Cold and Flu Season
By Ron Van Ness-Otunnu, MD, FACEP, Associate Chief, Emergency Care Center, Sturdy Memorial Hospital
Winter has arrived in full force and you may already be battling symptoms of a sore throat, runny nose, cough, chest congestion, aches, or fever. Here is some information that may provide some insight into your illness, help you find relief from your symptoms, and suggest when to seek the help of a medical professional.
Cold vs Flu
The common cold and influenza are caused by viruses. Common cold symptoms are milder than flu symptoms. Cold symptoms last about a week and include sore throat, runny nose, sneezing, cough, congestion, and low-grade fever. Flu symptoms are more severe, associated with a significant fever, cough, muscle aches, headache, sore throat, fatigue, and longer duration of symptoms. Both cold and flu are treated supportively by staying well hydrated and rested and taking over-the-counter medications as needed for symptom relief. For children < 5 and adults ≥ 65 years old, women who are pregnant, and those with significant medical problems, if influenza is identified within 48 hours of onset of symptoms, prescription of an antiviral medication may be considered. Although this may reduce the duration of illness slightly, it does not “cure” influenza and may be associated with adverse effects, such as headache or vomiting.
Viral vs Bacterial
A bacterial respiratory illness may share the same symptoms of a viral illness. Although a cough with sputum production may be present in either a viral or a bacterial infection, a bacterial pneumonia is more likely to be associated with rusty or blood tinged sputum, shortness of breath or increased rate of breathing, and persistent fever. Bacterial illnesses may not resolve on their own and may require prescription of an antibiotic.
It is common for “cold and flu” medications to contain a variety of active ingredients that address multiple symptoms. Although these medications may provide temporary relief, in general, they do not shorten the overall duration of illness.
Analgesics and Antipyretics
These manage pain or fever. Acetaminophen (Tylenol) is one type of this medication. Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are another. NSAIDs can have an adverse effect on kidney function so patients with kidney disease should limit or avoid their use altogether, as advised by their care provider.
These decrease nasal or chest congestion and may take oral, drop, or spray forms. Decongestants may be used for short periods, 3 days or less. 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.
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 combination of an antihistamine and decongestant together may work better than use of either type of medication alone.
Antitussives block the cough reflex. Side effects may include dizziness, drowsiness, and nausea.
Expectorants 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, nausea, and vomiting.
Taking precautions and when to seek medical attention
You should take precautions to prevent the spread of sickness for as long as you are symptomatic. 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, toothbrushes, or towels.
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, persistent for more than 3 days, or not responding to medication
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.