It’s definitely common cold season (ganmao, in Chinese). So, in this deeply cold week in Beijing, it’s a good time to review what treatments actually work for the common cold.

The New York Times has a nice review today (Patient Money – Tips to Treat a Cold or Flu, With Your Wallet in Mind) of treatments for the common cold. I’ve mentioned a lot of this before, but this is  a nice review for everyone. The unfortunate truth is that people spend a lot of money on over-the-counter medicines which work poorly, if at all. And one other major point, which many people still need to understand, is that antibiotics have no use against the common cold, which is caused by a virus and not a bacteria. Fortunately, there are some easy (and free) ways to fight it off:

So, what does work? While few, if any, medicines can shorten the duration of a cold, some can help reduce the onerous symptoms of upper respiratory infections. Nasal sprays shrink swollen blood vessels and relieve stuffy noses, though the relief is temporary and you should not use spray for more than three days.

Acetaminophen and ibuprofen can reduce fevers and body aches. Rinsing your nasal passages with a saline solution or breathing steam can help loosen mucous and increase nasal secretions, which can help to prevent a secondary sinus infection. Humidifiers and hot showers also help. Drinking warm liquids like tea has been shown to reduce a variety of cold and flu symptoms.

And don’t forget chicken soup. The age-old remedy, as you’ve no doubt heard, actually does help to reduce the symptoms of the common cold.

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As we all know, there’s precious little that Western allopathic medicine can do to prevent, or even treat, the common cold. That’s why complementary and alternative therapies are very popular, but it’s very difficult to sift through the internet and find evidence-based data. I’ve mentioned a few great sources of information before, especially the webpage from Natural Medicines Database. Now, there’s a new review of the best data from the well-regarded Medscape. The article is called Complementary and Alternative Medicine Therapies for Cold and Flu Season: What Is the Science?. I’ll let the two articles speak for themselves. People should also be aware of a good U.S. government website, the NIH’s National Center for Complementary and Alternative Medicine specifically set up to research all types of such medicine.

Personally, I am a big fan of jumping on natural medicines as soon as I feel any symptoms coming on. That would usually include Airborne tables, but I recently discovered and switched to ColdWar tablets that I found in America. Overall, my main focus involves vitamin C, zinc, elderberry, andrographis — and of course, black chicken soup with fresh ginger and garlic! What do you use?

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According to the Centers for Disease Control and Prevention, when cold viruses infect the respiratory tract, the body makes clear mucus that helps wash away germs from the nose and sinuses. After about three days, the body’s immune cells fight back, changing the discharge to a white or yellow color. ”As the bacteria that live in the nose grow back, they may also be found in the mucus, which changes to a greenish color,” the agency says. ”This is normal.”

So, No Antibiotics. What Helps?

Since this is almost always just a viral infection and not a severe bacterial sinusitis, the best treatments are decongestants. Pseudoephedrine (sudafed) products in the Tylenol Cold/Bufferin Cold pills work well for 4-6 hours, as do the Robitussin combo syrups. There’s also the oxymetazolone (“Afrin”) nasal sprays. Also important are natural treatments including salt water nose rinses, steam, menthol rubs, and keeping well hydrated. I’m a big fan of salt water nasal rinsing — easy, effective, non-toxic and free!

By the way, even if it is “sinusitis”, there is poor evidence that antibiotics do anything more than lessen the symptoms by a day or two. Yes, in some cases it helps, especially if symptoms are severe, but in general people are overprescribed antibiotics for an infection that would go away on its own with a little TLC and time.

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The weather is turning colder and flu season is ramping up. There is precious little that Western medicine can offer to fight off the common cold, so it’s good to review what natural medicines and foods actually help. I previously wrote about chicken soup and easy non-food prevention tips; now let’s discuss garlic. Many people swear that eating a clove or two at the start of a cold helps their symptoms. What’s the evidence?

Garlic is commonly used in many cultures to fight infections. And there are some lab studies that suggest anti-viral, anti-bacterial and anti-fungal properties. But a major review this year by the Cochrane group found only one good study worth examining; in this study, people who took daily garlic over three months had only 1/3 the amount of colds that the non-garlic group had. So, that’s encouraging news for prevention. But, when those patients were sick, each group’s cold symptoms lasted the same length. So, less convincing evidence for treatment. Their main conclusion:

There is insufficient clinical trial evidence regarding the effects of garlic in preventing or treating the common cold. A single trial suggested that garlic may prevent occurrences of the common cold, but more studies are needed to validate this finding. Claims of effectiveness appear to rely largely on poor quality evidence.

