/publications/issue/2002/2002-10/2002-10-7006

Cold and Flu Season Is Here

Author: Barbara Sax

Now that the winter season is almost here, there will be no shortage of patients looking for relief from cold and influenza symptoms. Pharmacists can expect plenty of questions from patients because experts have no clear advice on treatment for symptoms of the common cold. With so many products on the market to treat symptoms, patients are often confused when it comes to choosing what is best for them.

According to the American Lung Association (ALA), flu and the common cold are the most frequent respiratory infections, especially during the winter months. Influenza affects more than 100 million Americans each year, and Americans collectively suffer through 1 billion colds annually.

Although colds and flu are both caused by airborne viruses, they are different illnesses. Viral upper respiratory infections, or colds, are the bane of winter and cause more time away from work and school than any other illnesses. The first symptom of a cold is usually a sore throat, which is followed by nasal congestion, runny nose, watering eyes, sneezing, and cough. Patients may complain of feverishness, but fever associated with a cold rarely exceeds 100?F.

The age-old advice to drink plenty of fluids and get lots of rest is still the best course of treatment for easing the discomforts of the common cold. There is also plenty of merit in the chicken soup cure?the hot steam from the soup may be its chief advantage. In fact, drinking any hot beverage can have similar sooth ing effects. Colds generally run their course in 1 to 2 weeks, whether or not the symptoms are treated.

FLU: More Serious Than Colds
Flu symptoms generally are much more severe than cold symptoms and in some cases can be deadly.  Of the 3 types of influenza virus (A,B, and C), Influenza A is responsible for most flu cases.  Types B and C are far less common and cause milder illnesses.

Typically, flu symptoms begin to appear 1 to 4 days after exposure to the virus. Symptoms often occur suddenly and include headache, chills, sore throat, nasal congestion, fatigue, muscle aches, cough, and a fever that can run as high as 104?F.

Flu symptoms in children are similar to those in adults, although children?s temperatures  tend to run higher and can range from 103?F to 105?F. Elderly patients and those with weak immune systems are at risk of developing symptoms that can grow so severe that the illness may become life-threatening. Pneumonia, caused when bacterial infections reach the lower respiratory tract, is the most serious complication of flu.

Health experts say that the best way to prevent the flu or lessen its severity is to get a yearly flu vaccination. The US Centers for Disease Control and Prevention urges the following groups of people to be vaccinated:
? people 50 years or older
? pregnant women
? patients with an impaired immune system, diabetes, or chronic heart, lung, or kidney disease ? people living with any of these patients

October and November are the optimal times to receive a flu shot, but a flu shot can be given at any time during flu season. To be effective in fighting flu, a flu shot must be given annually, since the virus is constantly changing and new vaccines are developed each year.

Because the viral material in flu vaccines is grown in eggs, the ALA cautions against flu vaccination for patients who are allergic to eggs. Patients with an acute illness or a fever should wait until they have recovered fully before receiving a flu shot.

Patients experiencing severe flu symptoms should be referred to their physician. New prescription medications are available that must be taken within the first 2 days of illness. However, many flu patients and most cold sufferers will seek the aid of OTC medications. Flu patients seeking to reduce fever and the aches and pains associated with the viral infection should take acetaminophen, ibupro-fen, or aspirin. Children and teens should avoid aspirin and aspirin-containing products and should be directed instead to an alternative nonsteroidal anti-inflammatory drug (NSAID).

Alleviating Symptoms
Although symptoms associated with cold and flu are rarely life threatening, they can certainly make patients miserable. That is why there is no shortage of OTC products designed to alleviate cold and flu symptoms.
Decongestants, which help reduce ?stuffiness? and runny nose, have long been a mainstay of cold and flu treatment. Decongestants open the nasal passages by shrinking blood vessels in the mucus membrane of the nose, which is the primary cause of the nasal obstruction of colds. These products can be taken orally or applied directly on the nasal mucus membrane in the form of nose drops, sprays, gels, or vapors.

Nasal decongestants, which are available in a long-acting (from 6 to 12 hours) or short-acting (lasting about 4 hours) formula, work faster than oral decongestants and have fewer side effects. The main drawback to nasal-delivery decongestants?particularly the long-acting variety?is a resulting cycle of dependency and rebound. With prolonged use (more than 3 to 5 days), nasal decongestants lose their effectiveness and can exacerbate congestion. That can prompt patients to use the product more frequently. Prolonged use can cause swelling in the nasal passages, causing the problem to worsen further.

Oral decongestants have less immediate action but cause fewer problems with cycles of recurrent nasal obstruction than topical preparations do. Nearly every oral decongestant and combination OTC cold remedy now contains pseudoephedrine. Common side effects of oral decongestants include agitation and nervousness, rapid heart rate, changes in blood pressure, and drowsiness. Patients should avoid drinking alcohol when taking decongestants. The OTC products are also contraindicated with certain drugs, such as monoamine oxidase inhibitors and sedatives. Patients with heart disease, high blood pressure, thyroid disease, diabetes, prostate problems, or migraines?as well as pregnant women or women who are breast-feeding?should not use decongestants without seeking the advice of their physician. Infants and small children should be given pediatric decongestant preparations only under the supervision of a physician.

Antihistamines
Designed for use in treating allergy symptoms, antihistamines work by preventing the stimulation of the sneeze reflex. They are commonly found in OTC combination cold remedies, which combine them with NSAIDS, decon-gestants, and cough suppressants to address many symptoms. In some cases, use of the medication can cause side effects, such as drowsiness.

Combination products that include a cough suppressant as well as an expectorant are counterproductive and irrational. Experts say that products that address specific symptoms tend to be most effective in treating cold and flu symptoms.

Suppressing a Cough
Coughing can be the most maddening symptom of a cold. Coughs are divided into 2 classes: a productive cough that expels mucus and phlegm and an unproductive dry, hacking cough. Productive coughs should not be suppressed, since they are performing an important function of expectorating mucus and phlegm. Drinking plenty of liquids, using a humidifier or vaporizer, and using a cough medication containing guai-fenesin can also help to loosen phlegm and make coughs more productive.

Patients with dry, unproductive coughs can use antitussives, or cough suppressants. Dextromethorphan and dexbrompheniramine are the most common active ingredients in cough suppressants. Some contraindications exist; for example, patients who use monoamine oxide inhibitors should not take products containing dextro-methorphan.

Lozenges, gargles, and sprays containing antiseptics and topical anesthetics are also popular in treating cough and sore throat. Gargling with salt water or warm saline can help, as can drinking juices and water frequently and sucking on hard candy. All these procedures stimulate saliva, soothe sore throats, and help to ease dry cough.

Nontraditional OTCs
Because traditional OTC products have their limits?none can prevent a cold or lessen the duration of infection?many patients have turned to herbal remedies. Each winter season new studies suggest a new herbal remedy for treating or preventing colds.

Zinc has become a popular remedy for the treatment of colds. Pharmacists now commonly recommend zinc products to their patients for the treatment of cold symptoms. New information shows that zinc may also play a role in preventing colds. The findings of a recent study suggest that the zinc gluconate glycine formula in Cold-Eeze lozenges may have significant preventive capability in an adolescent population.

Echinacea is another common herbal remedy used to prevent or ease cold symptoms. In Germany, for example, approved forms of echinacea are widely used to treat colds in both children and adults. No clear studies have been done in the United States to test the effectiveness of echinacea, and there is little regulatory control over echinacea products.