water, juices, and decaffeinated liquids), but try to avoid milk and dairy products (they can thicken your mucus). You are doing a good job with fluid intake if your urine output is both frequent and clear.
  • Gargle with warm salty water and drink hot tea with honey and lemon to ease a sore throat.
  • Use cough drops (Cough-X®, and others), lozenges, or throat sprays to soothe a dry throat and to inhibit coughing.
  • Inhale steam from a hot bath or shower to relieve congestion in your nose, head, and chest. Use of a vaporizer in the bedroom is not advised as they can promote the growth of molds.
  • Vitamin C has not been proven to prevent a URI, but studies do show that it can shorten the duration of your URI. The optimum dose is 500 twice a day (after breakfast and dinner). People with a history of kidney stones should never exceed a daily dose of 1000 mg.
  • Echinacea: This is an herbal product well worth trying. It is derived from daisies and has been shown to improve immune system function. I recommend starting Echinacea (preferably with "Golden Seal") at the onset of a cold, and then stopping the herb once your symptoms have passed. I do not recommend staying on this herb long term, although new data has not shown any detrimental effects with continuous use.

I also feel that it's a good idea to take Echinacea on days that you feel "run-down" and susceptible to illness. The usual dosage is 250 - 500 mg. four times a day for acute infection. The dose for prevention of infection is 250 - 500 mg. once a day.

  • Studies have been inconclusive in documenting the effectiveness of Zinc lozenges in treating a cold. I personally believe that it may help if you can start it on the first day of symptoms (keep it on hand for future infections). It can cause some stomach upset if you have not eaten. Dissolve the lozenge in your mouth every 2 hours  (6 doses a day) until the symptoms pass, but no longer than 1 week.
  • Avoid close contact with others and if possible, curtail normal activities, including physical exercise, until your symptoms improve or disappear.
  • Avoid smoking during your cold, as it will cause further irritation to your upper respiratory tract.

Complications

Medical treatment (such as an antibiotic) is rarely needed for a common cold; however, bacteria that live in the nose and throat can sometimes gain a foothold and cause a secondary infection such as middle ear infections, bacterial sinusitis and bacterial bronchitis. If you develop any of the following symptoms that worsen or persist past 10-14 days, you should seek medical attention, since these complications may indicate a more serious infection:

  • Prolonged fever of over 102 degrees F.
  • Persistent cough which produces thick mucus lasting for over 7-10 days.
  • Chest pain or shortness of breath.
  • Persistent earache.
  • Difficulty swallowing.
  • Body rash.
  • Swollen lymph nodes.

Hopefully, this information will help you fight your cold safely and effectively without having to resort to antibiotics. Antibiotics have been overused for many years in the treatment of viral infections for which they have no proven value. We see many people in our medical practice who come in for a viral URI thinking they need an antibiotic in order to "do something" about their viral infection.

Contrary to lay opinion, antibiotics will not cure a cold, shorten the duration of a cold, or prevent a cold from getting worse.

Over the years, inappropriate antibiotic usage has led to the development of "Superbugs". That is, bacteria which are resistant to multiple antibiotics.

Antibiotics indiscriminately kill off the “good” bacteria that live in our intestinal tract and help with the absorption of vital nutrients from our foods. This is why antibiotics are frequently associated with diarrhea and vaginal “yeast” infections.

"Probiotics" are supplements that replace the "good" bacteria back into our systems. This can include plain yogurt, Lactinex®, or acidophilus supplements. Taking a probiotic while taking an antibiotic helps lessen this complication.

Antibiotics impair our natural ability to fight infections, thus we are likely to get infections more frequently. For these reasons, it is always in your best interest to fight viral infections as naturally as possible without resorting to antibiotics unless your doctor feels they are absolutely necessary.

Studies have shown that many doctors prescribe antibiotics, even when they know they are not really necessary, because of pressure from patients who expect, request, or even demand to have them prescribed.

The Centers for Disease Control and Prevention, along with the World Health Organization recommend an immediate change in the way that doctors prescribe, and patients use, antibiotics.

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