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Decoding Cough and Cold Remedies

‘Tis the season when holiday gatherings and bad weather cause groups of people to congregate inside together and spread “cold bugs” from person to person. Cough and The most common way to transmit colds is inhaling airborne virus from coughing and sneezing and direct hand-hand contact. Transmission does also occur through contact with contaminated surfaces. The most appropriate means of prevention is frequent hand-washing (for 15-30 seconds) and avoiding touching your nose and eyes. What else to do?

Deb Gutman is a practicing emergency physician, currently working at both Rhode Island Hospital in Providence and Concentra Urgent Care in Warwick, Rhode Island.  Today she shares her advice on decoding cough and cold remedies. If you have questions, concerns about an illness or medicine it is best to seek help from your healthcare provider. – Anisa

‘Tis the season when holiday gatherings and bad weather cause groups of people to congregate inside together and spread “cold bugs” from person to person. The most common way to transmit colds is inhaling airborne virus from coughing and sneezing and direct hand-hand contact.  Decoding cold medicineTransmission does also occur through contact with contaminated surfaces.  The most appropriate means of prevention is frequent hand-washing (for 15-30 seconds) and avoiding touching your nose and eyes.  Vaccinations for influenza and RSV (respiratory synctial virus) vaccinations in high risk infants can also be effective. Zinc has been marketed as being able to prevent a cold from progressing.  The evidence has been mixed so weigh the benefits against the risks of side effects which may include bad taste, nausea, diarrhea and loss of smell with zinc nasal products.

Should you or your child be one of the millions who ends up with a cold this winter it is luckily a self-limited illness that will usually last between 1-2 weeks.  Adults usually have 2-4 colds/year with symptoms lasting five to seven days with nasal congestion being the prominent symptom and fever being rare. Children younger than six have 6-8 colds/year with symptoms typically lasting up to 14 days. Symptoms include colored nasal discharge, fever in first 3 days, sore throat, irritability and decreased appetite.  Complications of cold viruses include ear infections, asthma, sinusitis and pneumonia.  Most of these will cause a new-onset fever a few days after symptoms begin.

Colds are not life threatening, however, they do cause discomfort and loss of school and work days.  At the first signs of illness we appropriately head out to the pharmacy to hunt down something to help us feel better so we can get back to work, school or play. Nowadays, with more products available over the counter (OTC) the cough and cold aisle can be overwhelming. Many of the OTC products are just different combinations of the same generic medications marketed under different brand names.  It is very important to read the product packaging for the active ingredients before combining different OTC cough/cold formulations. My personal recommendation to my patients is to buy the each ingredient separately.  This can allow you to maximize dosing and avoid accidental overdose.

Just like we’ve been learning to read our food products for their ingredients we also need to learn to read our medication boxes to figure out which is the right product. This is a simple symptom-based guide to match your symptoms to the appropriate medications.  Keep in mind there are very few clinical trials demonstrating benefit of many of these OTC medications, and caution is recommended in children younger than 2 years old where OTC medications have been associated with fatal overdose and adverse reactions. The FDA advisory panel recommends against the use of cough and cold medications in children younger than 6 years old. The simplest symptomatic approach in younger children is fever control with acetaminophen or ibuprofen, saline drops, hydration and humidified air.  Older children and adults have more options over the counter.


The three main products that will treat a fever are:

1) Ibuprofen (Motrin ®, Advil ®): Ibuprofen should be avoided in infants < 6 months.  Ibuprofen can be given every 6 hours and lasts longer than other fever control. It also has additional anti-inflammatory properties and is also helpful for the generalized bodyaches, sore throat and headache that accompany many viral illnesses.

2) Acetaminophen (Tylenol ®): Tylenol can be given every 4 hours, although there is now extended release preparations that are dosed differently so always read the labels. If taking Tylenol it is important to look at the labels of any of the combined cough/cold products you are taking to make sure you are not accidentally taking too much Tylenol.

In children with fever that is difficult to control you can alternate acetaminophen and ibuprofen every 3 hours.

3) Aspirin (Bayer ®): Aspirin should also be avoided in young children with fever because it is linked to Reye’s syndrome.

