How about the common cold ?
The common cold may be the most frequent ailment observed in cold and temperate climates. Surprisingly its treatment is often neglected. It is therefore useful to recall some basic notions or principles, mention a number of simple precautions, preventive measures and effective treatments, often ignored, misunderstood or overlooked.
Immediate care :
(1) From the onset of a cold, and for about a week, a zinc preparation can be taken by mouth. Zinc helps fight rhinoviruses, responsible for most common colds and may also boost immunity. Adults and children older than 4-5 years may take "Influzinc" lozenges (1/2 lozenge for younger children) 3-4 times a day. A liquid preparation must be used in babies : for instance zinc gluconate 5 per cent to be taken 3 times a day at the very low dosage of 0.1 ml / 3 kg body weight / dose. A significant shortening of the illness and a lower level of symptoms can be expected. This may be especially interesting in babies when wheezing is heard. More than half of bronchiolites not requiring hospital admissions are due to a rhinovirus. This treatment is safe beyond any doubt but its effectiveness awaits validation by a specific scientific study.
(2) The nose can be effectively decongested with oral Rhinathiol antirhinitis. The official warning restricting this medication to children older than 12 years can safely be ignored, it has no medical justification. The medicine has been used for more than 30 years in children as young as one year without problems provided the proper dosage is not exceeded : 1 ml / kg body weight / 24 h , divided in 2 ou 3 oral doses, as long as it seems useful. It is often beneficial to combine this treatment with an expectorant (to make secretions more liquid) such as bromhexin, acetylcystein, carbocistein, but these medications should preferably be given before 5 pm in order not to increase night time secretions. This side effects is especially common with bronchites and/or under the age of 12-18 months, even during the day. In this younger age group the best "cough syrup" is plain water, which effectively moistens mucous membranes and prevents secretions from drying. Otherwise they may become sticky and difficult to mobilize. On the other hand humidifiers are not recommended and may be counterproductive.
(3) in order to cleanse the nose : normal saline is effective, as much as decongestant nose drops and without the risk of nasal irritation. Drug rhinitis is common in children and presents as nasal congestion caused by local decongestants. Local (nasal) antibiotics are controversial and probably most often ineffective.
(4) Antipyretics : fever plays a role in fighting viruses. Suppressing it to vigorously may impair natural defense mechanisms, causing the disease to worsen or last longer. In children the upper limit of normal temperatures is 38°C, and it makes little sense to treat a fever <38.5°C. It is however reasonable to give medications to bring it down if the child is lethargic or refuses to drink, or if the temperature rises too much (>39.5°C). Otherwise it is often best to observe and maintain a high fluid intake. A tepid bath is no more effective than undressing a young child (bare chested) in a room at normal temperature (20°C). If a medication is given, paracetamol (acetaminophen) is preferable to ibuprofen which may irritate the stomach and depress immunity. If needed the latter medication should be used as little as possible. Some clinicians suspect regular ibuprofen use as a contributing factor in a significant percentage of recurring ENT infections.
* * *Long term or preventive treatments :
(5) Vitamin D is normally produced in the skin by the sun. There are almost no dietary sources (only
fish liver oil which also contains large doses of potentially dangerous
vitamin A, and mushrooms). Therefore
vitamin D deficiency is common in Europe (where dairy milk is not
enriched in this vitamin). It impairs calcium absorption
from food and into bones (leading to rickets in children, contributing
to osteoporosis in adults) but is often not obvious and ignored
even though it also weakens immune
defenses against infections (and some cancers). A
preparation such as D-cure, 5 drops once a day is standard in
babies and young children. In adults and older children able to suck
its content, one ampule of D-cure once a month is more
convenient, and sufficient.
(7) Influenza vaccine : colds and flus are distinct illnesses. However the flu is a debilitating disease which may pave the way for other infections. This probably explains why routine flu vaccination in day care centres at the beginnig of the cold season is associated with a lower risk of other viral infections in the ensuing months. The flu vaccine is not effective and validated before the age of six months, but from that age on is now recommended to all children, adolescents and youngsters, and employers know that it continues to be beneficial among adults. Since the vaccine composition changes every year, the immunity is cumulative : those who take the vaccine yearly benefit from a widening and increasing protection.
8) Bronchovaxom is an oral bacterial "vaccine" which boosts immunity and seems able to cut by half the number of colds, when frequent. It is a preventive treatment usually prescribed in late fall or early winter. The schedule is one capsule once a day for 10 days, followed by an interruption of 20 days, and so on three times (a treatment of 3 months).
* * *Specific treatments :
: recurring colds can result from reactions to
inhaled or ingested allergens. An allergic work up, with
blood, skin tests and/or challenges may disclose
significant sensitivities, leading to avoidance measures and/or more
effective specific treatments.
9) Allergy : recurring colds can result from reactions to inhaled or ingested allergens. An allergic work up, with blood, skin tests and/or challenges may disclose significant sensitivities, leading to avoidance measures and/or more effective specific treatments.
10) Cow's milk allergy
is a peculiar and complex situation. It often
leads to protracted minute blood loss from the
intestinal mucosa, resulting in iron deficiency. This impairs
mucosal resistance to infections and must be corrected.
Iron and zinc deficiencies, regularly associated,
both cause a decrease of the ability to taste (agueusia)
which makes food diversification and dietary
iron intake more difficult. In addition cow's milk allergy is often held
responsible of a gastro-esophageal reflux.
10) Cow's milk allergy is a peculiar and complex situation. It often leads to protracted minute blood loss from the intestinal mucosa, resulting in iron deficiency. This impairs mucosal resistance to infections and must be corrected. Iron and zinc deficiencies, regularly associated, both cause a decrease of the ability to taste (agueusia) which makes food diversification and dietary iron intake more difficult. In addition cow's milk allergy is often held responsible of a gastro-esophageal reflux.
11) Whatever their cause, gastro-esophageal refluxes may cause recurring respiratory symptoms and/or infections. The diagnosis can be confirmed by scintigraphy or analysis of the esophageal pH and a specific treatment may sometimes solve a persistent problem of colds, otites, bronchites, asthma, responding poorly to other therapies.
12) A chronic sinusitis (often linked to allergy) may present as more or less permanent or frequent colds. Classical treatments (decongestants, expectorants, antihistamines, anti-inflammatory drugs) may fail. Antibiotics are seldom necessary and offer no lasting solution. It is however often possible to obtain good results with low dose clarithromycin : 250 mg once a day in adults, a lower dose in children, adapted to their weight. This weak dose offers a potent anti-inflammatory action, has little or no antibiotic effect and can be taken for long periods if needed.
13) Every chronic illness which impairs the general condition or nutrition is likely to increase the frequency and severity of colds. Abnormally frequent or serious respiratory illnesses should therefore lead to a general work up. Specific or congenital immune deficiencies are much less common and beyond the scope of this brief survey.
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