Colds, Coughs & the Flu

Considering how frequently people suffer from the flu or colds—there’s a reason, after all, it’s called “the common cold”— it’s surprising how much misinformation there is out there about how we get and get rid of cold and flu viruses.

Folk wisdom maintains that becoming chilled—especially if clothes, hair or feet get wet—is likely to lead to a cold. Researchers have dismissed this belief as an old wives’ tale. They see viruses as the only cause of colds.

Scientists have squirted cold viruses into the noses of volunteers and then exposed them to cold temperatures to see if this makes a difference. Studies that were done decades ago did not find an effect.

More recently, though, researchers in Wales had 90 volunteers put their feet in cold water for 20 minutes. Ninety others served as control subjects. Those who were chilled with cold water were more likely to report cold symptoms over the next five days (Family Practice, Dec. 2005). The investigators concluded that the old wives may have been right after all, though they are not quite sure why.

We’ve often heard doctors say that if you take an over-the-counter (OTC) cold remedy, you’ll kick your cold in a week. Or, you can take nothing at all and recover in seven days. Their point is that cold remedies might relieve some symptoms, but don’t have any effect on the underlying viral infections.

There’s even evidence that some remedies may actually be bad for people with colds. Insomnia is a known side effect of oral decongestants such as pseudoephedrine and phenylephrine. Such ingredients are found in many popular cold remedies. Since sleep is essential for recovery from these nasty bugs (Archives of Internal Medicine, Jan. 12, 2009), anything that interferes with a good night’s sleep seems counterproductive.

Other possible side effects of oral decongestants include: heart palpitations, an increase in blood pressure, feelings of anxiety or nervousness, headache, dizziness, and nausea. This list almost makes it sound like the cure is worse than the cause. And sometimes that may be true.

Popular pain relievers like aspirin, acetaminophen and ibuprofen are found in many cold and cough remedies even though we’ve known for decades that there could be a downside to giving these pain relievers to someone with a cold. As early as 1975, researchers published such findings in the Journal of the American Medical Association. Not only did they conclude that aspirin provides little symptom relief, it also increased “virus shedding” by 38%—i.e. it makes cold-sufferers into virus factories. The investigators concluded that “Aspirin treatment, which permits the person to stay on the job with more infectious secretions, should make him a greater epidemiologic hazard.”

Australian researchers discovered that acetaminophen and ibuprofen were almost as bad as aspirin in this regard. A double-blind, placebo-controlled trial revealed that these pain relievers dampened the body’s natural immune response and actually “increased nasal symptoms.” (Journal of Infectious Diseases, 1990). And pharmacists at the University of Maryland reported that aspirin and acetaminophen actually prolonged flu symptoms by more than three days.

Antihistamines are ubiquitous in cold and cough remedies. Although such ingredients help relieve allergy symptoms, there has been some controversy over their benefit against colds or flu. They may relieve symptoms a bit by making your nose less drippy, but there are also drawbacks. Notably, they can make you feel so drowsy and dopey that it’s be hard to do anything requiring coordination or mental ability.

Of course if you have a bad cold, you shouldn’t be doing anything important anyway. But the manufacturers of these products often market them as good ways to get you back to work. We think that combination products probably shouldn’t be used in that way, both because people shouldn’t spread their viruses around at work and because driving or operating machinery while under the influence of an antihistamine is a bad idea.

OTC Cold Remedies

Be wary of multi-ingredient remedies that promise relief from a range of cold or flu symptoms. It’s better to select a single ingredient that works rather than a conglomeration of drugs that could cause side effects.

Not for Kids!

The president of the American Academy of Pediatrics, Jay Berkelhamer, MD, has said that OTC cough and cold medicines have “been found not to be effective in this population [infants and toddlers] at all.”

As a result of his and his colleagues’ efforts, the industry no longer markets to children under four. But Baltimore’s health commissioner, pediatrician Joshua Sharfstein, MD, is still concerned about children aged two to six. He has stated, “There is no evidence that these products work in kids, and there is definitely evidence of serious side effects.” Roughly 7,000 children under 11 are rushed to hospitals every year as a result of a bad reaction to a cough or cold medicine.

Common Antihistamines

• Brompheniramine
• Chlorpheniramine
• Clemastine
• Diphenhydramine

Decongestants

• Pseudoephedrine
• Phenylephrine

Oral decongestants work by constricting blood vessels in the nose.

Possible side effects

• Heart palpitations
• Blood pressure increase
• Anxiety or nervousness
• Headache
• Dizziness
• Insomnia
• Nausea