Prevention is Key During Cold & Flu Season

October 21, 2019

"A cold is caused by a respiratory virus, but more specifically the it’s caused by over 200 different strains of virus."

Fall and winter are upon us, and while the changing of the seasons is beautiful, it has its downsides... like the increased chance of catching a cold! In today's show with Dr. Keller Wortham, MD, he'll talk about why we get colds more often this time of year (spoiler alert: it's not from being outside in the cold) and then he'll give us some great tips for preventing and treating colds including a thorough review of over-the-counter medicine options.

Video Highlights

  • 01:02: What Causes Colds and Flus
  • 03:33: Symptoms of a Cold
  • 06:02: Treating a Common Cold
  • 07:23: Prevention
  • 10:11: Managing Symptoms
  • 19:31: Natural Options
  • 22:42: Wrap-Up

There are great things about fall and winter: the leaves changing, the holidays, maybe snow, the chance to go skiing... why does such an amazing season have to be tainted with colds and flus? What is it about winter that causes us to get sick more frequently? Well, colds as you know, are probably named after the colder winter months, but it’s not really being outside in the cold that makes you sick. 

What Causes Colds and Flus

Colds and flus are caused by a virus, and viruses tend to be more easily transmitted in colder months. That's because when the air is dry and less humid, like it is in the winter, viruses can stay alive longer in that environment and can be carried further. In humid times, they tend to precipitate out in the humidity and drop to the ground where the virus doesn't survive as long.  Additionally, we tend to be indoors more during the winter, insulating ourselves from the environment and the elements, and therefore we have more close contact with other people and less ventilation. So, although cold air doesn't really cause a cold, there is an association between the colder environment and the cold virus being more easily transmissible.  

A cold is caused by a respiratory virus, but more specifically the it’s caused by over 200 different strains of virus, not just one. And all these different viruses travel in our respiratory droplets from one person to another. Respiratory droplets are secretions that get into the air when we cough or sneeze, and they seek out another human beings to enter through their mucous membranes — our nose, eyes, and mouth — and then it finds its way into our respiratory tract and starts spreading. 

So, we can basically get it from the aerosolized droplets or we can get it when that lands on a surface and then we touch it, and then spread it to our own body’s mucous membranes. In other words, your mom was right — cover your mouth when you cough and sneeze, and don't touch your face. 

Symptoms of a Cold

Pretty much everyone has had a cold at some point, but we’ll go over the common cold symptoms. Symptoms of the cold virus have to do with inflammation of the respiratory tract, and include: a runny nose, sore throat, sinus congestion, and irritation of the upper airways that can lead to a cough. Those are some of the symptoms of a cold, and then there are also systemic symptoms where your whole body is feeling it. These can include headaches, muscle aches, and fatigue.  

After you’ve been exposed to a cold virus by touching a surface and transmitting it to your face, or by being exposed to respiratory droplets from someone else, it usually takes about one or two days for you to start experiencing the symptoms. Generally, you first start experiencing the symptoms right before you are most contagious. So, this pesky little virus can be spread around before we even notice what's happening. Then the infection and associated symptoms can last seven to ten days. Again, the worst part of that is usually towards the beginning, during the first two days. 

Interestingly, a lot of the symptoms we get from a cold have nothing to do with the cold virus destroying our body — it is our immune system reacting to the cold virus and trying to fight it off that causes the symptoms. So, a lot of those things we experience — headaches, sore throat, runny nose — that is our immune system trying to expel the virus. But the cold virus itself actually really doesn't do too much cellular destruction. 

Treating a Common Cold

So, you’ve got a cold. It's very common; billions of people get it all the time. But what do we do about it?  There is no vaccine for the cold, and unfortunately, there's no cure for the common cold either. Fortunately, cold symptoms are usually mild and the cold is self-limiting, meaning you don't have to do anything; it will go away on its own after it has run its course. However, with winter time and the close proximity that’s associated with it, you might want to think twice about being in densely populated rooms or areas like the office Christmas party. If you do go, just be really careful about who you're talking with and make sure you don't touch your face.

If you do have more serious symptoms — for example if you're starting to get short of breath, you're starting to get high fevers, or the cold is not going away — then you should see your doctor because it could be evidence that you do have something like the flu or that you've got something more serious like a bacterial sinus infection or pneumonia.  

