Colds, Viral Bronchitis, & Influenza

During the fall and winter seasons, classes resume for students and people in general are more crowded together due to cooler weather. Schools serve as large breeding grounds for colds (nasal discharge/stuffiness, headaches, sore throat), bronchitis (cough), and influenza. The students then pass the illnesses on to their families and in turn the general population. Influenza which is a much more severe illness mainly causes high fever, shaking chills, body aches, and a severe cough.

Colds and bronchitis are interrelated and may be caused by the same virus at the same time, or the illnesses may occur separately. There are hundreds of viruses that can cause colds and bronchitis.

Influenza is caused by a much smaller group of viruses. Influenza can be life threatening if you have HIV/AIDS, heart disease, lung disease, kidney disease, arthritis, or diabetes or if you are over 60 years of age.

There is no definitive treatment at this time for viral upper respiratory illnesses like colds and bronchitis. Despite the availability of treatments for HIV, hepatitis, and herpes, treatment for the large group of viruses that cause colds and bronchitis remains elusive.

Antibiotics such as penicillin, erythromycin, azithromycin (Z-Pak), tetracycline, ciprofloxaxin, or sulfa have absolutely NO effect on these viruses. In fact antibiotics may make you worse by causing a side effect such as diarrhea. If you take an antibiotic unnecessarily because you have a cold or bronchitis, the next time you really need an antibiotic, the antibiotic may not work for you. Avoid the temptation to take a leftover antibiotic or one that is offered to you by a family member or friend.

Occasionally an antibiotic may be recommended by your healthcare provider, but this is a judgment best made by someone trained to do so.

However, there are many other types of treatments that may make one feel better. Note that these treatments are quite different from those recommended for influenza (see below.)

1	Drink plenty of fluids. Fluid intake will keep your nasal secretions and your bronchial fluids thin and easy to expel. Additionally the fever and loss of appetite that is associated with colds and bronchitis may make you dehydrated. Dehydration itself can make you feel weak and bad. Drink enough fluid to make yourself urinate at the normal frequency and with the normal color. If your urine is bright yellow, you are not drinking enough. Any type of fluid will work with the exception of alcoholic beverages (beer, wine, spirits, coolers, etc.).
2	Take aspirin, ibuprofen, naproxen, or acetaminophen as directed for fever, pain, or body aches. Always take ibuprofen or any aspirin-like drug with food to prevent stomach upset. Avoid aspirin-like medications (aspirin, ibuprofen, naproxen, etc.) if you have weakened kidneys. Avoid a lot of acetaminophen if you have liver problems.
3	Try pseudoephedrine or Sudafed-PSE as directed for nasal congestion. Usually pseudoephedrine must be requested from the pharmacist, but the newer Sudafed PSE is available on the pharmacy shelves. Both of these drugs can provide relief of nasal congestion, but they may produce mild stimulation and difficulty sleeping especially if you take them late in the day. If you prefer, there are extended-release forms of pseudoephedrine available. Avoid pseudoephedrine if you have high blood pressure which is not very well controlled.
4	Use a nasal saline solution to flush your nose. There are many brands available, and they can be used frequently to cleanse your nose and moisten your membranes.
5	Eat well. You need food energy to fight the infection. However, your appetite will often be poor, and food will not taste very good.
6	Avoid the use of nasal decongestant nose sprays except for possibly the first 48 hours of your illness. These decongestant sprays are very addictive to your nose.
7	A bronchodilator inhaler may dramatically help your cough. Your cough is a reflex which tells you that you have excess secretions down in your bronchial tree. Many times there is accompanying inflammation which constricts the bronchial tubes with or without wheezing (a high or low pitched tone which can be heard when breathing in and/or out). The bronchodilator inhaler when used correctly causes dilatation of the bronchial tubes which allows one to cough up more of the secretions. When the secretions come up, there may be a diminished urge to cough. The bronchodilator inhalers (albuterol, levoalbuterol, etc.) are very well tolerated, but because they are chemically related to adrenalin, they may produce an increased heart rate and a mild hand tremor or shaking. This is always a temporary effect which gets better as you continue to use the medication. Although these inhalers are similar to some over-the-counter inhalers (such as Primatene), it is not recommended that the over-the-counter inhalers should be used. These inhalers require a prescription from your healthcare provider. Using an inhaler may be slightly tricky. Basically one activates the trigger for the inhaler at the same time as one inhales so that the mist is inhaled into the bronchial tubes. An inhaler actually increases your cough and occasionally this may trigger the gag reflex which results in vomiting. Although unpleasant this is not a particularly serious side effect.
8	Avoid smoking and smoky atmospheres. Smoking adds insult to injury. Smoking can prolong a cold for days to weeks. It is HIGHLY recommended that you temporarily cease all smoking or at least decrease your smoking dramatically. You might consider using this as an opportunity to stop smoking permanently!!!
9	Avoid the use of cough suppressant syrups if possible. The cough is a reflex that needs to attended to and encouraged. Suppressing a cough is not advisable from a common sense perspective unless the cough is so frequent and bothersome that one is unable to sleep. Occasionally a cough suppressant syrup might be useful to help one sleep for short periods of time.

