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Coughs and Sneezes – a low down on the Common Cold

July 12, 2017


A cure? We wish!
The common cold is an upper respiratory tract infection with a multitude of symptoms caused by over 200 different respiratory viruses. Antibiotics do absolutely nothing to help colds. Fortunately, colds are short lived and our bodies are effective at managing them. Despite this, colds are a significant cause of lost work or school-days and cause us all much misery.

Upper respiratory tract infections are the most common illnesses in humans, with adults experiencing on average two to five of them annually, but healthy children can get up to ten per year. Children are particularly vulnerable to a run of them in quick succession, so sometimes it seems that they hardly recover from one before succumbing to the next one. This is a very common scenario at whatever age they start day care. A winter cold is so common that self-diagnosis and self-treatment are normal. This has created a billion-dollar industry to supply the demand for over-the-counter and complementary and alternative medicines. Most colds follow a predictable pattern, with symptoms increasing in severity over several days, followed by a gradual decline over one to two weeks, but they can last up to a month. The risk of complications is generally very low.

What can be done to feel better??

Rest

Firstly, listen to your body. If you feel tired stay at home and rest. You can be assured that your work colleagues or school friends would rather not catch it, so stay at home and try not to share your bugs. To protect those you live with, cover your mouth if you cough, catch sneezes in a tissue, and wash your hands frequently. Use hand sanitiser liberally. Think of moving to the spare room or sofa so you do not cough and sneeze over your nearest and dearest all night.

Take time away from exercise, unless you only have a very mild case.

Hydrate

You will be losing fluids quicker than normal from your inflamed airways. Drink plenty of water. Hot drinks can be very soothing, particularly hot lemon drinks or fruit teas. At night, your throat will become sore as it dries out, because you are likely to breath though your mouth when your nose is blocked. Keep water beside your bed.

Skip the alcoholic beverages – they will only dehydrate you!

Cool down

If you have a fever you will likely feel miserable. A fever is anything over 37.5C, but most of us will normally run in the 36 C range. Turn off the heaters, open windows or even pop out for some fresh air. Cool drinks help. Hot showers or baths will likely make you feel worse.

If you are really hot, your body's thermostat malfunctions and you believe you are freezing cold and start shivering. This is when a thermometer is useful.

Paracetamol is the first-choice medication for those who are symptomatic with a fever, but you do not need to use it if cooling yourself down physically works well. Paracetamol will also help sore throats, headaches and painful ears. An adult does is two 500mg tablets up to four times daily. Ibuprofen is the second-choice medication, it is very effective at controlling fever and pain but can be harsh on the stomach and kidneys and is not suitable for everyone. The dose depends on the type you have. Beware, lots of medications contain paracetamol and ibuprofen, so make sure you know what you are taking if you buy Lemsip, Panadeine, Neuromol or Maxigesic for example.

Aromatics

Essential oils such as menthol and eucalyptus have been used for hundreds of years in the treatment of the common cold. Lozenges with menthol may relieve a sore throat by acting as a local anaesthetic. Menthol makes your nose feel cooler and clearer, which is often much appreciated. Vicks has been found to be effective in those over 2 years, to use to help with coughs and congestion. Use it either on the chest, under the nose, or inhale a small amount of it mixed in a bowl of boiling water.

Honey

Another oldie but a goodie. There is some evidence to suggest it works with coughs and sore throats. Do not use it in infants under one year of age, because of a small risk of botulism. Use 1 teaspoon as needed.

Nasal sprays

If your nose is running then a nasal spray may calm it down, particularly useful at night so you can sleep. Simple saline nasal sprays actually can help and is one of the few treatments that can be used for babies. Studies positively show that using saline nasal irrigation reduces time off school or work. However, it can cause nose bleeds.

Medicated sprays, such as Otrivin Plus, contain ipratropium which can reduce a runny nose but cannot clear a blocked nose. It can cause nosebleeds. Do not use it for more than 5 days otherwise it will cause a rebound runny nose when you stop.

Zinc

A big review of many studies found a significant reduction in duration, severity and incidence of the common cold in patients using zinc supplementation. However, in overdose it can cause nausea, constipation, diarrhoea or abdominal pain if taken at doses greater than 40mg daily.

Echinacea

A large analysis of multiple studies found no evidence for Echinacea preventing colds, although it may provide some symptomatic relief of a cold if the plant is used early on. Multiple preparations are available, and there may be difference in effect with different brands and dependent on which part of the plant is used. It is thought the stems and leaves are most effective.

