Upper respiratory infections are fun for no one. Every time I get sick, I am amazed at how much snot a person’s body can make. And everyone has an opinion on the best way to treat them – ask your neighbor, a family member, and your mailperson. Everyone has a different answer. When staring at the long aisle of options, it can be overwhelming so I’m going to try to run through briefly what they are and what they are supposed to do.
First are the analgesics – acetaminophen (like Tylenol) and ibuprofen (like Advil or Motrin). These will typically provide anywhere from four to six hours of relief from the body aches, fever, sinus pressure, sore throat, ear pressure, etc. It doesn’t relieve the aforementioned cough and congestion, but they can make life a bit more bearable. Effective
Next are the oral decongestants – phenylephrine and pseudoephedrine. These are the “D” component on some over the counter preparations. These medications are designed to cause vasoconstriction (tightening of blood vessels) so that you will leak less from your nose for a couple of hours. Neither of these meds are approved for children under four and their effectiveness is questionable in children under the age of six. Phenylephrine is what you will find on the shelves; Pseudoephedrine is behind the counter and will often require photo identification for distribution (it can be used to make methamphetamines). Phenylephrine by itself has inconsistent results; Pseudoephedrine is more potent and provides better symptom relief, but also more side effects like elevated blood pressure and increased heart rate. Minimally Effective
A topical decongestant (like Afrin) is very popular for users. It tends to offer quick reliable relief of congestion for twice daily use. Unfortunately, when used beyond the three days only recommendation, the rebound effect is impressive. When you stop using it, the congestion comes back worse than when it was started. I have had more than one patient come in upset that the medication was not working any longer and they are having to use it hourly to get the same effect. This is also not approved for children. Side note: I have sometimes used Afrin for some of my sleep apnea patients with colds who use CPAP overnight as well as stopping stubborn nosebleeds. Effective for THREE DAYS ONLY.
Next come the antihistamines – diphenhydramine is the most common in cold preparations and often prefaced the word “allergy” somewhere in the description. Antihistamines are not effective for colds. There have been a few studies suggesting combination with decongestants (“D”) may be helpful in 20% of people. Diphenhydramine (like Benadryl) will last about six hours and can be sedating. When rest is what you need, these may be helpful. Otherwise, leave them for allergies.
Guaifenesin is the most common expectorant like Robitussin or Mucinex. This ingredient is frequently identified in preparations with “Cough” on them. These are designed to help organize the mucus so that it can be expelled. Sounds gross, right? The studies have demonstrated these are not effective at actually reducing the cough. It is not unusual for these to have an accompanying “D” or “DM” indicating an additional ingredient. The “D” was explained above. The “DM” is dextromethorphan which is supposed to reduce the “tickle” of coughing. In reality, it only helps 10-15% of people. Dextromethorphan has been associated with overdoses, particularly in children and should be used cautiously in adults and not at all in children. NOT Effective
Next on the list are saline nasal washes and sprays. The studies say they will not make your cold go away faster and I wholeheartedly believe that. However, I also believe there is a role for this modality. Anyone with a cold who takes a long hot shower feels better after the thick snot is cleared. It is certainly not pretty, but it does allow for a brief respite from the sniffling and blowing. In addition, there have been studies that show this is helpful at preventing secondary infections. I often draw the comparison that there is less algae in a river than a lake due to irrigation. My recommendation is that if this helps you feel better, take it as there is no harm in using them. If you are prone to secondary sinus infections, this may prevent a trip to the doctor later as well as antibiotic unpleasantness. Use your best judgement.
Next topic is vitamins. While I remember my mother cheerfully flooding my system with orange juice, this treatment is not effective. Neither is vitamin D or vitamin E. Using vitamins for prevention have also not been effective. Having said that, my mother will continue to drop orange juice off at my house when I am sick until one of us dies. NOT Effective
Honey has been promising in some studies and the area where it has been most effective is in children for cough reduction. It will not help with congestion, but it can reduce cough for those over one year of age. Honey is still forbidden for infants less than 12 months old. It has not been as effective for adults. Effective for cough only in kids more than adults
Herbal remedies remain in the “not well studied” category. Several have been ruled ineffective including echinacea, but the well designed studies are few and far between for evaluating complementary alternative medications. The list is long for the next possible “miracle cure of colds.” However, no one treatment has really separated itself from the pack. I cannot reliably recommend any of these for consistent results. Unknown and Unproven
And finally zinc deserves its own category. High doses of oral zinc have been effective at reducing both the length and severity of colds by one day. Unfortunately, the bad taste and nausea of higher doses is substantial. I would strongly recommend against nasal sprays with zinc as it has been associated with permanent loss of sense of smell. Reducing symptoms is not worth forever losing the ability to smell bread and coffee. There has also been a role for zinc with prevention, but it must be ingested daily for five months before that benefit is found. Effective but substantial side effects
Ultimately there is no cure for the common cold. It remains a unicorn among medical therapy options despite decades of study. So like everyone else, I squint and stare at the sea of possible options while holding my box of Kleenex at the grocery store hoping for some relief when I should just go home, push the fluids and rest until my body’s immune system finally obliterates whatever darn virus I caught. Good luck to us all!
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