Colds and Flu: Time Only Sure Cure

It's not chicken soup. Believe it or not, a much more unorthodox therapy of warm-and-cold showers has recently been proposed--though not proven--for the prevention of the common cold. Shower therapy joins an ever-growing spectrum of suggested preventers and treatments for the common cold--among them, hand washing, vitamin C, interferon, seclusion, and various over-the-counter cough and cold medications.

"An efficient, practical and inexpensive prophylaxis [preventive measure] against one of the most frequent (and 'expensive') diseases has been identified at last," claims water therapy researcher Edzard Ernst, M.D., in the April 1990 issue of Physiotherapy. Though some may doubt his shower theory, Ernst is right about one thing--the common cold is a frequent and expensive disease, striking some people as many as 12 times a year and leading to some 15 million days lost from work annually in the United States. Influenza, or flu, likewise, is a frequent and expensive disease, reaching epidemic levels in the United States each year.

Identify the Enemy

Flu is like the cold in many ways--most basically, they're both respiratory infections caused by viruses. If a cold is misdiagnosed as flu, there's no problem. At worst, a cold can occasionally lead to secondary bacterial infections of the middle ear or sinuses, which can be treated with antibiotics. But if the flu is misdiagnosed as a bad cold, potentially life-threatening flu complications like pneumonia may be overlooked.

Some of the symptoms of a cold and flu are similar, but the two diseases can usually be distinguished. (See accompanying chart.)

Typically, colds begin slowly, two to three days after infection with the virus. The first symptoms are usually a scratchy, sore throat, followed by sneezing and a runny nose. Temperature is usually normal or only slightly elevated. A mild cough can develop several days later.

Symptoms tend to be worse in infants and young children, who sometimes run temperatures of up to 102 degrees Fahrenheit (39 degrees Celsius). Cold symptoms usually last from two days to a week.

Signs of the flu include sudden onset with a headache, dry cough, and chills. The symptoms quickly become more severe than those of a cold. The flu sufferer often experiences a "knocked-off-your-feet" feeling, with muscle aches in the back and legs. Fever of up to 104 degrees Fahrenheit (40 degrees Celsius) is common. The fever typically begins to subside on the second or third day, and then respiratory symptoms like nasal congestion and sore throat appear. Fatigue and weakness may continue for days or even weeks.

"The lethargy, achiness and fever are side effects of the body doing its job of trying to fight off the infection," according to Dominick Iacuzio, Ph.D., influenza program officer with the National Institutes of Health (NIH).

Influenza rarely causes stomach upset. What is popularly called "stomach flu"--with symptoms like nausea, diarrhea and vomiting--is technically another malady: gastroenteritis.

Cold and flu-like symptoms can sometimes mimic more serious illnesses like strep throat, measles, and chickenpox. Allergies, too, can resemble colds with their runny noses, sneezing, and general miserable feeling.

If symptoms persist, become severe or localized in the throat, stomach or lungs, or if other symptoms such as vomiting and behavioral changes occur, consult your physician. "With the typical symptoms, it's not necessary to contact your physician immediately," Iacuzio says.

The Treatment Arsenal

There is no proven cure for colds or flu but time. However, over-the-counter medications are available to relieve the symptoms.

"OTC cough-cold products can make you more comfortable while you suffer," says Debbie Lumpkins, a scientist with the Food and Drug Administration's division of over-the-counter drug products. "They are intended to treat the symptoms of minor conditions, not to treat the underlying illness."

Don't bother taking antibiotics to treat your flu or cold; antibiotics do not kill viruses, and they should be used only for bacterial complications such as sinus or ear infections. Overuse of antibiotics has become a very serious problem, leading to a resistance in disease-causing bacteria that may render antibiotics ineffective for certain conditions.

Children and teenagers with symptoms of flu or chickenpox should not take aspirin or products containing aspirin or other salicylates. Use of these products in young flu and chickenpox sufferers has been associated with Reye syndrome, a rare condition that can be fatal. Because cold symptoms can be similar to those of the flu, it's best not to give aspirin to people under 20 with these types of symptoms.

The active ingredients FDA considers safe and effective for relieving certain symptoms of colds or flu fall into the following categories:

	Nasal decongestants open up the nasal passages. They can be applied topically, in the form of sprays or drops, or taken orally. But using sprays or drops longer than three days may cause nasal congestion to worsen.
	Antitussives, also known as cough suppressants, can quiet coughs due to minor throat irritations. They include drugs taken orally, as well as topical medications like throat lozenges and ointments to be rubbed on the chest or used in a vaporizer.
	Expectorants, taken orally, help loosen mucus and make coughs more productive.