Vitamin C and Garlic

These have been studied repeatedly to see if they can help with colds. It looks like there may be a minor role in preventing colds but very limited benefit in treating them. Certainly having some mandarins and kiwi fruit is worth a try, and use garlic in your cooking, but there is probably no benefit in consuming it raw!

Cough mixtures

Save your money – these expensive preparations will not do any good and potentially could do you harm. There is little evidence that cough and cold preparations containing antitussives, mucolytics, expectorants, decongestants or antihistamines, have any clinically significant effect on reducing the symptoms or duration of the common cold and Medsafe has banned the use of most of them in the under 6-year-old age group.

If you are coughing continuously you may find you are better off sitting up rather than lying flat. A distraction from your cough may help you get to sleep – e.g. listening to the radio or watching TV. Sometimes going outside into cool air can stop a coughing spasm.

Commonly asked questions about colds.

I have a horrible cold. Do I need antibiotics?

Not for a cold. Antibiotics punch holes in the cell walls of bacteria but have no effect on viral infections. Sorry!

My nasal mucous is green. Do I need antibiotics?

Green snot does not signify anything really, it is an old wives' tale that green snot is a bacterial infection. As long as it is a cold nothing can be done unfortunately.

My cough is really "chesty". Do I need antibiotics?

Coughs almost always seem chesty. Mucous in the upper airways causes turbulence and makes everyone feel chesty. If you have a lower respiratory tract infection (e.g. a pneumonia or chest infection) then you may need antibiotics. You may need to come in so we can examine you to find out. However, people with a lower respiratory tract usually feel really ill, so if you have an annoying cough but do not feel ill in yourself then it is unlikely you need antibiotics.

How can you tell it's an upper respiratory tract infection?

Partly from the history and then from examination. We look at heart rate, respiratory rate, oxygen saturations, and sound the chest. We also inspect the ears and throat, look for cervical lymph nodes and assess general wellbeing.

Will antibiotics prevent me from getting a secondary bacterial infection?

Again, mostly no.

Sometimes an upper respiratory tract infection can lead to a secondary bacterial infection. This is not a frequent event. In children, middle ear infections can occur after colds, but the majority of these resolve in 48 hours and do not benefit from antibiotics. Some unlucky people may get a secondary bacterial infection such as pneumonia – this is more likely in those with pre-existing severe lung disease. It is thought that antibiotics given early will not necessarily prevent a secondary bacterial infection and in most cases, should only be used if one arises.

I have a horrible cold and I am going on holiday next week/I can't afford to take time off work/I have a sick relative, should I have antibiotics?

Unfortunately, antibiotics are still not likely to do any good. They will however strip your bowel of beneficial good bacteria, may potentially cause an allergic reaction and are likely to cause diarrhoea and vomiting. Overuse of antibiotics is also causing a massive problem as bacteria are now resistant to them.

My brother/sister/son/daughter/neighbour has the same thing and their GP gave them antibiotics. Should I have it too?

Their GP either may have given them antibiotics as they suspected a secondary bacterial infection such as pneumonia. Or they may be high risk for lung infections for example, they have had multiple episodes of pneumonia or have bronchiectasis. What may have happened was that they pressurised their GP into giving antibiotics against the GP's better judgement – which does not mean it was the right thing to do.

I have had my cold for 2 weeks now so should I have antibiotics?

It may be worth coming in to get checked out and your GP will carefully examine you to determine if you have an upper or lower respiratory tract infection. If it is an upper respiratory tract infection then antibiotics will not help.

Last time I had this I was given antibiotics and it cleared up immediately. Should I have them now?

The funny thing is that even when there is a proven bacterial infection (i.e. a pneumonia), and we know from sputum testing which antibiotic the bacteria is sensitive to, it can still take a long while to get better on the right antibiotic. You probably got better just because your immune system had got on top of the virus about when you started antibiotics.

Should I come in early to get on top of it?

Unfortunately, with a cold there is so little that we can do it does not make any difference coming in early.

When to seek help

Always seek help if you are concerned, but be realistic in your expectations. We can help with a sick certificate if needed or giving advice but we regrettably cannot cure a cold.

Seek help if you feel really unwell in yourself, if you are short of breath, if you have chest pain, if you cannot drink, if you stop passing urine, if you develop a rash, neck stiffness or an aversion to being in a bright room. Come in if you have been gradually improving then suddenly go downhill.

Asthmatics, those with chronic obstructive airway disease or bronchiectasis may need to come in for a review sooner if their respiratory symptoms have been triggered.

With children, normally things are not too bad if they are eating and drinking and relatively playful. A lethargic and still child is concerning, so is one who will not take fluids and or who is not passing urine.