PHOTO: Aacchhooo!

IT is six in the morning, and you wake up with a headache and stuffy nose. Your throat feels kind of scratchy. You body hurts all over and you hate to get up and go to work.

Yes, it is the familiar common cold again. Adults may have two to four episodes per year; children can have anything between six and eight episodes per year.

"You can catch a cold if you get caught in the rain."

Really? In our tropical country, with the more than occasional sudden downpour, how many of us have been caught in the rain, but do we always fall sick the next day?

The common cold is caused by viruses, tiny germs that spread by coughs and sneezes. Remember the health advice: cover your cough and wash your hands properly. Our hands are easily contaminated by the common cold virus and the droplets coming out from our noses and mouths spread easily to those around us.

Numerous viruses are known to lead to the common cold, and some of the more well known ones include rhinovirus, adenovirus, and the coronavirus. Thus common cold is actually a group of diseases, all having the similar symptoms such as cough, runny nose, sore throat, and occasionally fever with headache.

The word "flu" is often associated loosely to the common cold by most people, but this word originally came from "influenza". Most common colds are not caused by the influenza virus.

Gimme my meds!

Gimme my meds!

You wonder, perhaps, that a trip to the doctor to get a course of antibiotics will clear it up in a jiffy. Actually, scientific research has consistently shown that antibiotics do not really make you better any faster.

"But, it did seem to work the last time around when I took it," you may say. Well, this is where the mind is playing tricks with us. This infection lasts about a week or so. Because it resolves within a few days, we have a tendency to associate the natural recovery with the medications (usually an antibiotics) that we took. The fact is, a common cold normally gets better on its own even if we do nothing about it.

But, surely antibiotics are harmless, you might ask. No, antibiotics are hardly "harmless". Have you ever rushed to the toilet with diarrhoea after taking antibiotics? Antibiotics can kill too many good bacteria in the gut and this allows the overgrowth of bad bacteria, causing diarrhoea.

If you are unlucky, you can get a nasty allergy from certain antibiotics, causing symptoms such as rashes and incessant sneezing.

Widespread use of unnecessary antibiotics in viral infections is believed to be the reason for the rapid emergence of antibiotic resistance. Many of the antibiotics we have used in the past are now ineffective because the bacteria have "learnt" to resist them. There is a danger that superbugs that cannot be killed by commonly used antibiotics will become increasingly more common if doctors continue to prescribe antibiotics unnecessarily.

Forget antibiotics?

Does it mean antibiotics are never needed when you have common cold? Usually, they are not needed for common coughs and colds. However, if you have a bad sore throat, and you also have high fever and painful lumps in the neck (which doctors call lymph nodes), and your tonsils have pus on them, then you may need antibiotics.

So, antibiotics can make you well faster if you have tonsillitis caused by bacteria (sometimes, doctors call this a "strep throat"). The strep throat used to be a serious health problem in the past, affecting especially children in poor neighbourhoods (due to overcrowding).

With better nutrition and less congested housing, the serious complication of strep throat (e.g. rheumatic fever that may lead to heart valve damage) is now quite rare.

"Because I did not take antibiotics, my cough lasted for weeks!"

Sometimes, the cough with phlegm in a common cold can go on for several weeks. Most of the time, the cough is caused by the spread of the infection below the wind pipe into the air passages called bronchus. This is called "acute bronchitis" and it will clear up eventually.

"Doctor, I have lots of phlegm. Surely I need antibiotics?"

This may be so, if the phlegm is yellow or greenish and it's coming from your infected sinus or pneumonia. Do get your doctor to check this if you are worried.

However, most of the times, a little bit of whitish phlegm or slightly yellowish phlegm is common in acute bronchitis. It is still caused by the virus and antibiotics are not helpful.

What about antivirals and vaccines?

Alas, despite years of intensive research, most of the run-of-the-mill common colds cannot be treated with antivirals and cannot be prevented by vaccines. However, some of the viruses that have the tendency to reach epidemic proportions have been tackled with more concerted action.

Influenza, a viral infection that can cause havoc in the very young, very old, and those with chronic diseases (e.g. chronic bronchitis), may sometimes be indistinguishable from common cold in the early phase of the illness. Fortunately, effective antivirals and vaccines are now available for the currently circulating influenza strains, such as the A(H1N1) influenza.

Symptom relief

Symptom relief

So far, we have discussed why antibiotics are useless against the common cold, except in the less common situation of bacterial tonsillitis. So, what can we do to relieve the symptoms of cough and colds?

There are quite a variety of cough mixtures available over the counter. Many of them cause sleepiness, and this may be dangerous if you are driving or operating machinery.

The ability of cough mixtures to reduce cough and phlegm is not clearly shown in scientific studies. It is generally not worth the trouble to take these cough mixtures, except if the cough is causing sleep difficulties at night.

The sedative effect of these cough mixtures may also be dangerous in young children since young patients also have difficulty coughing out the phlegm on their own. So, wherever possible, children should not been given cough mixtures.

Some cough mixtures contain codeine, a weak narcotic (this is similar to drugs such as heroin and morphine), and frequent use can lead to dependency. Fortunately, cough mixtures containing narcotics are now banned in Malaysia.

During common colds, the stuffiness of the nose can be distressing. Decongestants taken as tablets or in the form of nose drops, if used judiciously, can help to reduce the blocked nose.

Again, the side-effect of sedation is a problem with some type of decongestant. Patients with high blood pressure should check with their doctor before using decongestants because some may cause a sudden rise in blood pressure.

Inhaling hot humidified air (e.g. by inhaling steam from a basin of hot water with the head and basin covered with a large towel) has been shown in some studies to loosen up the phlegm in the nose and air passages and allow it to come out more easily.

During common colds, the cough, phlegm, runny nose and fever that come along together may make you lose more water than usual. It is wise therefore to take more water during common colds.

Many people believe that taking vitamin C at the onset of a common cold helps to shorten the duration of the illness. This practice was first popularised by the Nobel laureate Linus Pauling, who recommended mega doses to treat common colds. There is no strong scientific proof of vitamin C as a treatment for the common cold, neither is there good evidence to support daily intake of vitamin C in preventing its occurrence.

Echinaceae, a flowering plant native to North America, has been claimed by some to possess the ability to treat or prevent common colds. Again, the scientific basis of such a claim is regarded as weak.

Zinc, provided in the form of lozenges, has been shown in some studies to reduce the duration of cold symptoms. Although labeled as a "cold cure" of sort by some advertisements, its benefit is probably overblown. Most users find the aftertaste quite disagreeable.

Interestingly, honey, an ancient home remedy, is making a comeback as a remedy for the common cold. Studies have shown that a spoonful of honey taken before sleep is able to reduce the severity of cough in children with the common cold, and indirectly ensuring a good night's sleep for the distraught mother.

So, a look at the various purported cold cures shows that nothing much can be done, medically speaking.

The next time you have a common cold, think twice before you make another trip to your family doctor, unless your symptoms are bad enough or you think you may have contracted something more unusual, such as influenza. You will probably feel better if you take a few days off to rest at home and request you mum (or your loved one) to cook for you a nice chicken soup.

Dr CL Teng is a family physician based in Seremban. He teaches full-time in the Department of Family Medicine, International Medical School. This article is contributed by The Star Health & Ageing Panel, which comprises a group of panellists who are not just opinion leaders in their respective fields of medical expertise, but have wide experience in medical health education for the public. The Star Health & Ageing Advisory Panel provides this information for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader's own medical care. The Star Health & Ageing Advisory Panel disclaims any and all liability for injury or other damages that could result from use of the information obtained from this article.