Prevention  

Prevention is always the first line of defense.  We've already alluded to some of the strategies for prevention, but we’ll go over them in more detail here:

  • Wash your hands — keep your hands clean all the time.  Wash them after you use the bathroom, after you've been on the subway or an airplane or just around the office, and certainly wash them before you eat. 
  • Don't touch your face —  You can get a virus on your hands and it won’t do anything. You're not going to catch a cold on your hands. But as soon as you rub your nose or touch your eyes, or lick your fingers after some good meal, that's how the virus gets into your body.  
  • Avoid people who are sick — Do your best to avoid people who are exhibiting signs or symptoms of a cold.  We recommend keeping a five to six feet of distance from people who are sick. Obviously, this isn’t always possible — if your kids or other family members are sick, or you work with children frequently, for example, you may not be able to maintain that much distance from all sick people all the time. Just do your best, and when you’re in those environments, be extra vigilant about the first two strategies we talked about (washing your hands and keeping them away from your face). 
  • Stay home if you’re sick — if you are exhibiting symptoms of a cold, do your coworkers a favor and call in sick. Stay home, especially during those first two days when you're most contagious and the rest of the world will thank you. Again, we know this isn’t always possible for everyone, but just do your best.
  • Don't share food and drinks in general if you can help it, because as we discussed, a lot of times people can be the most contagious before they even have symptoms. Drinking after someone else can bring their saliva into contact with your mucous membranes, and you could become infected.  
  • Take care of your immune system — this is the best preventative strategy we can offer. Do this by sleeping adequately, getting good exercise, eating a healthy diet, and mitigating or reducing stress in your environment. Stress is terrible for the immune system. If your immune system is in good shape, it can try to fight off that cold virus, or if you do end up with a cold, it can get rid of it a lot faster.

Managing Symptoms

If you've been to any pharmacy, you've seen that there is an entire aisle dedicated to cold remedies. That's because everybody gets colds, and everybody wants to treat them. It can be dizzying to go to that aisle; there are literally hundreds of options and combinations including daytime vs. nighttime, sinus vs. cough, and severe vs. normal. We’re going to break it down for you, so that when you get to that cold and flu aisle you can do your shopping efficiently and know what remedy is right for you.

Cold remedies exist in various categories:

Antipyretic

Most cold remedies have a first ingredient which is called an antipyretic, which basically means “fever reducer”. In the U.S., it will either be ibuprofen, which is also known as Advil, or acetaminophen, which is also known as Tylenol. Those are basically the two choices.  Which one you choose can depend on a couple of things: ibuprofen is good as a base fever reducer because it's also an anti-inflammatory. So, if you're getting some inflammatory symptoms in your sinuses and your respiratory tract, that might be the better choice. It is important to know that ibuprofen can be a little harsher on the stomach and kidneys, so if you're someone who gets stomach ulcers, GERD or gastritis, you may not want to opt for that one. If you've got kidney disease, consult your doctor before you take anything.  On the other hand, Tylenol is processed in the liver. So, if you have a history of liver disease, or if you drink a lot of alcohol, then Tylenol might not be the right choice for you.

Antihistamine

The next thing that most cold remedies will have is called an antihistamine.  That means it blocks histamine, which is responsible for giving you the runny nose, runny sinuses, and itchy eyes. If you're getting those symptoms, then look for something that includes an antihistamine. All of these ingredients are conveniently written on the side of the box, and are very easy to identify. Antihistamines come in two broad categories: drowsy and non-drowsy.  That is usually what determines whether they label something as daytime or nighttime symptom relief. Daytime is usually a non-sedating antihistamine, and nighttime medicines will knock you out. One of the main daytime options is called chlorpheniramine.  One of the main nighttime ones is diphenhydramine, also known as Benadryl.  So, if it's at night and you can't sleep because you're feeling terrible, then take a nighttime one.  If it's during the day and you need to stay awake, obviously you want to choose a non-sedating option.  

Cough Suppressant

If it's labeled “cough and cold”, it probably contains a cough suppressant — most commonly dextromethorphan. If the cough is the thing that's bothering you, then get one that includes that. A little note: if you feel like you've got a lot of phlegm that needs to come up, and you feel like maybe coughing is actually a good thing because you need to get it out, then you might want to opt for one that does not include a cough suppressant. That way your body will go through its natural reflex process and expel that phlegm.

