Common Cold

 

Each year, there are over a billion colds in the US.  That’s a lot of grumpy people and a lot of tissue!  But what is a cold?

What is a Cold? 

The term “common cold” refers to an acute illness that causes the following symptoms:

  • Nasal congestion
  • Runny nose
  • Sneezing
  • Sore throat

I figure you probably knew that, but it’s always good to make sure you define your terms.  Additional symptoms may also be present, including:

  • Cough
  • Headache
  • Decreased appetite
  • Your head feeling like someone filled your nasal and sinus passages with lead while you weren’t watching

Fever tends to not be present in adults, but is common to see in children with colds.  The symptoms generally last under a week.

Doctors, of course, have a fancier term for colds, calling them upper respiratory infections.  They are the same thing, but it sounds much smarter than saying it’s a cold.  At least it’s not a Latin word.

What Causes Colds?

Colds are caused by any of 200+ viruses, with the majority of them being from the rhinovirus family.  They call them this because under an electron microscope, the viruses have horns and charge other viruses.  OK, that’s not true; the name comes from the Greek word for nose, but that didn’t sound exciting enough so I made it up.

These viruses are highly contagious because a person with the virus will spread it to nearly anything they touch, infecting the next person who touches it.  That’s why most colds infect multiple family members.

The Good News

I do have some good news, though: there actually is a cure for the common cold.  It’s called time.  After a while, your body will fight off cold viruses and cure you nearly 100% of the time.  Sorry if that is not a glamorous answer, but there is no real need for a cure.  The treatment of these infections doesn’t focus on curing them but instead almost entirely on treating symptoms while your body goes after the infection.

I have some more good news: colds are often good for you.  Getting a virus is basically a workout for your immune system, making your body more able to fight off infections in the future.  Studies show children who are in daycare centers early in life (basically an “all you can eat virus buffet” for kids) don’t get sick as often later in life.  It’s not that I recommend going into the daycare center and licking pacifiers (please don’t!); I just feel that people are to quick to try and “cure” something that does no significant harm.

How to Treat a Cold

So, the focus of treatment is centered on reducing symptoms so you are not as difficult to be around.  Here are my tips for what to do if you catch a cold:

  1. Take Care of Yourself – Get rest and eat right.  Your body is working hard to get better; give it all the help you can.  You don’t have to lie in bed all day, but don’t stay up to watch Letterman.
  2. Treat Symptoms – There are a number of choices here:
    1. Decongestants – these medications open up the nasal passages so you can breathe better. Great.  The downside, though, is that the are related to adrenalin, which means that they can raise blood pressure, keep you awake at night, and give you heart palpitations.  The most famous of these medications is pseudoephedrine, the chemical found in Sudafed.  In general, anything with a “D” at the end (Allegra-D, for example) has a decongestant.
    2. Cough Suppressants – These (obviously) suppress cough.  While there are a few choices available, but the most common one is dextromethorphan.  If there is a “DM” at the end of the name, it usually means it has dextromethorphan in it.
    3. Expectorants – The expectorants loosen up the phlegm so your mucous comes out easier.  Guaifenesin is the most common of these, and is the main active ingredient to Robitussin (and is the ingredient that makes it taste sour) and Mucinex.
    4. Fever/Pain Relievers -- Acetaminophen is the most common of these, and is the safest (as long as you do not exceed the recommended dose).  Please understand that other medications may have acetaminophen added to them.  Read labels!  Ibuprofen and Naproxen (the active ingredient in Aleve) can also treat pain (ibuprofen treats fever too).  You can take these, but be aware they can upset the stomach and raise blood pressure (if taken in large amounts).
    5. Antihistamines – These are present in many cold medications, but they actually aren’t much good for a cold, although they may make it easier to sleep.  Check the labels and pick a medication that matches your symptoms.
  3. Moisturize – Using a humidifier and saline nasal spray can make your mucous easier to blow out of your nose.  Keeping things loose will make it less likely for it to turn into a bacterial infection like a sinus or ear infection.

You may have heard of recent recommendations to not use cold medications in young children.  That is not because they are dangerous, but because no study has shown they really help children.  Without that benefit, even the really small risk these drugs pose is not worth taking.  I tell parents not to give them to kids under 2.

