How do you treat it "with contempt"

How to deal with the common cold.

Herald A. Habenicht, M.D., F.A.A.P., is associate professor of health education at Andrews University, Berrien Springs, Michigan.

WHAT IS IT?

The most frequently encountered infection in America today,1 it affects children much more than adults. Children are the usual source of transmission in the home and in the community.

You guessed it—the common cold. Some 111 million days are lost from school each year because of acute respiratory illnesses. These are more than 50 percent of all the days lost because of illness. 2

The all-too-familiar common cold, with its throat irritation, runny nose, and watery eyes, is the work of some kind of virus, as are laryngitis, croup, and bronchitis. Tonsillopharyngitis, or inflamed, red, swollen tonsils and throat, can be caused by a bacterium or a virus. Fever blisters (cold sores) and canker sores are caused by a virus (herpes simplex). As with the common cold, there are many viruses and some bacteria that produce pneumonia. As one can readily see, the majority of respiratory infections are caused by viruses.3

In an extremely thorough investigation, Dr. S. West4 and her associates at Johns Hopkins have just reviewed all the reports of use of antihistamines to treat the common cold listed in the Indicus Medicus (the most complete medical reference source) since 1947. She found that 94 percent of those who consult a physician for a cold leave with a prescription. One third of these prescriptions contain an antihistamine. Three and one-half million prescriptions were written in 1972 for cough and cold preparations containing antihistamines. During that same year, $600 million was spent in this country for nonprescription cough and cold remedies. And with what results? Dr. West states: "There appears to be little valid evidence that antihistamines have any effect on the common cold," and continues, "There is large patient demand for some form of physician intervention in this discomfort. Prescribing antihistamines, as fairly innocuous drugs, is an understandable choice to meet patient demands and placate harried physicians."

What is Dr. West saying? That antihistamines are prescribed primarily for two reasons, patient demand and physician pressure. But administration of these drugs is not without problems of complications and side effects. These drugs induce thickening of secretion, making more difficult any effort to raise these secretions. They have a drying effect on the delicate membrane lining the respiratory passages. They possess sedative properties that make mental processes difficult—and some activities such as vehicle driving positively dangerous.

The Medical Letter* of October 24, 1975, reviews some 50 of 100-plus over-the-counter cold remedies available. The cost varies from less than a dollar to almost four dollars for a five-day supply. These products contain as many as eight different drugs, including one to three different antihistamines, analgesics (pain relievers), vitamin C, caffeine, antacids, laxatives, antitussives (cough medicines), expectorants (aids in eliminating mucus from the respiratory tract), belladonna alkaloids (drugs that dry secretions as well as cause mental agitation), and sympathomimetics (drugs that mimic the action of part of the nervous system). Here are some of the precautions and dangers associated with their use:

Antihistamines: Frequently cause drowsiness.

Decongestants: Cause generalized constriction of blood vessels and rise in blood pressure.

Analgesics: Stomach irritation, aggravation of bleeding tendencies. Aspirin causes an increase in viral shedding, enhancing the spread of infection. 6

Expectorants: Of little value. A humidifier or warm steam from a vaporizer is much more effective.

Belladonna (Atropine): Generally present in amounts too minute to be effective.

Antacids: To prevent stomach irritation of the aspirin. Food serves just as well.

Laxatives: Clearly irrational.

Vitamin C: No evidence that it can reduce the duration of a cold. May reduce severity of the symptoms a little.

Medical Letter concludes: "Widely used remedies promoted for relief of symptoms of the common cold offer irrational combinations of drugs at a high cost." 7

As with the use of any medications, the risk must be weighed against the benefits. It was Sir William Osier who once said: "There is just one way to treat a cold, and that's with contempt."

Is There a Better Way?

Prevention is obviously tremendously better than cure, and common sense and careful health habits are perhaps the best way to prevent colds. The following suggestions may be helpful:

1. Avoid undue exposure to cold and wet. Proper clothing and footwear are essential to prevent chilling of the extremities.