Expectorant  

In an expectorant, the main ingredient is usually guaifenesin.  Guaifenesin thins secretions in your lungs and sinuses, making them easier to get out.  So, if you're worried about a lot of chest congestion or sinus congestion, make sure it has an expectorant. And again, you might want to opt for an expectorant without a cough suppressant so that you can thin the secretions in your lungs and your body’s cough reflex will get them out. That can help reduce the chances that you get a bad sinus infection with bacteria, or later that you get pneumonia from all the gunk building up in your lungs.  

Decongestant

A decongestant opens up the sinuses and nasal passages. So, if you're really stuffy or if you're prone to sinus infections, get something with a decongestant. These are usually labeled “sinus and cold”, or “sinus headache”, or “cold and sinus”. Decongestants help drain the sinuses and help reduce the chances that you get a sinus infection by helping get all the gunk out. In the U.S., decongestants are usually either pseudoephedrine or phenylephrine, both of which are stimulants. Biochemically, stimulants work by opening up the nasal passages.  

However, stimulants can make you feel antsy and they can raise blood pressure.  So, if have hypertension (high blood pressure) you might want to think twice or at least consult your doctor before you get something as a decongestant. Some of the decongestants — the phenylephrine — you can just buy right there over the counter, but to purchase those with pseudoephedrine you may need to give your ID and get it from behind the counter. You don't need a prescription, but it’s not as easy to get because people sometimes use the ingredients in the production of illicit drugs.

Those are the broad categories. So, basically you need to ask yourself what your symptoms are, and what you are most concerned about. Is it the cough? Is it the itching and the runny nose? Is it my body aches? Are you afraid you’re going to get a sinus infection? Do you want to sleep right now or do you need to stay awake? This guide will hopefully help you make that decision.  Most of these medications include the same or similar doses, as specified by FDA standards. That means you can often opt for generic versions, which differ very little from name brands.

Natural Options

What if you don't want to take meds and prefer to treat your cold using natural remedies? In that case, Dr. Keller recommends (in addition to the natural prevention techniques we discussed already), Zinc products. Zinc is a natural element, that has been shown to help prevent viral replication and therefore reduce the duration and severity of a cold. It's not going to prevent the cold from coming on but it can help reduce that. Cold Eeze is a good example: it has zinc in it and comes in the form of lozenges, so it stays in the nasal oral area longer because you're sucking on it for longer. Zicam is another brand, which also includes zinc in rapidly dissolving tablets. 

You can also try some other age-old natural remedies:

  • Black tea with honey and lemon.  Honey and lemon are soothing, and black tea can actually help with some sinus decongestion, as well as numbing some of the irritation that you might have. Warm liquids are great, and if you don't want to drink caffeine, just drink warm water with lemon and honey.
  • Gargle with saltwater. Get some warm water, add salt, and gargle with it. It’s believed that there’s an osmotic process, basically a shift in concentrations that helps shrink down the swollen cells in the back of your throat. Salt is also known to help relieve or reprogram pain mechanisms.  
  • Homeopathic remedies. These include Vitamin C, echinacea, and similar products.  Studies show conflicting evidence about how effective these are, but they are almost certainly not going to harm you.

Wrap-Up

Finally, there are just a few more things to know about the common cold:

  • You do not need antibiotics. Don't go to your doctor and pressure him or her to put you on antibiotics. It's a virus, which will go away on its own. 
  • That being said, some people can end up with a bacterial sinus infection or pneumonia. So, if symptoms are getting worse after five or six days, go in and talk to your doctor. It could be that you've gotten a bacterial infection after the fact.  
  • If you get a high fever, you should see your doctor — that could indicate that it's a flu, or pneumonia. 
  • People often think that if they have yellow and green sputum they must have a bacterial infection, but that’s actually a myth. It simply means that you have white blood cells in your nasal secretions or your cough sputum. White blood cells are present for both viruses and colds.

As always, if you ever have questions, go see your doctor. Remember, don't touch your face, wash your hands, stay healthy, and have a great holiday season.

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