The science of the common ailment is still a mystery - East Valley Tribune: Get Out

The science of the common ailment is still a mystery

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Posted: Thursday, March 8, 2007 5:30 am | Updated: 7:26 pm, Fri Oct 7, 2011.

Colds are the annoying ailment that won’t kill you but may make you want to cut off your nose to breathe again. They often make adults feel like sniffly children, yearning for their mother’s comfort.

No wonder we shell out an estimated $250 million annually for “remedies” that don’t actually kill the viruses that cause colds and often don’t relieve symptoms any better than a placebo.

This eagerness to be rid of cold symptoms can sometimes exact a human toll: In January, the federal Centers for Disease Control and Prevention linked infant deaths to overuse of cold remedies and advised parents and caregivers not to give children 2 and younger cold medicines without a doctor’s approval.

Colds remain wrapped in lore that seems to leave people as foggy as if they had taken a swig of antihistamines. “Feed a cold, starve a fever” is the age-old advice (with no basis in science).

Many still mistakenly think that antibiotics, which kill bacteria but not viruses, can cure colds. And they are often annoyed when their doctors won’t prescribe them.

Cold sufferers complain that their flu shots didn’t protect them against the common cold. (The shots are not intended for that purpose. Influenza is caused by different viruses.)

Nor can most people tell the difference between the flu and a cold. Both cause respiratory symptoms, but influenza is a far more severe infection that comes with a fever, headache and muscle aches as well as a gut-wrenching cough. And unlike the common cold, influenza can be treated with antiviral medicines, provided they are started shortly after symptoms appear.

“Has a woman who knew she was well-dressed ever caught a cold?” asked the German philosopher Friedrich Ni- etzsche, who, like many today, was a bit confused about how colds are spread.

Scientists have not yet been able to get their heads around this persistent infection and its many symptoms. Researchers are still trying to unravel the cascade of events that in a split second has a cold sufferer eliciting a loud “Achoo!” The mechanisms of both coughs and sneezes are better understood in cats and other animals than in human beings. But a Spanish fisherman has helped researchers identify what they believe is the sneeze control region of the brain. While fishing, the man sneezed violently about 20 times, then became disoriented and could not walk.

At the hospital in Villagarcia de Arosa, neurologist Manuel Seijo-Martinez diagnosed a stroke. Tests showed that it had affected a region in the lower brain stem.

Seijo-Martinez tested the man’s sneezing reflexes by touching the inside of each nostril with a cotton-tipped stick. “What really shocked me,” says Seijo-Martinez, “is that if you touched the right nostril, he could not sneeze.” But tickling his left nostril still produced a sneeze. (And the man recovered otherwise.)

From that information, Seijo-Martinez concluded in a paper published in the Journal of Neurology, Neurosurgery and Psychiatry that the sneeze control in the brain appears to be in the medulla.

That’s just one more step toward understanding the many mysteries of colds and perhaps one day controlling them better. Until then: Gesundheit!

Cold sufferers, here’s what you’re up against

Treat a cold, and it lasts seven days. Leave it alone, and it’s gone in a week. That’s how the saying goes. Based on research from the University of Virginia School of Medicine, here’s how a typical cold is likely to progress:

Day 1: Expect the sudden onset of a sore throat, runny nose, nasal blockage and sneezing. Headaches, coughs, scratchy throat and hoarseness are less common. Fever is rare, afflicting only about 10 percent of people with colds. (Those who have flu, on the other hand, will typically be hit hard with general malaise, fever, aches and pains.)

Day 2: It may not seem like it, but your sneezing should start to diminish. Expect your runny nose, nasal obstruction, sore throat, coughing and hoarseness to get worse, though. You may feel a few chills. If you have had a fever — remember, rare for cold sufferers — it usually breaks.

Day 3: It’s likely that your runny nose, nasal blockage, cough and hoarseness will increase. But your sore throat should start to get a little better. And sneezing will continue to diminish. About 30 percent of cold sufferers also experience coughs about this time. (Coughing is usually far more common with influenza.)

Day 4: Here’s where you should be able to breathe a little better: Expect that drippy nose and your blocked nasal passages to start to improve.

Day 5: Only about one in 10 cold sufferers still complain of a sore throat. Just 20 percent continue sneezing.

Day 6: With the exception of coughing, all other symptoms should be improving. Runny nose is present in only about 30 percent of cold sufferers. Blocked nasal passages continue in only about 20 percent of cases. Sneezing is down to about 15 percent.