Until recently, another category of over-the-counter drugs called "antihistamines" was approved only for use by sufferers of hay fever and some other allergies. In October, clemastine fumarate, the active ingredient in products such as Tavist-1 and Tavist-D, was approved to treat cold symptoms. The effectiveness of other OTC antihistamines for this use is still being studied.

Most nonprescription cough-cold remedies contain a combination of ingredients to attack multiple symptoms. These combination products often contain antipyretics to reduce fever and analgesics to relieve minor aches, pains and headaches.

Users of OTC medicines should carefully follow the labeling instructions and warnings. Under a new FDA rule, all OTC products will soon have labels with a standardized format and simplified language to help consumers understand the information.

The Cold War

OTC cough and cold medication sales totaled 3.2 billion dollars in 1995, according to a national industry survey. That's no surprise, considering Americans endure about 1 billion colds each year.

Children get the most colds--six or eight a year. By contrast, adults average two to four a year, with a greater frequency in the parents of children.

The high rate in children is blamed on their lack of a built-up resistance to infection and the close contacts with other kids in schools and day care. Women's closer contact with children may also explain the greater prevalence of colds in women than in men.

Adults over 60 usually suffer less than one cold a year, probably because they have built up a natural immunity.

Most colds strike Americans in the fall and winter. Contrary to what many people believe, the increased rate of colds during this time is actually not due to the cold weather. So why do more people feel "under the weather" during the winter months? Probably, say researchers at NIH's National Institute of Allergy and Infectious Diseases, because of the greater time spent indoors in cold weather, increasing the opportunity for viruses to spread among people. Also, the lower humidity during the colder months helps cold-causing viruses to thrive and may dry the lining of the nasal passages, making them more susceptible to infection.

Because the symptoms of the common cold are caused by more than 200 different viruses--most by the so-called "rhinoviruses" (from the Greek rhin, meaning "nose")--the development of a vaccine isn't feasible. To minimize the spread of colds, people should try to keep their defenses up and their exposure down.

First Line of Defense

Cold viruses can be transmitted in one of two ways: by touching respiratory secretions on a person's skin (when shaking hands, for example) or on environmental surfaces (like doorknobs or handrails) and then touching the eyes, nose or mouth, or by inhaling infectious particles in the air (like respiratory secretions from a cough or sneeze).

The best way to break the chain of infection? Hand washing is the key, according to Iacuzio, along with not touching the nose, eyes or mouth.

"Your mucus membranes are your first line of defense against infection," according to Iacuzio. "Interference with the constant passage of mucus raises the chances for entry of the virus." That's why drinking liquids and maintaining a humid environment with a vaporizer may lower susceptibility.

To minimize the spread, other helpful measures include avoiding close, prolonged exposure to people with colds, and always sneezing or coughing into a facial tissue and immediately throwing it away. Cleaning environmental surfaces with a virus-killing disinfectant is also recommended.

The Flu Fighters

Flu typically affects 20 to 50 percent of the U.S. population each winter. It's a highly contagious disease, spreading mostly by direct person-to-person contact. "With the flu, coughing--even more than sneezing--is the most effective method of transmission," Iacuzio says.

The flu virus can linger in the air for as long as three hours. In close quarters, conditions are ripe for the spread of the virus. That explains why the highest incidence of the flu is in 5- to 14-year-olds, who spend much of their time in school, in close contact with their classmates. The most serious complications occur in older adults, however.

Years ago, there were no practical tools to protect people from flu. In 1918-1919, a global flu epidemic, or pandemic, struck half the world's population and claimed the lives of 20 million. Still today, 10,000 to 20,000 Americans--almost all of them elderly, newborns, or chronically ill--die each year from flu complications, usually pneumonia.

The challenge for scientists trying to protect us from the disease is that influenza viruses can change themselves, or mutate, to become different viruses. Scientists have classified flu viruses as types A, B and C. Type A is the most common and leads to the most serious epidemics. Type B can cause epidemics, but usually produces a milder disease than type A. Type C viruses have never been associated with a large epidemic.

