03/18/2020
The ABC's of the Upper Respiratory Tract Infection (URI) also known as the "Common Cold"
1. Upper respiratory tract infections (URI) are caused by viruses 95% of the time. URIs caused by viruses are often called "Colds"
Cold viruses do not respond to antibiotics which are therefore ineffective treatments
2. Because there are at least 150 different cold viruses, each cold may act very differently. And because most symptoms are due to your own immune system reacting to the virus, each person may exhibit a unique set of symptoms and severity of symptoms to the same virus.
3. The most common symptoms are sore throat, nose congestion with or without sneezing, throat congestion, coughing, low grade fever (less than 101); ear pain with pressure, popping, or muffling (eustachian tube dysfunction), weakness, tiredness, headaches, achiness, and a change in voice (laryngitis).
4. Colds often start with one symptom (i.e. sore throat) and migrate into the nose and chest over period of 2-3 days. Most acute cold symptoms will last approximately 7-10 days, but coughing may linger for 2-8 weeks (average 18 days). Coughing will generally last longer in older patients, those with a smoking or asthma history, and sedentary individuals. The darkening of sputum to a yellow or green color is a natural occurrence in the course of a cold and is rarely significant. While both novel Coronavirus (COVID-19) and Influenza have fever and cough as predominant early symptoms Influenza generally has a more rapid onset of a high fever typically >101 within 24 hrs. with painful cough, extreme fatigue, achiness and headache. Nasal congestion and sore throat are less common with both Coronavirus and Influenza than
with other common cold viruses.
5. Those with bronchial symptoms (cough with central chest tightness and/or wheezing) may benefit from bronchodilator inhalers (albuterol, levoalbuterol) which require a prescription.
5. Colds symptoms can be reduced with over-the-counter (OTC) medications that can be bought without a prescription.. Most cold remedies are short acting, so you should take them the maximum number of times recommended on the packaging. Using combinations of medications as described below either separately or in combination preparations may help you feel better as the cold runs its course.
a) Pseudoephedrine (SUDAFED) is found in many cold remedies. It is an effective oral decongestant that opens up and dries nasal passages to improve nasal breathing. It may also aid as a mild cough suppressant. Some people will experience side-effects of stimulation, jitteriness and/or insomnia with pseudoephrine. Those with high blood pressure (hypertension), a history of stroke or heart disease should consult with their doctor before using pseudoephrine (SUDAFED). The maximum recommended daily dose of pseudoephedrine is 240 mg. Because of new laws regulating the sale of pseudoephrine (due to its use in the manufacturing of methamphetamine), it may only be purchased (with a signature and ID) behind the pharmacy counter. As a substitute many cold remedies now use phenylephrine which is a less effective decongestant with similar side-effects. Phenylephrine is dosed 10 mg every 4-6 hours with a maximum daily dose of 60 mg.
b) Decongestant nasal sprays containing Oxymetazoline (AFRIN) or phenylephrine (Neo-Synephrine) can decongest the nose while avoiding pseudoephedrine side-effects. Decongestant nasal sprays are safe to use in patients with high blood pressure or heart disease. The normal dose is 2 sprays every 12 hours for no more than 5-7 consecutive days. Breathe Right nasal strips can improve nasal airflow.
c) FOR COUGH: Guaifenesin is an expectorant found mainly in cough syrups, but also in some cold pills. It is the active ingredient in ROBITUSSIN. Guaifenesin helps to liquefy and loosen secretions in the lungs, throat, and nose, allowing them to be expelled more easily. It is also a mild cough suppressant. The maximum recommended daily dose of guaifenesin is 2400 mg. Dextromethorphan (DM) is a cough suppressant found in many cough remedies, and is often combined with guaifenesin.. The maximum recommended daily dose of dextromethorphan is 120 mg. The combination of guaifenesin and dextromethorphan often works better than either medication alone. MUCINEX DM (capsule) , ROBITUSSIN DM, VICKS 44E (elixir) are branded combinations of guaifenesin and dextromethorphan. The capsules are taken every 12 hrs and the elixirs every 4-6 hours. BENZONATATE and PROMETHAZINE WITH CODEINE by prescription are other medications that can be taken in addition to guiafenesin and detromethorphan. NYQUIL cough elixir contains an antihistamine doxylamine which is similar to BENADRYL (diphenhydramine) that can make you drowsy helping you sleep through the night.
d) For sore throat pain, headaches, achiness, and ear pressure take analgesics such as ibuprofen (Advil, Motrin IB) every 6-8 hours with food (maximum 2400 mg per day), naproxen (Alleve) every 8 to 12 hours with food (maximum 1000 mg per day), and/or acetominophen (Tylenol) 500-1000 mg every 6 hours (maximum 3000 mg per day). Acetominophen may safely be taken together with either ibuprofen or naproxen for additive pain relief. Topical anesthetic preparations such as Cepachol lozenges or sore throat sprays may help.
e) The allergy nasal spray, Flonase (fluticasone), has been shown in one study to shorten the duration of a cold by about 1 day if started within 48 hrs of the cold onset. Nasal Sinus/Rinse kits (Sinus Rinse) which flush saline (salt) water into your nasal cavity may also help decongest the nose, prevent sinusitis, and shorten the duration of a cold. Taking zinc lozenges every 2-3 hrs while awake has been shown to shorten cold symptoms in some studies, but not others. Other herbal remedies such as echinacea have not shown effectiveness in studies.
f) Rarely colds can turn into bacterial infections (pneumonia, bacterial sinusitis) usually developing more than 5-7 days after a cold has started. You should notify your doctor if you develop a higher fever (greater than 101 degrees F), shortness of breath, chest pain, pain over your face, worsening cough or suspect Coronavirus or Influenza infection. Get Influenza vaccination.
Feel Better Quickly Dana Eisenman, MD (310) 360-7671
