Coping With the Common Cold

Determined this cold season to nip your sneezing, runny nose and scratchy throat in the bud before those nasty respiratory symptoms sideline you?

There's a broad array of cold remedies you might want to try, ranging from over-the-counter preparations to basic ingredients tucked away in your kitchen pantry.

So what'll it be? A combination pain reliever and nasal decongestant? Vitamin C and echinacea? Tea with honey? A brimming bowl of chicken soup?

It turns out the best advice for dealing with the misery of a cold is the same principle mothers often apply when trying to coax their unruly toddlers to take a nap: Whatever works.

After all these years, scientists still have not nailed down a cure-all for the 200 different viruses known to cause symptoms of the common cold. And while nutritionally oriented doctors often tout the cold-fighting properties of certain vitamins, minerals and herbs, others say the evidence is mixed.

Dr. Norman H. Edelman, a consultant for scientific affairs for the American Lung Association, lumps vitamin C and the herb echinacea into the category of "the unprovens." They might work, he said, but there's a lack of scientific evidence to demonstrate their effectiveness.

"We advise patients to do the sensible things," he offered. "The most important thing is to try to avoid a cold." Frequent hand washing, for instance, is a must.

That's little comfort to the Americans who collectively suffer an estimated 1 billion colds a year, according to the National Institute of Allergy and Infectious Diseases. Colds are particularly prevalent among children, who get six to 10 a year. Adults have about two to four colds a year, mostly between September and May, the American Lung Association reports.

While the typical cold is little more than an annoyance, lasting a week or two, its societal toll is huge. Nearly 22 million school days are lost each year due to the common cold, according to the U.S. Centers for Disease Control and Prevention.

With so many people desperate for relief, researchers continue to grasp for evidence to substantiate or dismiss potential cold remedies.

Several years ago, experts tapped by the Cochrane Collaboration, a United Kingdom-based nonprofit that disseminates medical evidence, reviewed 30 trials involving long-term vitamin C supplementation. Taking large daily doses doesn't prevent colds, they found, but it does appear to modestly reduce the duration of cold symptoms.

"For people who have vitamin C-deficient diets, it very likely works as both a treatment and a preventive," said Dr. Bruce Barrett, an assistant professor in the Department of Family Medicine at the University of Wisconsin at Madison.

As for echinacea's medicinal properties, "I think the jury's still out," said Barrett, who was the lead author of a 2002 Annals of Internal Medicine study of the popular herb. It's no better than a placebo for shortening a cold's duration or reducing the severity of symptoms, he found.

And then there's zinc, an essential mineral purported to have some benefit as a cold remedy. But the evidence is equivocal, Barrett said. Of the 14 trials conducted to date, eight reported positive results and six found no benefit, he noted.

Zicam, an over-the-counter zinc-containing nasal gel, is one way to get the benefit of that mineral without having to endure its unpleasant metallic taste. A study reported last year, paid for by the makers of Zicam, found it can cut the length and severity of a cold by half when the patient begins treatment within 48 hours after symptoms have begun.

"I wouldn't discount it at all," Barrett said, "but when you just have a couple of studies that are pretty much embedded in one corporate research structure, I don't think it's proven yet."

In the throes of a miserable cold, many Americans still reach for familiar pain relievers, decongestants and antihistamines in the cold-and-flu aisle of their local drugstore. These products can't cure a cold but may provide instant relief from symptoms.

Antihistamines, such as Benadryl, will dry up a runny nose, but virtually all of the over-the-counter products cause drowsiness, Edelman cautioned. Non-drowsy exceptions include Alavert and Claritin, which contain the antihistamine loratadine, he said.

"If you have to drive, then you probably ought to take a non-sedating antihistamine," he advised.

Cold products that relieve nasal congestion without sleep-inducing antihistamines often contain pseudoephedrine, a type of decongestant that can cause nervousness, dizziness or restlessness. People with heart conditions or high blood pressure should consult a doctor before taking products with this ingredient.

"In general, I would steer people away from the decongestants because they work like adrenaline, like a stimulant," Barrett said.

To reduce a fever or ease body aches, try taking aspirin or acetaminophen.

Got an irritating cough? There's little evidence that cough-suppressing anti-tussive medications actually work, yet there appears to be a strong placebo effect, Barrett noted.

In fact, as with many cold-relieving strategies, if you think it works, it probably will, said Barrett, who finds evidence in support of the placebo effect too strong to ignore. Over the next three years, he hopes to enroll 800 cold sufferers in a trial that will examine the healing power of suggestion using echinacea versus a placebo.

It will be several years before those results are in. In the meantime, Barrett has a health tip for those who feel the sniffles coming on.

"Without any scientific evidence whatsoever, I can recommend that people drink their favorite herbal teas or chicken soups," he said. "It helps because people believe in it; it helps trigger your own innate system of healing."

The American Lung Association can tell you more about ways to prevent and treat the common cold.

SOURCES: Norman H. Edelman, M.D., consultant, scientific affairs, American Lung Association, New York City; Bruce Barrett, M.D., Ph.D., assistant professor, Department of Family Medicine, University of Wisconsin at Madison; National Institute of Allergy and Infectious Diseases, Bethesda, Md.; U.S. Centers for Disease Control and Prevention, Atlanta

Reference Source 62
October 3, 2004

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