Day 7: One week on, sneezing is usually over. Ninety percent of cold sufferers say their sore throats and hoarseness are gone and about 75 percent say that they no longer have a runny nose or any nasal obstruction. Now all you have to do is avoid the next cold that comes around.

- KEN MAINES, FREEDOM NEWS SERVICE

You’ve got a cold, and you’re trying to figure out how you got it.

Could it have been that dash out the door into frigid air without your coat? Was it sharing the computer with a co-worker? Did your sniffly toddler give it to you along with that wet kiss on your lips?

“We all get colds, “ notes J. Owen Hendley, a pediatrician who studies colds at the University of Virginia School of Medicine. “We feel like flaming hell, and then we try to point fingers at someone” as the source of the scourge.

The misconceptions about how colds are spread are legendary. Here are some common myths — as well as the cold, hard facts — to help set the record straight:

• Getting chilled sets me up for a cold; so does going outside with wet hair. Nope, it does not. Don’t try this at home, but scientists have found that dropping cold viruses directly into the noses of volunteers infected 95 percent of them regardless of the ambient temperature. Other research shows that colds are no more common — and no more severe — in people who were chilled or wet before they got a cold than those who were infected at a comfortable room temperature. One study even recruited volunteers to sit in their underwear in a cold, drafty hallway. They didn’t get more colds, either.

So, parents, there may be reasons — such as comfort — to get your kids to bundle up, but catching cold isn’t one of them.

• Now that I’m suffering through one cold, I should be immune to them for the rest of the winter. Not so fast. Research shows that adults get two to four colds per year, and children average about twice that number annually. The good news: Age has an advantage when it comes to colds. Infections decline with rising years. Why? Experts think it’s probably a combination of immunity to cold viruses — a person who is 60 years old has likely had a couple hundred colds — and less exposure to young children.

• I was run-down and tired. That’s why I have this cold. You may be burning the candle at both ends, but that’s not likely the cause of your infection. Researchers at the University of Virginia report that healthy people have no extra protection against colds than those with a weakened immune system.

• There’s a cold going around the office and now I have it. “Colds don’t spread that well at work,” Hendley notes. “But they sure do spread well at home.” Close quarters and frequent contact between family members, especially children, are likely routes of infection. Odds are, Hendley says, that you gave the cold to yourself by rubbing your eyes. Or picking your nose. The prime route of cold transmission seems to be from the hands. You touch something that is contaminated with the virus and then infect yourself by touching your eyes or nose.

• My girlfriend had a cold. We kissed. And now I have one, too. The lining of the mouth is not very hospitable to cold viruses, so kissing isn’t likely to spread colds, Hendley says, although nose-rubbing Eskimo kisses might. Studies show that about 25 percent of people infected with a cold have no symptoms at all and spread their infection without knowing it. Plus, cold sufferers are infectious for a couple of days before sneezes and coughs emerge.

• How not to catch a cold: Wash your hands frequently and encourage your kids to do so, too. Another tip: Cough or sneeze into the crook of your elbow rather than into your hand. That’s a good way to cut down on hand-to-hand spread of cold viruses.

No way to wash your hands? Use a virucidal hand lotions. A University of Virginia study showed that these lotions interrupted the transmission of colds in volunteers. And it’s not a bad idea to take them with you when traveling, since U-Va. researchers have also found that the cold-causing rhinovirus lives for about a day in dried mucus found in hotel rooms.

Learn more at www.commoncold.org, a Web site run by U-Va. researchers.

CHOOSING THE RIGHT REMEDY

When your nose starts dripping like a faucet and you’re wracked by coughs and sneezes, all you want is relief. But knowing what to choose from the shelves crowded with products can be daunting.

There are no remedies to cure a cold. But you may be able to ease your symptoms. A little.

Avoid the growing number of combination cold products that “promise to do everything,” advises Ronald Turner, professor of pediatrics at the University of Virginia School of Medicine.

That’s because they often have ingredients that you don’t need. And you could get an overdose if you combine them with other drugs or over-the-counter remedies, such as aspirin or Tylenol.

Here’s a guide to help you make sense of the huge array of treatments available when a cold sidelines you or your family.

PROVEN EFFECTIVE

TOPICAL DECONGESTANTS: Afrin, Neo-Synephrine, Vicks Sinex — all oxymetazoline

Verdict: “Nose shrinkers” are what doctors call these sprays because they work so well in reducing swollen nasal passages. “Don’t use them for more than three to four days because you become dependent on them,” says J. Owen Hendley, professor of pediatrics at the University of Virginia. If you do become dependent, expect to get a stuffy nose equal to or worse than the original cold symptoms when you quit.

