Bay Area Medical Information
Cold, Flu, or Hayfever?

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Is there any truth to the old saying, “Starve a fever, feed a cold?”

No. In fact, when you have a cold or the flu, you should be sure to eat healthful foods and drink plenty of fluids, but there is no need to eat more or less than usual. There are however, a few important tips that will help you feel more comfortable and speed recovery:

ArrowDrinking plenty of fluids is important to maintain good hydration. This helps keep the mucous thin. When it is thin, the mucous is more easily drained from the sinuses and coughed up from the upper respiratory tract. Thick mucous that remains in the sinuses or respiratory tract is more likely to cause a secondary bacterial infection such as a sinus infection, bronchitis, or pneumonia.
Chicken soup is soothing and helpful when you have a cold or the flu

ArrowChicken soup is good for a cold or the flu, and is not just an old saying. Broth based chicken soup is a warm and soothing food that helps clear nasal congestion.

ArrowGinger helps settle stomachs.

arrowBuckwheat honey 1/2 to 2 tsp of before bedtime has been found to be helpful in suppressing a dry cough during sleep. (Never give honey to a child less than 1, however)

ArrowAvoid milk and milk products during a cold or the flu, as they will increase the mucous production.

What's the difference between a cold and the flu?

The flu often makes a person sick enough to stay in bedInfluenza typically comes on suddenly and hits hard. In fact, many people who become sick with the flu say it is like being hit by a truck. People with the flu often end up in bed for at least 1 day, whereas those with a cold can frequently keep going. Cold symptoms are typically much milder than flu symptoms.

The initial distinguishing characteristics of the flu are severe body and joint aches, whereas the simple, common "cold" begins with symptoms limited to the head such as nasal congestion, sore throat, and headache.

The flu and the common cold are both respiratory illnesses, but they are caused by different viruses. The virus that causes influenza targets the entire repiratory system which starts at the nose, and includes the throat, bronchial tubes, and possibly the lungs. Generally the virus that causes the common cold infects only the upper respiratory tract--the nose and throat.

While influenza does have an impact on the total body, it typically avoids the gastrointestinal tract (the stomach and intestines) and is typically not associated with nausea, vomiting, or diarrhea. What some people call "stomach flu" or "intestinal flu" is really a different type of virus that targets the gastrointestinal tract and causes vomiting and diarrhea. In fact, these symptoms can be caused by many different viruses, bacteria, or even parasites but these problems are rarely the main symptoms of influenza.

An exception to this general rule has been with the swine flu virus of 2009 where many adults had nausea, vomiting and diarrhea as well as as the typical respiratory symptoms.

Is it the flu, a cold, or an allergy?
Symptoms
Flu
Cold
Allergy to Airborne Allergens
Cough Common Common Sometimes
General aches and pains Severe Slight Never
Fatigue, weakness Severe Sometimes Sometimes
Itchy eyes Rare or never Rare or never Common
Sneezing Severe Common Common
Sore throat Common Common Sometimes
Runny nose, stuffy nose Common Common Common
Fever Common Rare Never
Duration 1 to 2 weeks 3 to 14 days Weeks (ex: 6 wks for ragweed or grass pollen seasons) Check the pollen count


Over-the-counter medicationOver-the-Counter Medications
for the Symptoms of Allergies,
Colds or the Flu

Caution: These Drugs Can Be Very Helpful or Very Harmful!
Elderly
should avoid taking any over-the-counter cold medications due to the increased potential for serious side effects.
Children: Parents should always consult with your pediatrician before giving any of this medication to a child. Children under the age of 4 should never take over-the-counter cold or cough medication. Each year, thousands of children under age 12 go to emergency rooms after taking over-the-counter cough and cold medicines.
Be sure to read the labels before taking so you don’t combine the same active pain relief ingredients, such as acetaminophen. This is a very common, and potentially harmful mistake!
If You Have This Symptom
Choose a Medicine With This Type of Ingredient
Stuffy nose, runny nose
Stuffy nose

Decongestants can relieve nasal stuffiness due to allergies, colds, or the flu. They are available in many OTC products in both oral tablets and nasal sprays. The most common ingredients are:

  • Pseudoephedrine (oral)--Available only behind the pharmacy counter. More effective than phenylephrine.
  • Phenylephrine (nasal, and now in many oral forms),
  • Oxymetazoline (nasal)
  • Saline nasal spray (salt water, or Ocean Nasal Spray or Drops) every 2 hours or as needed, is the safest method to help clear the nose. Nasal irrigation is also a popular method of thinning mucus and flushing it out of the nasal passages. Although several methods of nasal irrigation exist, one of the most popular is the Neti pot. Neti pots are available over-the-counter at many drug stores, health food stores, and online retailers. They usually cost between $10 and $20.

