The Sneezin' Season
You’ve got a nasty respiratory infection, but is it just a bad cold or is it the flu?

by Diana Swift

This winter, most Canadians will be coughing and wheezing their way through a viral infection of the respiratory tract. Here’s how to tell a common cold (even a serious one) from it’s more dangerous cousin, influenza—and how to get relief from over-the-counter preparations.

The common cold

CAUSE This affliction is caused by more than 200 infective viruses but most often by the rhinovirus (nose virus), of which there are more than 100 types. Other culprits are the adenovirus and the coronavirus (SARS is caused by a novel coronavirus). The sheer number of these microbial malefactors makes it unlikely that science will develop a single cold vaccine any time soon, says medical microbiologist Dr. Karl Weiss, an associate clinical professor of medicine at the University of Montreal. “And most of the time, a cold is a benign and self-limiting condition, so why put a lot of time, money and energy into a vaccine for something that isn’t a serious health problem?”

Illustration: Sandy Nichols

SYMPTOMS

Usually gradual in onset, symptoms include the familiar runny nose and nasal/sinus congestion, often affecting speech (“I feed a code cumbingk gon”). Count on several of the following: sneezing, weepy eyes, sore throat, hoarseness, mild hacking cough, headache, earache and possibly a low-grade fever and minor fatigue. Cold sufferers often continue to function quite well, however, and may have near-normal appetite (darn), though less ability to taste the food (darn again). Usually, cold symptoms are pretty well gone within seven days.

The flu

CAUSE

Influenza is a viral infection affecting the respiratory tract. (There is really no such thing as the “stomach flu, ” says Weiss. That is a viral or bacterial infection of the gastrointestinal tract. The two main perpetrators are the more common influenza A strain and its less common B counterpart.

SYMPTOMS

Flu symptoms normally come on more rapidly than those of a cold and may include sudden severe exhaustion (“Geez, I feel like I just got run over by a truck”). Other hallmarks are high fever (102°F to104°F, or 39°C to 40°C), coughing, weakness, aching muscles (especially in the legs), chills, shakes and sweating. You may have a poor appetite and sometimes nausea and/or diarrhea. Above all, you have a profound need for bedrest.

Fever begins to subside within a few days, and cough and congestion improve after that. The flu sometimes leads to serious respiratory infections such as pneumonia. According to Health Canada, between 10% and 25% of Canadians get the flu each year. Up to 1,500, mainly seniors, die of flu-related pneumonia, while 4,000 to 8,000 die of complications when the flu interacts with chronic diseases.

But no matter how bad your infection, do not press your doctor for antibiotics, as these are useless against viruses and effective only against bacteria. Only antiviral drugs can combat these tiny micro-organisms. “Antibiotics have saved millions of lives, but overusing them is harmful to your system. You definitely don’t need them for a virus,” Weiss says. In fact, the overuse of antibiotics has fuelled the rise of drug-resistant super-bacteria by giving them an open field in which to grow.

A few people may acquire a bacterial infection that warrants antibiotic therapy. “ If you have a persistent fever for more than five days, check with your doctor to see if you have a secondary infection,” advises Weiss. As for supplements, there is no evidence that echinacea, zinc and high-dose vitamin C prevent colds and flu or reduce the severity and duration of symptoms, he says.

The avian flu

Illustration: Sandy Nichols

Researchers are working hard to develop a vaccine against the Avian influenza strain, H5V1, which some fear may cause the next global pandemic. But the bird flu is proving to be a big challenge, says Dr. Karl Weiss, a University of Montreal expert in infectious diseases. First, the pandemic has to be already underway before researchers can isolate the strain to make the vaccine. “Second, it appears we need more of the H5V1 virus to make this vaccine than a regular vaccine,” he says. “And people may also need to have two shots to achieve a good immune response.” In light of a possible pandemic, the scientific community is now taking a second look at the benefits of oral antiviral drugs such as zanamivir (Relenza) and oseltamivir (Tamiflu). “And there are several new antivirals in the pipeline,” Weiss says.

Over-the-counter remedies

These products can soothe symptoms but will not shorten the duration of your cold or flu

STUFFY NOSES and sinuses may respond to nasal decongestants, which come in sprays, drops, tablets, capsules and pills. These contain agents such as oxymetalozine, pseudoephedrine and phenylephrine, which reduce swelling in nasal blood vessels by causing them to constrict. Use these products for no more than three days; after that they can cause rebound congestion. Decongestants should generally be avoided by people with hypertension as most of them contain compounds that may raise blood pressure and interfere with antihypertensive drugs. Stuffy noses may unplug with good, old-fashioned mentholated rubs and inhalers. Your pharmacist can help you choose a safe product to ease your symptoms.