ANALGESICS: Advil (ibuprofen), Aspirin (acetylsalicylic acid), Tylenol (acetaminophen)

Verdict: They can “make you feel a little better even if you don’t have a fever,” Hendley says, by relieving headaches and the general discomfort that comes with a cold.

ANTIHISTAMINES: Benadryl (diphenhydramine), Clistin (carbinoxamine), Tavist (clemastine), Chlor-Trimeton (chlorpheniramine), Dimetane (brompheniramine).

Verdict: These drugs dry out secretions, but they make you very sleepy, experts say. So if you use them, take them before going to bed. And stick with these older, original antihistamines. Newer antihistamines — Claritin and Zyrtec, for example — have no proven effectiveness against cold-related symptoms, according to the American College of Chest Physicians (ACCP).

ANTIHISTAMINES: Andehist; Bromfed; Dimetapp Cold and Allergy Elixir; Lodrane — all brompheniramine and timed-release pseudoephedrine

Verdict: The ACCP says there’s strong evidence that this combination has benefit in treating coughs associated with the common cold.

ORAL DECONGESTANTS: Dimetapp; Drixoral; PediaRelief; Sudafed; Triaminic — all pseudophedrine.

Verdict: These products may help you breathe better. Effects are very modest. If you have high blood pressure or heart problems, check with your doctor before using these medications.

INCONCLUSIVE

MUCUS THINNERS AND EXPECTORANTS: Mucinex (guaifenesin)

Verdict: Used for a couple of decades, this foul-tasting liquid is a common ingredient in nonprescription cough syrups. More recently, it has been formulated into a pill, making it easier to swallow. There’s little evidence that it can thin mucus, says Hendley, but “it’s worthwhile trying.”

SALINE NASAL WASHES: Breathe Right Moisturizing Saline Spray; Simply Saline — all purified water and sodium chloride

Verdict: There are no definitive studies of these products’ effectiveness, but rinsing the nose with saline helps wash away mucus, which could help relieve blocked nasal passages. “It’s completely safe,” says U-Va.’s Turner. “So if it makes you feel better, fine.”

INEFFECTIVE

COMBINATION DRUGS: Dayquil; Nyquil; Theraflu — all various ingredients including: acetaminophen, chlorpheniramine, dextromethorphan, doxylamine, diphenhydramine, guaifenesin

Verdict: The ACCP says to skip the combination medicines — advice echoed by other experts to prevent overdosing and getting ingredients you may not need. “They promise to do everything,” notes Turner, “but you can get into some trouble.” Better, he says, to find single-ingredient products.

COUGH SUPPRESSANTS: Robitussin DM; Delsym; Vicks 44E; Buckley’s — all dextromethorphan

Verdict: There’s so little evidence for effectiveness in treating cold-related coughs that the ACCP strongly discourages the use of these popular medications, especially for children 14 years and younger.

ECHINACEA

Verdict: This popular herb is widely used for both treatment and prevention of colds. But the studies examining its effects have often been flawed. In 2005, the National Center for Complementary and Alternative Medicine found that it did little to prevent or shorten colds. “We really don’t see any clinically significant effects,” says Turner. Experts say save your money.

VITAMIN C (ASCORBIC ACID)

Verdict: A 2004 Cochrane Review of 29 studies involving more than 11,000 people found no evidence to justify giving megadoses of vitamin C to prevent colds in the general population. Taking up to four grams of vitamin C at the start of a cold also did not show any benefits.

ANTIVIRAL TISSUES: Kleenex (virucidals)

Verdict: Purportedly kills the two leading cold viruses, two types of influenza viruses and respiratory syncitial virus within 15 minutes of their being in the tissue. But there’s no evidence that killing viruses in tissues helps to reduce, treat or prevent colds. “It only takes one virus particle to infect you,” Hendley notes.

ZINC LOZENGES: Cold-Eze (zinc)

Verdict: “There have been an awful lot of studies done on zinc,” but results have been inconsistent and so modest that they are not clinically significant, Turner says.

HOMEOPATHIC ZINC SOLUTIONS: Zicam Cold Remedy (minuscule amounts of zinc)

Verdict: In 2006, the maker of Zicam agreed to pay $12 million to settle 340 lawsuits brought by consumers who claimed the product’s nasal gel damaged or destroyed their sense of smell. The company said the agreement was not an admission of liability but an effort to end most of the litigation over the homeopathic remedy. “Can I imagine putting that stuff in my nose?” says Hendley. “It’s hooey.”

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