Upper Respiratory Tract Infections

The symptoms of upper respiratory tract infections include nasal stuffiness and dripping, head congestion, sore throat, dry cough, slight eye redness, low-grade fever, muscle achiness and some fatigue. Colds are responsible for a tremendous amount of illnesses and loss of time from work. They also have complications. What to do about colds is a constant source of frustration to patients and doctors. Viral infections cause colds and the medical world has no good, safe treatment for this malady; therefore, we are left with treatment that is symptomatic. This means the doctors give patients medicine that make the cold more tolerable but do not cure it or make it go away earlier. Below are some things we can do for relief from colds. Also listed are complications for which you might wish to visit a physician.

1. For the general achiness and fatigue, Tylenol or aspirin (two five grain tablets or two 325 mg tablets every four to six hours) is very helpful. People under 18 should use Tylenol only. These medicines are best taken with food; otherwise, they may upset the stomach.

2. For nasal drip, Afrin or Neosynephrine nasal sprays, preferably the long-acting variety, are good but they may make you feel excessively dry. They should not be used for more than a total of five days as one may become dependent on them leading to rebound worsening of congestion on discontinuation. For short periods (1 to 2 days), they are effective and have few side-effects. An alternative is the use of antihistamines and/or decongestants discussed below.

3. For head stuffiness and congestion with or without nasal drip, the sprays above may be enough. If not, or if symptoms persist beyond five days, one might try the following possibilities, such as:

• Keeping secretions loose. One wants to keep the drainage loose so it comes out more easily. This is helped by drinking lots of liquids, room nebulizers or vaporizers when you sleep, and hot soups or liquids that send steam into your nose (the famous chicken soup remedy). Another method is saline rinses once or twice a day.
• Decongestants reduce swelling in the nasal passages while allowing secretions out. These can be quite helpful and should be used for symptomatic relief as you need them. An over-the-counter example is Sudafed or any generic brand of pseudoephedrine. The doses are usually 160mg every 6 to 8 hours or the long-acting 120mg every 12 hours. This medicine is beneficial in that fatigue is not a common side effect as with the combinations discussed below.
• Antihistamine/decongestant combinations are the most effective remedy, but the antihistamines may cause fatigue. Persons with hypertension must be careful with the use of these since they can increase blood pressure. There are an unbelievable number of these combination medicines around but many of them are identical or similar. A few examples are Drixoral, Triaminic, Novahistine Cold Tablets or elixir, and Chlor-Trimeton Decongestant. There may be cheaper generic cold equivalents to these; ask your pharmacist. Many over-the-counter cold remedies also contain pain and cough medicines in combinations with the above. It is best to avoid these as they have increased side-effects and usually decreased doses of the effective agents.
• Generally, cough medicines are not needed because much of the cough is from the drippage, and the above remedies will suffice. Nasal drippage or throaty cough is part of a head cold. A chest cough produces sputum, you do not want to stop it. However, if it is non-productive, you may want to suppress it so you can get some rest. The best over-the-counter cough suppressant is dextromethorphan. It should contain about 15mg of this agent per teaspoon (5ml). Robitussin DM or its equivalent is a good choice. Another excellent choice is Delsym. The best anti-cough preparations are codeine or its derivatives and these are generally by prescription only. However, in Virginia, the pharmacist may let you sign for it without a prescription. Ask for Elixir of terpin hydrate with codeine.

Most frequently the above, while not curing the cold, will enable you to wade through it. However, there are several situations that call for a visit to the doctor. These are most commonly the complication of bacterial infection of the ears, sinuses, or chest. Below are some warning signals:

1. If you are uncertain if it is "just a cold", you may want to call or come in to clarify it.
2. Persistence of the symptoms without improvement of more than fourteen.
3. Significant headache or facial pain, especially with fever greater then 101 degrees F.
4. Dark yellow, green or brown nasal or sinus drainage.
5. Fever of greater than 102 degrees F. in adults is unusual and if it persists, it should prompt a visit.
6. Any symptoms of chest congestion, including shortness of breath, wheezing, sputum from the chest or chest pain.
7. Earache despite the use of decongestants.
8. A sore throat may be part of a cold, but it could also mean strep throat or tonsillitis. Any significant sore throat should be cultured to rule out a strep infection because antibiotics are then needed for treatment.

Because doctors have no good treatment of the "common cold", our present remedies are limited. Most physicians and patients favor a minimal amount of the above medicines and allow healing by "tincture of time". If the above warning signals of bacterial or chest infection occur, see your doctor.

For those people with chronic sinusitis, the above treatments are appropriate remedies to employ as a year-round or as needed basis. If allergies are the underlying problem, this needs further discussion and treatment. Also, in people with chronic sinus and nasal problems, bacterial infections may occur more commonly and antibiotics may be needed.

Normal Saline is approximately the consistency of the body's water. It has the saltiness of tears.

The purpose of using it as a nasal rinse is to wash out the secretions and pus; to moisten the membranes; and soften any crusting that is occurring around the holes to the sinuses.

Most people will use it at room temperature; however, if cold water is used, there will be some constriction of the blood vessels in the membranes and therefore the rinse will act as a decongestant.

Mix 8 ounces of water with 1/2 level teaspoon of salt a pinch of baking soda

Use an ear syringe (available at a drugstore) or the palm of your hand to squirt or sniff a large amount of solution into the nostril. Allow nose to drain, then blow nose gently.

This rinse may be repeated as often as you like. It is absolutely harmless.

Tap water may be used, however, if your water is heavily chlorinated, you may prefer boiled water that has been allowed to cool to room temperature.