Vaccine a Powerful Weapon

The most important tool for fighting the ever-changing flu virus is immunization by a killed virus vaccine licensed by FDA. The vaccine is made from highly purified, egg-grown viruses that have been made noninfectious.

Vaccination is available to anyone who wants to reduce their chances of getting the flu. Studies have shown the vaccine's effectiveness rate to be 70 to 90 percent in healthy young adults. In the elderly and in people with certain chronic illnesses, the vaccine sometimes doesn't prevent illness altogether, but it does reduce its severity and the risk of complications.

The government's Advisory Committee on Immunization Practices strongly recommends vaccination for the following high-risk groups:

	people aged 65 or older
	residents of nursing homes and other facilities that provide care for chronically ill persons
	people over the age of 6 months, including pregnant women, who have certain underlying medical conditions that required hospitalization or regular doctors' visits during the preceding year. These conditions include: asthma, anemia, metabolic disease such as diabetes, or heart, lung or kidney disease impaired immune system due to HIV infection, treatment with drugs such as long-term steroids, or cancer treatment with radiation or chemotherapy
	children and teenagers (6 months to 18 years) who must take aspirin regularly and therefore may be at risk of developing Reye syndrome if they get the flu.

Because it takes the immune system about six to eight weeks to respond to vaccination, the best time to get the flu vaccine is mid-October to mid-November, before the December-to-March U.S. flu season hits.

The vaccine's most common side effect is soreness at the vaccination site for up to two days. Some people may experience post-shot fever, malaise, sore muscles, and other symptoms resembling the flu that can last for one to two days. Actually, the flu vaccine can't cause flu because it contains only inactivated viruses.

The vaccine should be repeated annually, since the immunity is believed to last only about a year, and because the vaccine's composition changes each year based on the flu strains scientists expect to be most common.

To decide which strains of influenza virus should be incorporated into the vaccine for the coming flu season, FDA's Vaccines and Related Biologicals Advisory Committee meets in late January each year to consider reports from national and international surveillance systems. A World Health Organization panel meets in Geneva in mid-February to make final recommendations for the next season's flu vaccine. The strains are labeled by their type (A, B or C) and the place where the strain was isolated.

"In the not-too-distant future," says Iacuzio, "consumers may have alternatives to the flu shot, including different delivery methods like nasal drops or a spray." Major pharmaceutical companies, in cooperation with scientists representing NIH, FDA's Center for Biologics Evaluation and Research, and academia, are making significant strides, also, toward an even more protective vaccine.

Some people--but not many--should avoid the flu shot. People allergic to eggs and people with certain other allergies and medical problems like bronchitis or pneumonia should consult a doctor before getting a flu shot. And those with a high fever should not receive the vaccine until they feel better.

Pregnant women who have a high-risk condition should be immunized regardless of the stage of pregnancy; healthy pregnant women may also want to consult their health-care providers about being vaccinated.

In the rare cases when the vaccine is not advisable, two prescription drugs are available for prevention of type A influenza: Symmetrel (amantadine), approved by FDA in 1976, and Flumadine (rimantadine), approved by FDA in 1993. Either drug also can be used to reduce symptoms and shorten the illness if administered within 48 hours after symptoms appear.

First Do No Harm

If, despite precautions, you do get a cold or flu, besides taking an OTC medication if needed and as directed, drink fluids and get plenty of bed rest. "Your body is trying to attack the virus," Iacuzio says. "Give in, and give your body a chance to fight off the infection. It takes energy to do that."

Many people are convinced that vitamin C can prevent colds or relieve symptoms. There is no conclusive evidence of this, but the vitamin may reduce the severity or duration of symptoms, according to the National Institute of Allergy and Infectious Diseases. But taking vitamin C in large amounts over long periods can be harmful, sometimes causing diarrhea and distorting common medical tests of the urine and blood.

Another proposed therapy, interferon-alpha nasal spray, can prevent infection and illness but causes unacceptable side effects like nosebleeds, according to the institute.

Many patients have their own, unproven theories about what works. "As long as it's not harmful, why not try it?" says Iacuzio. "But be skeptical of something that hasn't been clinically proven in a well-designed, placebo-controlled study." So what about chicken soup? It may soothe a sore throat, unstuff clogged passageways, and hydrate a thirsty body. At the very least, according to Iacuzio, "It's good TLC. Psychologically, that's important when you're sick."

Is It a Cold or the Flu?

(Source: National Institute of Allergy and Infectious Diseases)