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.   (6)  Probiotics :  A better intestinal flora  protects  against intestinal but also respiratory infections. Breast feeding is associated  with the optimal gut flora. Many  infant formulas  try to emulate this protection by containing  pre-  or probiotics.  But formulas are seldom used after the age of 30 months. Thereafter a bifidus yoghurt once a day and/or a probiotic  preparation such as Protectis pédiatrique 5 drops daily can achieve this,  provided  they are taken  long enough   and are likely to make a  difference in  winter.  (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  :  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.   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.