Until recently, pseudoephedrine has been the more commonly used decongestant and the main active ingredient in many popular nonprescription cold and allergy medications. Unfortunately, pseudoephedrine is also a key ingredient in the production of methamphetamine, a highly addictive illegal stimulant. In an effort to combat methamphetamine production, federal law has recently required that all nonprescription medications containing pseudoephedrine be taken off drugstore shelves and be stored behind the counter in the pharmacy. To purchase these medications, you must go to the pharmacy, show some form of government-issued identification, and sign a logbook.

Some drug companies are concerned that this inconvenience may discourage people from buying cold and allergy medications containing pseudoephedrine. As a result they are quietly reformulating these products — removing the decongestant ingredient or replacing pseudoephedrine with phenylephrine. The label has not changed, and many people naturally assume that the product is unchanged as well. Phenylephrine was does not work as well as pesudoephedrine, so it's worth while asking the pharmacist for a product that contains pseudoephedrine.

Caution--Important facts about decongestants: Decongestants taken by mouth can have a number of side effects:

  • Anxiety/palpitations/Insomnia:Taking a decongestant gives most people a caffeine-like reaction. It may make you feel anxious, increase your pulse, make you feel like you have a racing heart or cause insomnia. Most combination cold products will combine a decongestant, which is usually stimulating, with an antihistamine, which is usually sedating, to achieve a product that is suitable for night-time cold relief, in most people. It is important to realize that individual reactions to these ingredients can vary. One person can take the night-time cold medicine and be sound asleep within 20 minutes, while another person can take the same medicine and be wide awake most of the night. In general, however, if the product says it's for night-time, most people will feel sedated after taking it.
  • Elderly are often advised to avoid decongestants and combination cold products altogether due to the potential for serious side effects. Saline nasal spray is recommended as an alternative.
  • People with chronic medical conditions--Check with your doctor if you have chronic medical conditions such as thyroid disease or high blood pressure before using any medication for a cold.
    Decongestant nasal sprays may work more quickly but have a rebound effect if you use them more than 3-5 days. They are best for short-lived colds and not for persistent allergies.
  • Phenylpropanolamine (PPA) is an ingredient that previously was widely available in weight loss drugs and decongestants. Although an effective decongestant and appetite suppressant, it has been associated with hemorrhagic stroke and most drugs containing this ingredient have been reformulated. However, there are still a small number of cold remedies and weight loss drugs still on the market with this ingredient. If you find this ingredent in your medicine cabinet, throw it out.

Runny nose, sneezing

The droplets expelled into the air from a sneeze
The droplets propelled into the air from a sneeze, dramatically illustrating the reason one needs to cover his/her mouth when coughing, or sneezing, in order to protect others from germ exposure. Image courtesy of the CDC

Antihistamines relieve symptoms related to allergies. With the exception of loratadine, the antihistamines usually cause severe drowsiness which can be a helpful side effect if sleep is needed. This side effect does wear off fairly quickly, however, with continuous use. The individual response of each of these medicines varies from person to person. Common antihistamines include:

  • diphenhydramine HCl (Benadryl Allergy, Tylenol PM),
  • brompheniramine maleate (Dimetapp),
  • cetrizine HCl (Zyrtec), non-drowsy in most people.
  • loratadine (Allavert, Claritin), non-drowsy in most people.
  • chlorpheniramine maleate (Chlor-trimeton),
  • clemastine (Tavist Allergy).

    It's very important to read the label before using these products. Elderly should be particularly cautious in using antihistamines, especially on a regular basis. The following precautions usually apply to this category of medication: Asthma and lower respiratory disorders, glaucoma, hyperthyroidism, hypertension, cardiovascular disease, GI obstruction, urinary obstruction, children, pregnancy. Diphenhydramine interacts with: alcohol and other CNS depressants as well as MAOIs.

Dry Cough that is not productive of sputum and is keeping you awake at night
Coughing is necessary to clear the lungs

Coughing is necessary to clear the lungs.

Cough suppressants should be used sparingly, mostly to allow sleep.

Cough suppressants may not relieve cough caused by asthma.

Cough suppressant-- Coughing is necessary to clear the lungs. Cough suppressants should be used sparingly, mostly to allow sleep. Cough suppressants may not relieve cough caused by asthma.

For children: always check with your pediatrician before giving your child any over-the-counter medication. The most effective cough remedies are available only by prescription. The following over-the-counter remedies are mildly effective:

-1/2 to 2 tsp of buckwheat honey before bedtime has been found to be helpful in suppressing a dry cough during sleep. A recent study compared the effectiveness of dextromethoraphan (the active ingredient in OTC cough suppessants) to 1/2 to 2 tsp of buckwheat honey, and the honey was found to be more effective. (Honey should never be given to children less than 1 year old.)

-Diphenhydramine (Benadryl) and/or the decongestant pseudoephedrine (Sudafed) is recommended by the American College of Chest Physicians, for the relief of a mild cough related to a cold. There are important contraindications for all of these medications, particularly pseudoephedrine and diphenydramine in the elderly. Always read the label and know what you're taking.