What about Zinc?  There was a lot of buzz around this metal, as one study showed that sucking on a zinc lozenge decreased the rate of infection with cold viruses.  No other study has verified this.  Again, it doesn’t hurt to use zinc, but it can put a nasty taste in your mouth.

The same holds for Vitamin C and Echinacea; they don’t hurt you, but there is little evidence they make colds go away faster.  The good news, however, is that no matter what you do, colds almost always go away.

Please understand that using medications for a cold does not make it go away quicker or prevent complications. The only reason to treat it is to make you feel better.  You need to take this in mind when you use medications that themselves may carry risk. 

When Should You Worry About Your Cold?

Sometimes colds can become more significant infections.  Ear and sinus infections are the most common of these, and may need antibiotics if they are bad (although they too will clear up without antibiotics).  Be careful with young children who develop bad coughs, as there are a few serious viral infections they can get. 

In my opinion, it’s never wrong to contact the doctor’s office.  If you are worried there may be something more serious going on, go to your doctor.  I never mind having someone ask me easy questions.  Just don’t push for antibiotics.  Giving antibiotics to someone with a virus runs the risk of producing resistant bacteria.  

Common Cold Myths

 

Finally, there are some things you may have heard about that are not true:

  • You don’t get a cold by letting your feet get cold, going to bed with wet hair, or going outside without a jacket.  No matter how many moms or grandmothers say so, it just isn’t true.
  • Starving colds and feeding fevers is dumb advice.  Just eat healthy food no matter how you feel.
  • Drinking extra fluids doesn’t do more than make you have to pee a lot.  Just drink enough to avoid dehydration.
  • Green mucous doesn’t mean you need antibiotics.  Mucous will eventually turn green in most colds.
  • Bronchitis is a term describing inflammation in the airways leading to the lungs.  Doctors use this term for people with a loose cough.  Most bronchitis is viral, and does not require antibiotics.

Copyright Dr. Rob Lamberts, LLC.  The Information in this post is for the use of my patients.  Use of this information is intended to be done in conjunction with access to my care.  Use outside of that relationship should be done with caution.  

Sinusitis

What it is

This article applies to adults with sinusitis, so go here if you want to read about it in children (although or children over 10, it's basically the same thing).

Sinusitis is an infection of the sinuses caused (usually) by bacteria.  The sinuses are hollow cavities in the bones of the skull that serve several purposes:

  1. They give resonance to the voice (think of how you sound with a stuffy nose)
  2. They probably help filter the air going through the nose
  3. They get infected a lot - mainly the maxillary and frontal sinuses.

While sinusitis is not dangerous, it is uncomfortable, with pain generally on the face over where the sinus cavities are located.  The pain is caused by a difference between the pressure inside the sinuses and that of the outside world.  The usual mechanism of this is as follows:

  1. The sinuses are filled with mucous cells, producing mucous to sweep away any air particles that enter the sinus cavity.  The mucous then drains into the nasal passages and on to the stomach.
  2. The holes out of which the mucous drains get plugged, so the sinus mucous does not drain.  This plugging usually starts with inflammation (swelling) caused by:
    1. Allergies
    2. An upper respiratory infection (caused by a virus)
    3. Smoking
  3. The non-draining mucous sits around in the warm, dark, wet sinus cavity, which is a perfect place for bacteria to grow.
  4. Bacteria, which are always present in small numbers, binge on the "all you can eat buffet" of mucous in the sinus, causing the mucous to thicken.
  5. The thickened mucous makes drainage of the sinuses even more difficult.

Symptoms

The symptoms of sinus infections are varied, but the most common symptoms include:

  • Pain or tenderness over the sinuses
    • The top of the cheeks between the eyes and the mouth, for the maxillary sinuses
    • The forehead area just above the eyes for the frontal sinuses
    • The ethmoid and sphenoid sinuses don't usually get infected, so we'll ignore them for now.
  • Painful teeth (caused by maxillary sinus pressure)
  • Headache

"Green Mucous" is not a classic symptom of sinusitis, and nasal congestion or runny nose are usually caused by the virus infection or allergy that started the trouble in the first place.