2. Proper rest. Extreme stress and fatigue predispose to lowered resistance of the body to infection.

3. Proper diet. Though a good, all-around diet, with concern for total calories, protein content, vitamins, and minerals, is absolutely essential, only two factors will be mentioned here:

a. Vitamin C: This is a very controversial area because of the work of Dr. Linus Pauling. The literature would indicate that supplemental C does not en able one to avoid the common cold or to shorten its duration.8

b. Refined sugar in the diet: "The free use of sugar in any form ... is not unfrequently a cause of disease." 9 Dr. George P. Foust,10 of Loma Linda University, did a study to determine the effects of sugar on the body's resistance to disease. He developed the term phagocytic index to determine the number of bacteria a leucocyte (white blood corpuscle) would take into its system and thus inactivate. A person with a normal blood sugar (78 mg. percent) had a phagocytic index of 14. After taking 100 gms. (24 tsp.) of sugar (about the amount found in a banana split), the phagocytic index dropped to one; a bottle of pop dropped the index to 10; a piece of lemon meringue pie to 5-1/2; and a piece of chocolate cake to 2.

4. Avoid unnecessary exposure to infected individuals, at home as well as in the school and community.

5. Take advantage of immunization procedures, such as influenza vaccine and DPT.

6. Avoid air pollution. Stay away from smokers. Stay out of cities and off freeway systems where there are high pollution levels.

7. Get daily exercise—preferably in the fresh air.

8. Sleep with the windows open, even on the coldest nights.

9. Avoid overheating your homes and overdressing your children.

And when you have a cold . . .

1. Remember that the great majority of respiratory illnesses are caused by a virus. Don't insist that your physician prescribe an antibiotic for you. In fact, don't be afraid to suggest that perhaps you don't need to take one.

2. Allow nature's remedies to help you. Use air, sunlight, proper diet, rest, water, exercise, temperate living, and trust in divine power. 11

3. Learn how to use properly such simple remedies as heating compresses, fomentations, hot foot baths, steam inhalations, et cetera.

4. Avoid the use of nose drops, narcotic-type cough suppressants, and over-the-counter medications.

5. Know the serious problems and complications that should tell you to consult your physician.

a. Earaches.

b. Respiratory distress, rapid or labored breathing.

c. Severe croup.

d. Suspicion of a strep tonsillitis (see no. 6).

e. High fever (over 104 ) or convulsions.

f. Asthma or other severe allergic manifestation.

g. Suspicion of a foreign body, coughing, choking, disappearance of some object into the mouth or nose, et cetera.

6. Know the distinguishing characteristics between a virus throat infection and a strep throat. (Sometimes not even your physician can tell without the help of a throat culture.) (See box.)

7. Recognize that the same virus infection can have different manifestations at different levels. For example, in the same family the parents may have a common cold; the infant, bronchitis; a young child, croup; an older child, sore throat; and the teen-ager, a mild unrecognized infection.

Notes:

1 A, S, Monto and B. M. Ullman, "Acute Respiratory Illness in an American Community," JAMA 227(2):164-169, 1974.

2 D. C. Kent, "He!p Keep Our Children's Lungs Healthy," Clinical Notes on Respiratory Diseases 14(1):2, 1975.

3 V. C. Vaughan and R. J. McKay, Nelson Textbook of Pediatrics (Philadelphia: W. B. Saunders Co., 1975), p. 939.

4 S. West, B. Brandon, P. Stolley, and R. Rumrill, "A Review of Antihistamines and the Common Cold," Pediatrics 56(1):100-107, 1975.

5 A bi-weekly journal prepared by reputable, recognized scientists in the field of pharmacology (drugs) to acquaint physicians with unbiased and reliable information about drugs.

6 JAMA 231:1248, 1975.

7 "Oral Cold Remedies," The Medical Letter 17(22):91, 1975.

8 "Vitamin C and the Common Cold," The Medical Letter 16(21):85, 86, 1974.

9 Ellen G. White, Counsels on Diet and Foods (Washington, D.C.: Review and Herald Publishing Assn., 1938), p. 197.

10 "Sugar," International Nutrition Research Foundation, Bulletin No. 5 (Riverside, Calif.).

11 , The Ministry of Healing (Mountain View, California: Pacific Press Publishing Assn., 1905), p. 127.


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Herald A. Habenicht, M.D., F.A.A.P., is associate professor of health education at Andrews University, Berrien Springs, Michigan.

July 1977

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