HEADACHES and general aches and pains may be eased with oral painkillers (see “Fever”).

COUGHS For a dry cough, try an antitussive syrup containing dextromethorphan to suppress the cough reflex. For a wet, phlegmy cough, you need an expectorant formula containing guaifenesin. This latter agent loosens throat and chest congestion, allowing mucus to be coughed up. In some cases, greenish mucus can signal a secondary bacterial infection that may require an antibiotic if it persists.

COLD SORES  Topical preparations are designed for the temporary relief of pain with numbing agents such as camphor, menthol, alcohol, benzocaine or lidocaine, but according to the University of Saskatchewan’s College of Pharmacy and Nutrition, these may cause drying or counter-irritation. Some contain zinc or heparin, which certain studies suggest may slow replication of the virus and promote healing. Oral analgesics can also reduce pain, and topical moisturizing balms will reduce drying and cracking.

FEVER and chills can be relieved with oral analgesics such as acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs), such as acetylsalicylic acid (ASA), ibuprofen and naproxen. Give kids pediatric-formula ibuprofen or acetaminophen, not ASA, which in children has been linked to Reye’s syndrome. This life-threatening condition targets all organs of the body and is associated with the use of salicylate drugs and a prior viral infection such as chicken pox or the flu.

SORE THROAT and hoarseness are soothed with lozenges, some of which contain painkillers such as lidocaine, benzyl alcohol or benzocaine to numb the swollen and painful tissues of the throat. Others may contain antibacterials such as phenol. Anesthetic and antiseptic gargles, sprays and relief strips are also available.

Coughs

This is a clearing reflex that occurs with the irritation of the airways caused by colds and flu. A cough can be dry or hacking with no mucus (“non-productive”) or pulpy, wet and phlegmy (“productive”).

Cold sores

To add insult to injury, these painful, fluid-filled blisters, caused by the emergence of a dormant herpes simplex virus, often appear around the mouth and nose when your poor embattled immune system is trying to fight a cold or flu.

See your doctor if you have

•           A cold that lasts for more than 10 days

•            Earache or fluid draining from your ear

•           Severe pain in your face or forehead

•            Temperature above 102°F (39°C)

•            Shortness of breath

•            Persistent hoarseness, sore throat or cough

•           Chest wheezing

—College of Family Physicians of Canada

Your best shot

Vaccination isn’t just for kids—it’s a lifelong process

Health Canada encourages all healthy people two years of age and older to have an annual influenza vaccination flu (protection kicks in after about two weeks). A shot is crucial for children age six months to two years and adults 65 and older. It is also essential for anyone with chronic conditions such as heart or lung disease, diabetes, cancer, kidney and blood disorders or compromised immunity.

Other flu-shot candidates are people regularly caring for children zero to 23 months of age, health-care providers and pregnant women who will give birth during the November-to-April flu season (these women should be vaccinated in the third trimester). Adults with serious medical conditions such as AIDS should also receive a single dose of pneumococcal vaccine.

All Canadian adults should maintain immunity to tetanus and diphtheria with a booster shot every 10 years. These shots can now be combined with the whooping cough vaccine. Although most provincial health-care plans do not cover adults for this vaccine, authorities recommend that you have it once, at the same time as your 10-year tetanus-diphtheria booster.

Frequent travellers outside North America, excluding Mexico and western Europe, should receive vaccines for hepatitis A and B. All adults—especially females of child-bearing age—who have never had chicken pox need to be vaccinated for varicella.

Contact your local public health department for its recommended immunization schedule and a list of vaccines provided free of charge. For more information, go to www.phac-aspc.gc.ca and click on Immunization & Vaccines.

—Kristin Jenkins

Floo Fighters

To keep flu and colds at bay, observe these rules of respiratory etiquette

1. Get a seasonal flu shot (see “Your best shot”).

2. Stay up to date with regular vaccinations to keep your immune system in fighting form.

3. Wash your hands frequently and carry a pocket sanitizer for times when you can’t get to a sink.

4. Avoid the habit of touching your nose and mouth with your hands.

5. Keep your distance from folks with a cold or the flu and don’t share food or utensils with them.

6. Get adequate sleep and eat a healthy diet to nourish your immune system.

7. Reduce stress, both mental and physical, including excessive exercise.

8. Avoid smoking, second-hand smoke and excessive alcohol consumption.