You drag your winter coat out of the closet, empty the pockets of last year’s soiled tissues and unused cough drops and begin your march through another New England winter. A few weeks pass and one morning you awaken with a familiar feeling. You are unusually tired and achy, feel a bit warm, or have chills. And come to think of it, last night you “just didn’t feel right”. As the day progresses, maybe you begin to develop a cough, runny nose, sore throat, sneezing, mild headache, nausea, or feel weak. Your body is telling you something: you’re sick!
Hopefully, prior to this, you received an influenza vaccination and established care with a primary care provider for when the going gets rough. You trudge down to the pharmacy seeking medication for symptomatic relief. You are confronted with aisles stacked high with little expensive boxes, their flashy labels overwhelming, their fine print dizzying. There are at least two unpronounceable names on every box you pick off the shelf. How will you choose what is right for you? Here is some information to help you weather the trials of seasonal illness, find some relief from your symptoms with supportive care, avoid common pitfalls, and know when to seek the help of a medical professional.
This information applies to otherwise healthy adults. Approach to illness can vary for certain groups, such as: infants and young children, adults > 65 years old, pregnant patients, and those with significant underlying illness such as cancer, diabetes, heart, lung or kidney disease, or those who reside in a nursing home or other care facility. When significant new symptoms arise in these groups, it is best to consult a health care professional.
Viral or Bacterial illness?
Whether it is the common cold or influenza (“the flu”), these are caused by viruses. Rhinovirus is a major cause of the common cold and includes about 100 different virus types. With rare exceptions, such viral infections are treated with what is termed “supportive care”: staying hydrated, well rested and perhaps using over-the-counter medications as needed for symptom relief until the illness completes its course. It is not uncommon in the setting of non-specific symptoms like those mentioned above to initially proceed with a plan of supportive care with the expectation that symptoms can last for 5 to 7, or even 10 days, with individual symptoms lingering for 2 weeks in some cases.
A bacterial respiratory illness may share the same symptoms of a viral illness and also may resolve without the need for prescription medications. For severe or persistent symptoms despite supportive care, persistent fever, or in cases where there is initial improvement and then return of fever or development of shortness of breath, seek medical evaluation. Bacterial illnesses may not resolve on their own and may require prescription of an antibiotic.
Do I need an antibiotic?
Brand name medications and their generic equivalents may address a single symptom or multiple symptoms. It is common for “cold and flu” medications to contain multiple active ingredients that address a variety of common symptoms. It is important to note that although these medications may provide temporary relief and make an illness more tolerable, in general, they do not shorten the overall duration of illness.
Classes of medications that may be used to treat a viral illness include:
1) Analgesics and Antipyretics (treatment of pain and fever)
2) Decongestants (decrease nasal or chest congestion)
3) Antihistamines (decrease secretions and inflammation)
4) Antitussives (cough suppressants)
5) Expectorants (make it easier to cough up sputum)
You probably know the brand names from the many advertisements. Read the smaller print on the label to find the active ingredient(s) which will reveal the generic name(s). This can help you purchase more affordable generic versions. Knowing the ingredients is especially important if you buy cold and flu medications as these contain a combination of different drugs. You want to avoid taking more than you should of any particular medication. If you are not careful when you take multiple medications for your symptoms, you may take an additional dose of a drug that is already contained in the cold and flu medication that you have already consumed.
Medications will hopefully provide the intended benefit, but any medication may result in unwanted side effects or allergic response. Special precautions may limit your ability to take certain medications or limit the amount you can safely take, such as known kidney or liver disease, cardiovascular disease, gastrointestinal bleeding risk, use of blood thinning medications, blood pressure medications, sedatives or other medications. If you have any concerns, please ask your health care provider or pharmacist for help.
Analgesics and Antipyretics
There are two main categories of oral medications for over-the-counter pain and fever relief. Acetaminophen (Tylenol) is one. It may be used to manage pain or fever. It is a component in hundreds of over-the-counter and prescription medications, including cold and flu formulations. It is distinctly different from the family of medications known as non-steroidal anti-inflammatory drugs (NSAIDs). NSAIDs include ibuprofen (Motrin, Advil), naproxen (Aleve, Naprosyn), and aspirin (Ecotrin), to name just a few. NSAIDs can be used to treat fever or pain caused by an inflammatory process. As they can have an adverse effect on kidney function, patients with kidney disease should limit or avoid their use altogether, as advised by their care provider.