(Dextromethoraphan is commonly the active ingredient in over-the counter cough suppressants and is no longer recommended for the the symptomatic relief of a cough associated with the common cold. It has been shown to be effective in relieving a mild cough, and when taken in large amounts, dextromethorphan can produce hallucinations or "out-of-body" experiences similar to those caused by the hallucinogens phencyclidine and ketamine. Because of it's availability in the medicine cabinet, an alarming number of teens are abusing this medicine and causing serious, irreversible damage to their bodies.)

Expectorant to help bring up the sputum (guaifenesin) This is a very useful medication used by physicians to help manage respiratory infections. Mucinex is a brand often recommended by physicians and is frequently used in the elderly. Not recommended for children < 6 years. For children: check with your pediatrician before giving your child cough medicines or expectorants.

Fever, headaches, body aches and joint pains
Body aches and joint pains are distinguishing features of the flu

Pain Reliever--Children and teen-agers suffering from flu-like symptoms, chickenpox and other viral illnesses shouldn't take aspirin because of the possibility of Reye syndrome. Be sure to educate teen-agers, who may take OTC medicines without their parents' knowledge.

The most common ingredients for pain relief are acetaminophen (Tylenol), ibuprofen, naproxen sodium or aspirin. Many prescription and OTC combination, multi-symptom cold and flu preparations also include one of these pain relievers as active ingredients. Be sure to read the labels before taking so you don’t combine the same active pain relief ingredients. This could result in a toxic dose of that ingredient.

Acetaminophen (Tylenol) Many cold remedies contain acetaminophen (Tylenol), thus overdoses can easily occur by taking acetaminophen (Tylenol) in addition to these preparations. Many prescription and OTC combination, multi-symptom cold and flu preparations also include pain relievers as active ingredients. (Tylenol) Acetaminophen is the most widely used pain reliever and fever reducer in the United States, and it's readily available in most parts of the world. Acetaminophen causes more overdoses and overdose deaths than any other drug in the United States. Toxic levels of acetaminophen can result in severe liver damage or liver failure. Your liver is a vital organ--you can't live without it. Acetaminophen and alcohol don't mix. Even as few as three drinks at one time may have toxic effects on the liver when combined with certain over–the–counter medications, such as those containing acetaminophen.

Ibuprofen (Advil) Useful for minor arthritic pain, fever, headaches, minor aches and pain. Always take with food and fluids as it can cause stomach irritation, ulceration or even GI bleeding. Contraindicated in people with aspirin allergy, 3rd trimester pregnancy. Precautions dehydration, pregnancy, nursing mothers. Increased risk of GI bleeding wtih alcohol. Do not take aspirin or other pain relievers with ibuprofen. For children: Ask your pediatrician if it is safe for your child to take ibuprofen.

Naproxen Sodium (Aleve) for minor arthritic pain, headaches, minor aches and pain. Should be taken with food and fluids as it can cause stomach irritation, ulceration or even GI bleeding. Increased risk of GI bleeding wtih alcohol. Do not take aspirin or other pain relievers with naproxen. Not recommended for children. Contraindicated in people with aspirin allergy, 3rd trimester pregnancy. Precautions gastrointestinal disease, liver or kidney disease, dehydration, pregnancy, nursing mothers.

Aspirin (salicylate or salicylic acid) is used to relieve pain, fever, and the inflammation associated with arthritis. Aspirin may also be used to lessen the chance of heart attack, stroke, or other problems that may occur when a blood vessel is blocked by blood clots. Aspirin helps prevent dangerous blood clots from forming, but only should be taken under the supervision of a physician.
Warnings:
1) Can irritate the stomach or cause GI bleeding. Aspirin should always be taken with food, preferably after a meal due to its potential for stomach irritation and GI bleeding.
2) Children and teen-agers suffering from flu-like symptoms, chickenpox and other viral illnesses shouldn't take aspirin because of the possibility of Reye syndrome. Be sure to educate teen-agers, who may take OTC medicines without their parents' knowledge.
3) The anticoagulant effect of aspirin may increase the chance of serious bleeding in some people. Therefore, aspirin should be used for its preventive anticoagulant effects only when your doctor decides, after studying your medical condition and history, that the danger of blood clots is greater than the risk of bleeding.
4) Aspirin is also contraindicated in: people with allergy to aspirin or NSAIDs (Advil, Motrin, Alleve, etc), 3rd trimester pregnancy. Precautions: History of asthma or peptic ulcer, severe hepatic (liver) or renal (kidney) dysfunction, bleeding disorders, diabetes, gout, pregnancy or nursing mothers. Aspirin interacts with many medicines. For more contraindications and a list of drugs that interact with aspirin, click here

Daytime relief Read the label--choose one that doesn't cause drowsiness
Nightime relief Read the label--choose one that causes drowsiness
Read More
References


Cold and Flu Guidelines from The American Lung Association
Common Over-the-Counter Medications from the American Academy of Pediatrics

--Written by N Thompson, MSN, ARNP Last updated November 2009


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