Managing symptoms of viral upper respiratory illness

Overview

• Colds and flus are both caused by viruses. Symptoms include fever, runny nose, sore throat, headache, general aches, muscle pains, fatigue, weakness, exhaustion, chest discomfort, cough and sinus pressure. The flu is caused by a specific virus called influenza, which is more common during the winter months and typically makes you feel more miserable than a cold.

• Cold symptoms can last up to two weeks, and the cough typically lasts longer. The average duration of a viral cough is 18 days.

• The flu shot can help to prevent the flu and is encouraged every fall. There are many other cold viruses that a flu shot will not prevent.

• Antibiotics are not effective for colds and flus; they do not help with symptoms or recovery. Antibiotics are only prescribed when necessary to treat a bacterial infection. Taking antibiotics unnecessarily greatly increases the chance of having side effects, which can be serious. Doctors do not have remedies to make colds go away faster. Your body's immune system is the only cure. We can help you with non-antibiotic/non-curative prescriptions in some cases when symptoms are severe or persistent.

When to be evaluated

• The presence of persistent chills and high fevers beyond the first three days, feeling increasingly out of breath, or pain in face or teeth after two weeks of cold symptoms warrants an appointment to rule out pneumonia or other serious infections.

• It is always best to come in and be evaluated if you have concerns that your illness is more serious.

Common symptoms

• Viruses commonly cause fevers. A fever, defined as a temperature greater than 100.4°F, is your body's natural response to fighting infection and is common in the first few days of a cold. A fever is not typical after four days of cold symptoms.

• Pain in the sinus region is common early on in a cold and does not mean there is a sinus infection. A sinus infection requiring antibiotics typically takes two to three weeks to develop after the onset of a cold. A sinus infection can occur as a complication of a cold due to prolonged inflammation and nasal blockage that allows bacteria to breed in the sinuses.

• Colds can commonly produce green and yellow mucus as a result of inflammation caused by the virus. Color is not a sign of a bacterial infection.

• Bronchitis is also called a chest cold. "Bronchitis" is defined as an inflamed airway — "-itis" means inflammation and "bronchus" means airway. If you have a cough with your cold, which is typical, you have viral bronchitis. The main symptom is a cough, which may or may not bring up colored phlegm, and is often worse at night. Approximately 95% of bronchitis is viral and does not require antibiotics. Like a cold, bronchitis needs to run its course.

• A sore throat is the inflammation caused by the virus affecting the throat ("pharyngitis"). Sore throats are usually viral, especially in adults. Strep throat does not cause congestion, cough or hoarseness. If you have these symptoms with your sore throat, it is unlikely to be strep and you will not need antibiotics to get better.

• Pink eye is inflammation of the inside lining, or conjunctiva, of the eyes ("conjunctivitis"). When pink eye accompanies other cold symptoms such as congestion or cough, it is an extension of the same virus. As with other viral symptoms, it will resolve on its own, and no eye drops are needed. Learn more about if you need antibiotics to treat pink eye. If having severe eye pain or persistent visual changes, please be seen.

• Voice loss is inflammation of the voice box, or larynx ("laryngitis"). It can also be a part of your cold and does not indicate a more serious infection.

Over the counter (OTC) options for symptoms

We cannot cure your cold, however, there are remedies that may make your symptoms more tolerable. Treating symptoms at nighttime is especially important if your symptoms are keeping you up. If your sleep is disrupted, your immune system has a harder time fighting your illness. Rest is important for healing.

Pain and fever

• Naproxen (Aleve)/Ibuprofen (Advil, Motrin) alone or in combination with Acetaminophen (Tylenol) helps with headaches, muscle aches, sore throats, sinus pain and fevers. You can take both, if either alone is not sufficient for discomfort. Avoid naproxen/ibuprofen if you have kidney disease, congestive heart failure, uncontrolled high blood pressure or stomach ulcers.

• Dosing: Acetaminophen 325mg or 500mg OTC — one to two tablets every six hours as needed (maximum dose 3250 mg/day).

• Ibuprofen 200mg — two to three tablets (400mg-600mg) every six to eight hours as needed (maximum dose is 2400mg/day - 12 tablets).

• Naproxen 220mg — one to two tablets (220mg-440mg) twice daily. Naproxen lasts longer than ibuprofen, which is especially helpful at night to prevent sleep disruption from a return of symptoms when medicine wears off. You can take ibuprofen or naproxen, not both.

The dosing above is considered "prescription strength," exceeding that which is listed on the bottles, and is considered safe for short-term use.

Congestion

• Large volume OTC saline nasal irrigation (NeilMed) products can help with sinus pressure. They are easy to use and should be used with distilled water. Smaller volume, such as "Ocean" nasal spray, are not as effective.

• Pseudoephedrine (Sudafed) is a decongestant for runny or stuffy nose. Buy the product that is sold "behind the counter" without a prescription from the pharmacist. The OTC Sudafed sold in the aisle is "phenylephrine." Phenylephrine is rarely helpful. Both can raise your blood pressure temporarily while using. Use with caution/monitor if you have high blood pressure or a heart arrhythmia, or if you have an enlarged prostate. Do not use in the evening or before bed as this may cause insomnia and is not recommended for children under 12.

• Oxymetazoline nasal spray (Afrin) is effective for congestion and nasal blockage but must only be used for a maximum of three days. If taken longer, it can become addictive and cause worsened congestion. Initially, it causes a burning sensation in your throat which goes away in a few minutes. The no-drip formulations cause less irritation. Use is beneficial before bed if congestion is interfering with sleep.

• Nasal spray Cromolyn Sodium (NasalCrom) OTC can improve nasal congestion.

Cough

• Drinking hot tea with honey throughout the day is soothing and suppresses cough and sore throat. Honey is anti inflammatory, use it more generously when sick, unless you have poorly controlled diabetes. Some honeys may be better than others. Buckwheat honey, harder to find in stores, but available online, is something you might try for cough suppression. It does have a stronger odor and taste.

• Menthol cough drops suppress cough. Menthol rubs (such as Vicks® VapoRub™) can also be soothing for congestion and cough.

• Dextromethorphan ("DM," i.e. Robitussin® DM), available in capsule and liquid forms, can help with cough suppression, but does not help everyone. DM products can cause side effects in some such as drowsiness and dizziness. There is increasing concern about abuse of DM products in high doses, especially in teens. DM is not recommended for children under four.

• Diphenhydramine (Benadryl®) is sedating and can be taken at night to help you sleep through your symptoms while sometimes helping with cough suppression. Sleep is important for healing so if your cough is keeping you up, adding one or two tablets of diphenhydramine at bedtime can be beneficial. Avoid taking diphenhydramine if you are over 65 years old.

• If cough persists more than two weeks, a prescription steroid inhaler or other prescription medication for cough might be considered. Your doctor will likely require an appointment before prescribing cough medicine. Steroid inhalers can be prescribed in some cases without an appointment if they have previously been effective for similar symptoms of prolonged cough following a cold, known as "post-viral cough syndrome."

Other tips

• Avoid combined cold and cough preparation (such as Tylenol Cold and Flu, Advil Cold and Sinus, Dayquil, etc.). These contain inadequate doses of some ingredients and contain phenylephrine instead of pseudoephedrine as a decongestant. You are better off taking appropriate doses of individual ingredients.

• Know what works for you. Individual preference varies for cold and flu symptom treatment - it is not one size fits all.

• Stay hydrated by sipping warm liquids, including broth or soup, or warm lemon water with honey, which can be soothing.