Personally, I think it’s a good idea to try garlic for treating a common cold, not as prevention. Especially if the garlic is freshly crushed; adding it to chicken soup is perfect. The New York Times has a nice review of the literature at this link: Really? – The Claim – Garlic Can Be Helpful in Warding Off a Cold.

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But really, there isn’t strong evidence that cold temperatures by itself cause more colds. In fact, there is good evidence that cold weather does not cause the common cold. Yes, it does seem intuitive that cold weather may lower your immune system, and some studies do suggest that. And it makes sense that since a low-grade fever can increase neutrophil response, that a cold temperature would do the reverse and slow those infection-fighting cells. But the fact remains that the best studies which specifically separated patients into two groups (a cold group and then a normal temperature group), then exposed them to the common cold virus, showed no change in infections in the cold-exposed group. There’s also a pretty good review of the medical evidence at Wikipedia, along with sources of relevant articles. I included one link at the end of this post which details one of the more famous articles.

One likely reason that people think being cold causes a cold is that the rhinovirus always flares up during the winter months. Also, in winter people are huddled together in close quarters, so they expose others to the virus via respiratory particles. So, colds are always more frequent in the winter — but not because of the cold temperature itself on your body.

This is an interesting academic debate which is far from agreed upon by researchers, and honestly I am still a bit skeptical and would love to see other studies, especially from Chinese journals. No matter what you believe, common sense still prevails — I have no plans to start jogging naked through the winter streets. The American Academy of Pediatrics, which agrees with the American Lung Association that “cold weather does not cause colds or flu”, has a nice handout on winter safety tips for children.

Article: UNDERSTANDING OF VIRAL RESPIRATORY ILLNESSES PROVIDED BY EXPERIMENTS IN VOLUNTEERS.

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No Combos For Children Under Four

Recent reviews have consistently shown that, unfortunately, there is no major evidence that any common OTC products help well for a cough. In fact, side effects outweigh benefits so much that last year the FDA recommended that no child under 4 years should take any OTC cough syrups. The major problem is overdosing due to the confusion of multiple pharmacy packages, and many children unwittingly receive the same medicines from different sources (for example, taking Robitussin syrup as well as a Tylenol Cold pill, both with similar medicines). Common side effects include rapid heartbeat, drowsiness, suppression of the respiratory system, seizures, and other adverse events.

Even cough drops don’t have much proven efficacy. The overall benefit seems to be simple coating of the mouth and saliva production, causing short term relief from dryness and irritation. That means that a hard candy would have the same effect as an expensive imported “medicated” cough drop. Personally, I prefer Ricola sugar-free drops, but again there is no evidence that one is better than another.

Parents can find more information from the CDC, as well as a PDF file from the American College of Chest Physicians that provide helpful tips regarding their child’s cough. Adults can find more information from the Mayo Cinic and WebMD as well as an OTC review from Familydoctor.org. There’s also a good resource from MedlinePlus.

Does Nothing Work Well?

Of course, you need to try something for a cough, right? Sure, as long as you are prudent with the dosing, you can try these medicines. But it’s important to realize, if you didn’t know it before, that many just don’t work well — so if you’re taking it and your cough is unchanged, just stop taking it. A failure of cough syrup does not automatically mean that you need antibiotics, it just means the medicines don’t work well.

So what’s the best Rx to take? In general, the cough is triggered by all the mucus in the throat, so anything to decrease that mucus would help. Sometimes, pure dextromethorphan syrup is good, especially Delsym (hard to find in China). A pure decongestant like pseudoephedrine (Sudafed) can nicely clear mucus, as well as the nasal sprays using oxymetazoline (Afrin-type sprays).

Other natural and safe ideas, especially for children under four years, can include a menthol rub on the chest; humidifiers; and nasal saline rinses/sprays. The OTC Antuss drops also work fairly well for some (they have pseudoephedrine and dexamethasone). Some feel that lemon water with honey works as well as any OTC medicine for cough, although honey is never recommended for infants due to the risk of botulism.

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Article: Really? – The Claim – Lack of Sleep Increases the Risk of Catching a Cold. NYTimes.com.