Other symptoms that may suggest a sinus infection include:

  • Cough
  • Bad Breath
  • Fever

Treatment

If left untreated, sinus infections will usually get better on their own.  There are two reasons to treat a sinus infection:

  1. People don't like to feel bad and get really grumpy
  2. Grumpy people make the lives of others around them miserable.

Really.  The chance of a sinus infection turning into something serious is quite low, so it's really a quality of life issue more than anything else.  

The treatments for sinus infections include:

Non-medication treatments

The use of saline nasal spray or humidifiers can loosen phlegm and reduce pain.  This is often the quickest way to feel better.  Some people go to the extreme, using nasal irrigation (such as a neti pot), which does help a person feel better, but does have the disadvantage of pouring a liquid into your nose.

Over-the-counter medications

These relieve the symptoms and can restore the mucous flow.  These medications include:

  • Expectorants - Like Mucinex (Guaifenacin) or Robitussin - These thin the phlegm and let it drain easier.
  • Oral Decongestants - Phenylephrine and Pseudoephedrine (and others) are related to adrenaline, and work on receptors in the nose that open up the sinus passages and allow drainage.  They also decrease the flow of mucous.  The do, however, cause some problems (due to their being related to adrenaline), such as rapid heart rate, palpitations, elevated blood pressure, dry mouth, and difficulty urinating.  For healthy people this is OK, but be careful with these medications.  Most medicines containing decongestants have the letter "D" after their name (Mucinex-D, Robitussin-D, for example).
  • Nasal decongestants - Nasal sprays like Afrin contain the same kind of medications in the oral decongestants, but are more effective and have fewer side effects.  They can provide nearly instant relief, but should be used with caution for two reasons:
    • Some medical conditions, such as Glaucoma, can be aggravated by them.
    • Use of them for over 5 days can cause a rebound effect when they are stopped, increasing congestion significantly.  Some people refer to this as an "addiction", but there are no nasal spray 12-step groups that I know of.
  • Antihistamines - These are not usually useful in sinus infections, but can help with the allergies which brought the infection on in the first place.  They also tend to make you sleepy, which may not be all bad if you are kept awake by sinus symptoms.

Prescription Medications

Prescriptions are used when appropriate (see below for guidelines).  These medications include:

  • Nasal steroids - these decrease inflammation and may help a person avoid antibiotic use if started early.
  • Oral steroids - medications such as prednisone also decrease nasal inflammation and can prevent antibiotic usage, but they do have side effects if used too often, and some folks go crazy when they take them (not many, but it's impressive when it happens).
  • Antibiotics - These are the first thing people ask for and yet are the last resort.  They kill the bacteria which thicken the phlegm, but studies are not clear if they really make you get better faster.  Please read the antibiotic section of this website if you haven't done so yet to learn the risks and benefits of their usage.

Preventing sinus infections

An ounce of prevention is worth a pound of antibiotics, plus it makes you a lot less grumpy.   Here are some things to do to prevent sinus infections, or at least to minimize your need for antibiotics:

  • Don't get sick.  Taking precautions to prevent getting sick in the winter is a good move.  Get a flu shot, get lots of sleep, eat well, and don't let people sneeze on you.
  • Treat allergies.  Since allergies (cats, molds, pollens) are often the first step down the road toward grumpiness, taking antihistamines or using nasal steroids if you have allergies can keep your sinuses flowing.
  • Keep mucous moving.  If you do get sick, use nasal saline, neti pots, or hot showers to loosen the phlegm.  Expectorants may be helpful as well.

A reasonable approach to sinusitis

Here is a reasonable approach to dealing with sinusitis:

  1. Only treat if you are having enough symptoms to merit treatment (or are grumpy enough).
  2. Start with nasal saline when you do get sick, using the other over-the-counter medicines if needed.
  3. Use antibiotics only if you have been sick for about a week or are intolerably grumpy.
  4. Especially avoid antibiotics if you are a "frequent flyer" with sinus infections or antibiotics.
  5. If you keep getting sinus infections, figure out what is at the root of your trouble.  Stop smoking, get rid of the cat, get allergy tested, or avoid aunt Harriet who sneezes on you if you need to.