It is important that you see your healthcare provider if you have been exposed to someone with influenza or possible influenza. If you are developing symptoms of influenza, you should see your provider as soon as possible or go to an Emergency Department or urgent care center. Treatment may involve fluids, medication for fever, and antiviral medications that are specific for influenza such as oseltamivir (Tamiflu.) Regular antibiotics do not affect influenza either.

1	Avoid persons who are ill. If you must be near someone with a viral infection, avoid sleeping in the same bed and wash or sterilize your hands frequently.
2	Wash or sterilize your hands frequently during the fall and winter. You can carry an alcohol gel such as Purell in your pocket and use it frequently after shaking hands, touching doorknobs, touching any surface, and handling children. Make sure the alcohol gel is at least 60% alcohol. If you prefer to wash your hands, wash with soap and wash for approximately one minute or the time to say the alphabet quickly.
3	Avoid touching your eyes, nose, and mouth. The moist membranes in your eyes, nose, and mouth are very sensitive to any virus that you may have on your hands.
4	If you are ill, stay home from work or school so you don't pass the virus to other people. The appropriate time to return to work is when you are no longer having to blow your nose or cough anything up.
5	If you are ill, wash or sterilize your hands immediately after you sneeze or cough into your hand or a tissue.
6	Ask your physician whether you should take a vaccination for influenza each year. If you have HIV/AIDS, heart disease, lung disease, arthritis kidney disease, or diabetes, you probably should get vaccinated. The vaccine is very well tolerated. A very small percentage of persons who receive the vaccine may feel somewhat flu-ish for a few hours afterwards. This is very brief. The influenza vaccine is a killed vaccine; it does not contain anything live. It cannot cause influenza or colds. Sometimes people will get a cold after they get the vaccine coincidentally. This is because the vaccine does not prevent colds and colds happen frequently anyway. The vaccination and the cold are not related.
7	Avoid smoking. Smoking makes you more susceptible to colds and bronchitis. For this purposes of this subject, smoking includes cigarettes, cigars, pipes, marijuana or other drugs.

Notify your healthcare provider or go to an emergency department if you have fever over 102 degrees Fahrenheit, shaking chills, severe weakness, severe pain, shortness of breath, large amounts of blood in your sputum, nausea and vomiting, inability to take fluids or food, or confusion.

PDF	HERE
Last Revision	11.5.2006
Author	James A Zachary MD

Colds	Symptoms: runny nose, congestion/blockage of the nose, headaches, sore throat with or without fever, body aches, loss of appetite Nasal discharge: clear, yellow, green, or slightly bloody
Bronchitis	Symptoms: cough with or without fever, central chest pain which is worse with cough, body aches Sputum (the mucous that is coughed up) or "phlegm": clear, yellow, green, or even slightly bloody
Influenza	Symptoms: High fever, shaking chills, severe cough, body aches, weakness, loss of appetite, minor runny nose