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Their main conclusions for the most effective treatments:

• Thorough disinfection — 70% decrease
• Handwashing more than 10 times daily – 55% decrease
• Wearing masks — 68% decrease
• Wearing N95 masks — 91% decrease
• Wearing gloves — 57% decrease
• Wearing gowns — 77% decrease
• Handwashing, masks, gloves, and gowns combined — 91% decrease

Obsessive-Compulsives Are Right!

Let’s review those findings a bit. First, handwashing is extremely effective at reducing the spread of a virus. Unfortunately, it has to be done often — and correctly! As I discussed before, you need to wash with soap and water for 40-60 seconds or use alcohol-based gel for 20 seconds. I’m a big fan of those Purell-style alcohol gels; and it’s really not very practical to get someone to count to 60 every time they use soap and water. So stock up on alcohol gels!

It’s also important that your ayi is hand washing properly as well. I found a good website with PDF hand-washing instructions in multiple languages, including Chinese; print one that she can look at. This issue is another reason the alcohol gels are good; you can leave these plastic bottles all over the house and one squirt a few times a day is a lot more practical for an ayi (or anyone) than running to the sink with soap and water.

By the way, there’s little to no evidence that the antibacterial soaps do anything better than regular soap, so save your money.

And the winners are…

Sorry, Cheap Masks Don’t Work Well

This review also reiterates what I mentioned before; that the cheap, regular surgical masks work a little bit, but not nearly as well as the N95 masks. And forget about layering; even wearing as much as 5 layers of the regular surgical mask wasn’t as good as N95!

The Take-Home Message (Literally)

But we have to be honest here; it’s not easy at all to wear masks all day, let alone gowns and gloves. But households with small children definitely benefit the most from more aggressive measures. In one Hong Kong study, if all family household members used masks and alcohol gel handwash within 36 hours of a family member’s viral infection, the risk of a family member getting sick was cut by 67%.

Article: Physical interventions to interrupt or reduce the spread of respiratory viruses: systematic review — Jefferson et al. 339: b3675 — BMJ. You can also download the PDF

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But a healthier treatment is simple, inexpensive nasal saline. A seawater-type spray is very common in treating children and newborns, since the OTC medicine Sudafed isn’t considered very effective or safe for children under 24 months.

There’s also an even better way to use nasal saline; instead of a small spray, you can completely irrigate the nose with a small bottle (~200 cc each nostril) of warm salt water. Many people with chronic congestion from allergies, or repeated sinus infections, love this treatment and swear that it cuts down on their frequency of infections and need for medicines.

Buy One, Or Make One Yourself

One of my professors back in San Francisco, pulmonologist Dr KC Mehta, a few years ago became very wealthy simply by repackaging a small plastic squeeze bottle with some salt packets, and now his NeilMed Saline Rinse packages are in every American pharmacy (yes, I’m jealous). I don’t think NeilMed is available here in China, but there are many other versions available, both imported and local, in some (not all) expat pharmacies and local pharmacies and stores. They usually sell the bottle as well as pre-made salt packets. There’s also another style of bottle called a neti pot, which some find more comfortable.

You can also make your own system. All you need is a medium-size squeeze bottle (try Muji), or even a large 50cc medical syringe, or a bulb.  The syringe or pick should be sterilized frequently or replaced every two to three weeks to avoid contamination and infection.

The recipe: Use a clean one-quart glass jar. Fill with warm (not hot) boiled tap or bottled water. Add 1 to 1 1/2 heaping teaspoons of non-iodized salt (usually not table salt, as it almost always has iodine which makes this less effective; pickling/canning salt is good). Add 1 teaspoon baking soda (pure bicarbonate). Mix and store at room temperature. Then, each time you pour out some into a small bowl and fill your syringe/bottle. You should throw away leftover solution after 1 week.

How often? Once or twice a day is best; twice a day is best for chronic problems.

“Fun For The Whole Family”?

OK, that was a little joke. Many people get grossed out thinking about rinsing their nose. It’s not for everyone, but it’s worth a try since it’s essentially free and has no major side effects. And anyone with chronic nasal issues or frequent colds here in Beijing should think about trying this as a daily routine.

Here is a video on how to rinse your nose properly (from NeilMed website). You can read their  text directions here.

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Click on the “Full” icon to watch the slideshow on full screen

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