Runny nose/nasal congestion/facial pain:

1) Antihistamines: The following are common OTC antihistamines: diphenhydramine (Benadryl ®), brompheniramine (Dimetapp allergy®, Nashist B®), chlorpheniramine (Chlor-Tremeton®), clemastine (Tavist®).  There are also non-sedating antihistamines available OTC such as cetirizine (Zyrtec ®) or loratadine (Claritin®). These medications are meant to reduce nasal secretions, however, in trials they have been ineffective in reducing secretions related to the common cold and are more effective for nasal secretions related to allergic/seasonal allergies.  Side effects include either sedation or excitability and drying of the eyes, nose and mouth.

2) Decongestants: These are medications that cause constriction of the membranes in the nasal passages and sinuses. These have been shown to be effective in reducing nasal congestion in adults but there are now studies in children. Common decongestants include pseduoephedrine (Sudafed) and phenylephrine hydrochloride (Actifed®, Drixoral®). Side effects include a rapid heart rate, palpitations, and elevated blood pressure.  Decongestants are nor recommended for use in children or adults with high blood pressure.  For adults with high blood pressure they can try Coricidin HBP.  Pseudoephedrine is probably a more effectie decongestant and is now kept behind the pharmacy counter and you must show the pharmicist your driver’s license to purchase it.

3) Nasal sprays:  The most common nasal sprays will be either decongestant nasal sprays such as oxymetazoline (Afrin®) or phenylephrine (Neosynephrine®) or steroid nasal sprays (flonase®, nasonex®).  Both types aim to reduce the nasal swelling to allow ease of breathing. Caution should be used with decongestant nasal sprays;  extended use beyond 2-3 days may cause increased nasal swelling that is very difficult to treat.

4) Humidified Air and saline drops: Humidified air can improve symptoms of nasal congestion and runny nose. For infants, parents can try saline nose drops to thin the mucus, followed by bulb suction to temporarily remove nasal secretions. Saline nose drops can be made at home by adding 1/4 teaspoon salt to 8 ounces (1 cup) of warm (not hot) water. An older child may try using a saline nose spray before blowing the nose.  Adults may try a saline lavage such as a neti pot.


1) Cough suppressants: Cough suppressants are a controversial OTC medication.  Many studies show that neither OTC or prescription cough suppressants have the ability to actually suppress coughing.  For many children and adults the cough may be an activation of asthma type symptoms triggered by the cold virus.  Cough suppression could result in mucous plugging and worsening of their respiratory status. The most common cough suppressants are dextromethorphan (Delsym®) and codeine.  Insomnia and respiratory depression are reported side effects.

2) Cough expectorants:  Again, there is limited evidence to suggest that cough expectorants actually work. Their main purpose is to thin the mucous to make it easier to cough up and clear the airways. The most common OTC cough expectorant is guaifenesin (Mucinex®, Hytuss®).

Sore throat:

This is best treated with common pain relievers such as acetaminophen and ibuprofen.  However, warm fluids, throat lozenges and throat sprays should be used if they provide relief.  Warm fluids with honey or apple cider vinegar may also provide some relief.

Other remedies:

1) Echinacea: The data does not suggest benefits for the common cold  and in children there was a higher frequency of rash.

2) Vitamin C: Previous studies suggested that mega doses decrease the duration of symptoms but further research is needed to support its use.

3) Honey: A single dose of honey at bedtime has been suggested to be effective in reducing cough .  There are few side effects, although honey should be avoided in infants.

4) Antibiotics have no role in treating the common cold and should be reserved for clearly diagnosed bacterial infections including otitis media (middle ear infections), sinusitis (with symptoms greater than 14 days) and pneumonia.  They are associated with significant side effects and increasing risk of antibiotic resistance.

Indications to see a healthcare provider would include:

– Inability to eat/drink > 24 hours

– Behavior changes, specifically decreased responsiveness

-  Difficulty breathing, breathing fast or working hard to breath

– Fever greater than 101 F for greater than 3 days

– Significant ear or chest pain with coughing

-  Development of second wave of fever after 3 days of illness

More info found at: http://www.uptodate.com/patients/index.html

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