Assuming that you do not have any contraindications to take either family of medication individually, you may take an NSAID in conjunction with acetaminophen (Tylenol), but only take one anti-inflammatory medication at a time. That is, do not take ibuprofen with naproxen as this is the same class of medication and taking multiple such medications together can lead to adverse gastrointestinal, kidney, or toxic effects. NSAIDs can be useful, and are best taken over brief periods of time in small quantities and with food to avoid acid reflux (“heartburn”), stomach pain and other adverse effects. Avoid NSAIDs if you are also taking a blood thinning medication like warfarin (Coumadin) or a new generation anti-coagulants such as rivaroxaban (Xarelto) or apixaban (Eliquis), as taking these together may lead to serious bleeding. Always read the label to understand the indications and potential side effects of the medications you take and consult a medical professional if you have any questions.
These may take oral, drop, or spray forms. Decongestants may be used for short periods, 3 days or less, to help to constrict swollen blood vessels and reduce the tissue inflammation that contributes to nasal congestion. They may be beneficial in a previously healthy individual with acute symptoms of congestion due to an upper respiratory illness. Decongestants include pseudoephedrine or phenylephrine (Sudafed) and oxymetazoline (Afrin).
Nasal decongestants are not recommended for use for more than 3 consecutive days as they may cause rebound congestion. Patients with uncontrolled high blood pressure, significant heart disease, bladder emptying problems, overactive thyroid, angle closure glaucoma, among other conditions as noted on the packaging, should avoid nasal decongestants as they may worsen underlying conditions. If you do have underlying illness, consult with your health care provider before initiating such medication.
Antihistamines are typically used for symptoms of itching, runny nose, watery eyes, and sneezing. Side effects may include dry mouth, thickened secretions, and drowsiness. A common antihistamine is diphenhydramine (Benadryl). A combination of an antihistamine and decongestant together may work better than use of either type of medication alone. Loratadine (Claritin), cetirizine (Zyrtec), and fexofenadine (Allegra) are also antihistamines, however, these are only recommended for use in allergies.
Antitussives, such as dextromethorphan (Robitussin), are cough suppressants which block the cough reflex. Side effects may include dizziness, drowsiness, and nausea.
Expectorants, such as guaifenesin (Mucinex), loosen and thin secretions from the lungs and reduce the feeling of chest congestion by assisting in mucus drainage. Side effects may include gastric irritation and nausea and vomiting.
What if you don’t like to take medications?
If you don’t like to take medications for your cold symptoms you are in luck, because you don’t have to! A viral illness will often resolve in 5 to 10 days. Stay well hydrated, well rested, and eat well. Pay attention to the coloration of your urine. If it appears concentrated (darker yellow than usual), it probably means you need a bit more fluid intake.
Precautions to prevent the spread of illness to your family and friends
Thorough hand washing, especially after trips to the bathroom, coughing, sneezing, or blowing your nose, and surrounding food preparation are helpful in preventing transmission of illness. Cover your mouth and nose with a tissue or with the crease of your arm if you cough or sneeze. Do not share utensils, tooth brushes, or towels.
Avoid direct contact with groups that may be at risk for infection or for whom infection may have greater consequences, such as infants and young children or the elderly, pregnant women, patients undergoing therapy for cancer, patients with a known immune disorder or on immunosuppressants, transplant patients, or those with other reasons for high susceptibility to illness.
Duration of illness and when to seek medical attention
A typical viral upper respiratory illness or influenza-like illness can last up to 10 days, and you may experience some lesser, lingering symptoms for a bit longer. You will be most contagious in the first 1 to 3 days of illness and should take precautions to prevent the spread of sickness for as long as you are symptomatic.
You should seek medical attention for
• Difficulty breathing
• Severe chest pain
• Inability to keep down liquids
• No improvement in symptoms after 7 days
• Persistence of cough for greater than 2 to 3 weeks
• Return or worsening of symptoms after initial improvement
• Fever ≥ 102° F that is worsening or not responding to medication
• Fever with recent travel to area where malaria is common
When in doubt, if you have any concerns, reach out to your primary care provider for assistance.
An ounce of prevention is worth a pound of cure
Experiencing illness does help us appreciate the complexity of our body and the value of healthiness. Prevention and management of viral illness is only one aspect of health consciousness. On a daily basis, respect your body and make a focused effort to treat it well. If you are a tobacco user or in close, regular proximity to a tobacco user, such exposure is contributing to ongoing lung damage, long term cardiovascular disease, kidney disease, increased risk of blood clots, and cancers. You may early on notice that you suffer more frequently from episodes of bronchitis than your family or friends. Take action, make a plan to gradually reduce your exposure, and solicit the assistance of your health care provider. If you have family or friends who smoke, support them with thoughtful encouragement as they strive to improve their health. If you review your dietary intake and find that too often your consumed calories include items of poor nutritional content or are high in sodium, know that this will have a measurable effect on your quality of life as you age and contribute to such illnesses as diabetes, hypertension, and elevated “bad” cholesterol which can result in disease states that can reduce the quality and span of your life. We are creatures of habit and although we may acquire some bad habits, new, healthier habits can be acquired too. Treat your body well and enjoy the rewards!