Cold, Flu or Worse?

Cold and flu season will be upon us in full force very soon. With the changing weather and the kids going back to school, it is likely there will be a stuffy nose in your future. But knowing how the different “bugs” work may help you get through these next months in good health.

The common cold can be caused by one of more than 200 viruses (tiny micro-organisms) that infect your upper respiratory system. Colds are typically spread by hand contact and then touching the eyes or nose; inhaling large respiratory droplets spread by coughing or sneezing; or being around someone who is sick and inhaling smaller droplets over longer periods of time.

There are a few things that can help prevent you from contracting a viral illness. Be sure to wash your hands frequently and thoroughly when around the sick. Disinfecting contaminated surfaces can help. Viruses can survive on doorknobs, tabletops, and other surfaces for up to 3 hours after being outside the human body. A good diet, moderate exercise and plenty of rest can help boost the immune system. While Vitamin C, Echinacea, and Zinc are popular cold remedies, there unfortunately is little evidence to support their use.

For influenza, a serious and sometimes life threatening viral illness, there is effective prevention with the annual “flu” shot. This will protect only against the most prevalent strain of influenza but not other respiratory viruses. While viruses cause the majority of upper respiratory illnesses, there are some that are caused by a bacterial source, and thus require antibiotic therapy. These include “strep throat,” sinusitis or “sinus infections,” “middle ear infections,” and sometimes pneumonia or bronchitis. Strep throat typically does not include runny nose or cough. Rapid tests are available that allow doctors to check for strep while in the office.

Ear infections are commonly a problem in younger children and usually occur within a couple of days of common cold symptoms. Typical symptoms include intense ear pain and fever. It is also possible to have ear pain and hearing loss from blockage of draining mechanisms of the ear, the direct result of swelling from allergies or viruses. A visual exam of the eardrum can help doctors differentiate between the two.

Sinus infections manifest as pain just above and below the eyes after approximately 10-14 days of viral symptoms. The “double sickening” history is also sometimes suspicious for a sinus infection; this is when nasal congestion initially seems to get better, but then fever, sinus pressure, and pain soon develop. Occasionally the pain from sinus infection will radiate to the front teeth. Contrary to popular belief, colored mucous often has no relation to bacterial infection; clear mucous will turn yellow, green, or brown if it sits in the nasal passages long enough with a viral illness.

People with damaged lungs from smoking (such as emphysema) or who have a chronic lung disease are predisposed to getting bacterial bronchitis. Asthma sufferers tend to have worsening of their breathing with a viral illness, and may require a medicine called a corticosteroid to decrease the inflammation in their lungs.

“Whooping cough” or pertussis is on the rise. It typically presents as a sore throat, fatigue, and occasionally a runny nose followed by a cough with clear mucous. After 2 weeks of these symptoms the coughing fits last up to several minutes and tend to be more intense sometimes followed by vomiting or a characteristic gasping whoop after the fit. Tests are available to confirm pertussis exposure in an outpatient setting.

Pneumonia manifests as a cough, shortness of breath, wheezing, fever, and occasionally painful breathing. Careful listening by a doctor and chest x-rays can help confirm the diagnosis. “Walking pneumonia” is a less severe, but bothersome illness that antibiotics can help. Other forms of pneumonia can be life threatening.

So what's one to do? If there is any doubt, seeing a medical professional is your best bet. This includes questions about over the counter medications, possible interactions with prescription medications, or potential implications for other medical problems. If it seems like the typical symptoms of a cold, treat the symptoms. For fever, aspirin, ibuprofen (Advil, Motrin), or acetaminophen (Tylenol) can be helpful. Antihistamines such as Benedryl or Clor-Trimeton can slow down a runny nose for some. Use caution, however, as drowsiness is a common side effect. Decongestants such as Sudafed help open stuffed up nasal passages. As these medicines have some stimulant effect, use with caution if you have high blood pressure or heart problems. Expectorants like Robitussin help loosen thick secretions in the nose, throat, and chest by making them more watery, and thus are helpful for nagging coughs. Nasal sprays such as Afrin or Neosynephrine can open nasal passages effectively, but should be used briefly (3 days) as long term use can lead to worsening congestion, and therefore dependence on continual doses. There are combination preparations that contain antihistamine, decongestant, and fever reducer like Alka Seltzer Cold and Flu, Advil Cold and Sinus. Consider the store brand generics; they are always cheaper.