Common Cold: A Collection of Articles on Medicine and Prevention

• Cold and Cough Medicine for Infants and Children
• 10 Tips to Prevent The Common Cold
• Making Sense of OTC Cold and Cough Medications

Medical Author: Benjamin C. Wedro, MD, FAAEM
Medical Editor: Melissa Conrad Stöppler, MD

Once upon a time, not so long ago, children were allowed to have runny noses and coughs. Colds were expected to last a few days and were considered an inconvenience.

But times have changed. The traditional family unit of one working parent and one at home is no longer the norm. Aside from not wanting your child to suffer, the practical considerations of adjusting day care and work - means adding more stress to a home with an ill child.

Acetaminophen (Tylenol) and ibuprofen (Advil, Motrin) are important drugs to use to control fever in children, but too often they are bundled with combinations of antihistamines, decongestants, and cough suppressants, suggesting an all-in-one cure for the common cold. Store shelves are filled with these over-the-counter medications that beckon parents to make life a little easier for their child. Yet, even in adults, these medications are less than helpful, and the side effects can be potentially deadly.

The Consumer Health Care Products Association, a group of companies that make these cold medications, pulled the drugs off the market in October 2007 "out of an abundance of caution." And while this will make good press, I am uncertain why the abundance of caution existed on October 11, 2007, when the FDA made their public health advisory announcement two months earlier on August 15, 2007.

The FDA advisory is a little confusing. They warn of the potential danger to children under the age of 2, but much of pediatrics is based on weight, not age. And how much different is a child who is 2 years and 1 month old (25 months old), compared with an infant 2 months younger (23 months old). I presume this is why the FDA is now studying the safety of cold medications for children under 6 years of age.

Aside from fever control, good hydration, and adequate humidity, there is little else to offer the cold sufferer, except time. Cough suppressants tend not to work and the American College of Chest Physicians recommend not using them in children under 14 years of age. Decongestants contain pseudoephedrine, a chemical that acts like adrenaline, and may cause children to become "wired". Antihistamines may be useful but can cause excessive sleepiness in children (remember that they are the active ingredients in over-the-counter sleep medicines), and some children paradoxically get agitated with antihistamines.

The bottom line is that children get colds and they get miserable. Parents want to make their child feel better, and that is not always easy.

References: American College of Chest Physicians, "Patient Information for Parents of a Child With Cough". FDA Public Advisory, "Nonprescription Cough and Cold Medicine Use in Children," August 15, 2007. Consumer Healthcare Products Association Press Release October 11, 2007 "Makers of OTC Cough and Cold Medicines Announce Voluntary Withdrawal of Oral Infant Medicines."

 

Medical Author: Melissa Conrad Stoppler, MD
Medical Editor: William C. Shiel, Jr., MD, FACP, FACR

The common cold is arguably the most common illness in humans. According to the U.S. Centers for Disease Control and Prevention (CDC), it is also one of the most common causes of work and school absenteeism, with up to 22 million school days lost each year in the U.S. Colds are caused by viral infections. Over 200 different viruses can cause cold symptoms of varying severity.

Viruses that cause colds are spread from person to person through tiny droplets of mucus that enter the air from the nasal passages of infected persons and are inhaled by others. Colds can also be spread by touching surfaces that have been contaminated by contact with infected persons and then touching your mouth, nose, or eyes.

While it is impossible to completely prevent the spread of colds, there are steps you can take to reduce your and your family's chances of becoming infected with a virus that causes colds:

• Wash your hands often. This is probably the single best measure to prevent transmission of colds. Especially after shopping, going to the gym, or spending time in public places, hand washing is critical. Frequent hand washing can destroy viruses that you have acquired from touching surfaces used by other people. You can also carry a small tube of hand sanitizer or sanitizing hand wipes when visiting public places. Teach your children the importance of hand washing too.

• Avoid touching your face, especially the nose, mouth, and eye areas, if you are around someone with a cold or have been touching surfaces in a public area.

• Don't smoke. Cigarette smoke can irritate the airways and increase susceptibility to colds and other infections. Even exposure to passive smoke can make you (or your children) more vulnerable to colds.

• Use disposable items if someone in your family is infected. Disposable cups can be thrown away after each use and prevent accidental spread of the virus from sharing of cups or glasses. This is particularly important if you have young children who may try to drink from others' cups.

• Keep household surfaces clean. Door knobs, drawer pulls, keyboards, light switches, telephones, remote controls, countertops, and sinks can all harbor viruses for hours after their use by an infected person. Wipe these surfaces frequently with soap and water or a disinfectant solution.

• If your child has a cold, wash his or her toys as well when you are cleaning household surfaces and commonly-used items.

• Use paper towels in the kitchen and bathroom for hand washing. Germs can live for several hours on cloth towels. Alternatively, have separate towels for each family member and provide a clean one for guests.

• Throw tissues away after use. Used tissues are sources of virus that can contaminate any surface where they are left.

• Maintain a healthy lifestyle. While there isn't direct evidence to show that eating well or exercising can prevent colds, maintenance of a healthy lifestyle, with adequate sleep, good nutrition and physical exercise can help ensure that your immune system is in good condition and ready to fight infection if it occurs.

• Control stress. Studies have shown that people experiencing emotional stress have weakened immune systems and are more likely to catch a cold than their calmer counterparts.

 

Medical Author: Melissa Conrad Stöppler, MD
Medical Editor: Barbara K. Hecht, PhD

Unsure about the hundreds of cold and flu preparations on the drugstore shelves? You're not alone. Deciding among the OTC (over-the-counter) remedies for cold, flu, or allergy symptoms can be intimidating, and a basic understanding of the types of drugs contained in these medications can help you make an informed choice.

Decongestants

Decongestants are the drugs of choice for a stuffy, congested nose. Decongestants act by narrowing the blood vessels in the nose, leading to decreased blood flow in the nasal tissues and reduced leakage of fluid from the nose. Decongestants can either be taken orally or applied locally (topically) in the form of nasal sprays or drops.

Pseudoephedrine (for example, Claritin-D, Sudafed, Allegra D) and phenylephrine are decongestants that can be taken orally. Phenylephrine and oxymetolazone are examples of topical decongestants. While topical decongestants are effective after a few minutes, oral preparations (tablets) can take about 30 minutes to work. Decongestants act as stimulants that can increase heart rate, raise the blood pressure, exacerbate palpitations, and lead to feelings of nervousness or feeling "hyper."

It's important to note that decongestants do not relieve a runny or itchy nose.

Antihistamines

Antihistamines counteract the effects of histamine, a chemical released by the body during allergic reactions. Histamines can cause sneezing, itching of the throat and eyes, and a runny nose. Over-the-counter antihistamines belong to one of two groups: first-generation antihistamines and the newer second-generation antihistamines.

The drugs found in first-generation OTC antihistamines include:

• brompheniramine,
• chlorpheniramine (for example, Tannate-12 S, Tannihist-12 RF, Trionate, Tussi-12 S, Tussizone-12 RF, Tussionex)
• dimenhydrinate,
• doxylamine, and
• diphenhydramine (Benadryl).

They generally have an opposite effect from decongestants and can be sedating. Paradoxically, infants and children may sometimes become irritable after taking antihistamines. Common OTC antihistamines take about 30-60 minutes to work. Loratidine (Claritin, Claritin RediTabs, Alavert, and others) is an example of the newer, second-generation antihistamines that is available OTC.

The second-generation antihistamines do not possess the sedating effects of the older, first-generation antihistamines.

Cough medicines

Cough medicines may be expectorants or cough suppressants.

Expectorants are medicines that help bring up mucus from the airways. Guaifenesin (Humibid, Humibid LA, Robitussin, Organidin NR, Fenesin) is a common expectorant. It promotes drainage of mucus from the lungs by thinning the mucus and also by lubricating the irritated respiratory tract.

Cough suppressants

Cough suppressants are intended to decrease coughing. A common OTC cough suppressant is dextromethorphan (Robitussin, Vicks 44), which acts on the brain to suppress coughing. Interestingly, dextromethorphan was not found to be any more effective than placebo in clinical trials involving children, and there are no indications established for its use in children. Suppression of coughing can also be dangerous in people suffering from certain airway diseases. Coughs due to upper airway viral infections can be treated simply with humidity and fluid administration.

Combination preparations containing one or more of the above drugs, sometimes along with pain and fever reducing drugs (aspirin, acetaminophen, ibuprofen, or naproxen sodium) are common. These are available in both tablet and liquid form. The liquid preparations are particularly useful for children who may need smaller doses. Combination decongestant/antihistamine medications can be well-tolerated since the stimulant effect of the decongestant and the sedative effect of the antihistamine often offset each other.

Remember to read the labels and note which active ingredients are contained in any medications you are taking. You should not take additional pain or fever reducing drugs if you are taking a combination medication that includes them. Your pharmacist or doctor can guide you to appropriate preparations for your particular symptoms and condition.