By Rick Mitchell, M.D.
“The centurion replied, “Lord, I do not deserve to have you come under my roof. But just say the word, and my servant will be healed.”- Matthew 8:8
What would you want to do if you could inject $2.9 billion dollars into the US economy? Not enough? Oh, very well. How about $4 billion? Still not enough? OK then, $40 billion? Do you think you could do something worthwhile in this country with $40 billion?
These staggering numbers represent the money spent on over the counter cold medicines alone; cold medicines plus unnecessary antibiotics; and cold medicines, unnecessary antibiotics, doctor visits, and losses related to lost time at work, respectively.
Knowing what a “cold” really is can help people understand what medical science can and cannot do about this annoying health problem. “Colds” – viral upper respiratory tract infections – are caused by several large families of viruses. Literally hundreds of viruses are found in these families, and they are all different, which explains why we can’t make a vaccine against the common cold. These viruses irritate the delicate skin lining the upper respiratory tract, including the inside of the nose, the back of the throat, and the upper part of the lungs. As part of its effort to get rid of the virus, your body releases chemicals which cause all these linings to swell up and leak a protein rich fluid called mucus, and these changes cause most of the misery we experience when we get a cold.
Let’s start at the nose to understand the symptoms we develop. Fluid comes through the nose’s lining to give us runny noses. It can run down the backs of our throats to cause post-nasal drip and a resulting cough. The openings to our sinuses swell shut and we have congestion and pressure in our faces. Our Eustachian tubes swell shut and we get fluid in our ears which makes it hard to hear and makes our ears pop. The back of our throats is irritated, which makes them sore. Our vocal cords can be irritated, causing hoarseness and laryngitis. The upper part of our lungs is irritated, which can lead to a feeling of chest congestion and more coughing.
Pain, as a symptom, is typically treated with one of three or four over the counter medications. Cold medications, on the other hand seem to number in the dozens, in staggering numbers of combinations. This tells us two things: first, we need to be careful using them, and second, none of them is clearly superior. Most studies of over the counter ingredients show that few of them have any clear benefit (alas). I’ve broken them down for you in the chart below:
| Ingredient | Symptom Treated | How It Works | Is it effective? |
| Dextromethorphan | Cough | Suppresses the urge to cough in the brain | No definite effect, but we need better studies to know for certain. |
| Antihistamines (diphenhydramine, loratadine, fexofenadine, cetirizine) | Runny nose, cough (from runny nose) | Prevents the body’s immune response to things to which it’s allergic | Works well for allergies, but doesn’t work for colds |
| Phenylephrine / Pseudoephedrine / Oxymetazoline | Nasal congestion / runny nose | Reduces congestion and fluid by shrinking blood vessels | These actually work – they help people feel less nasal congestion, and sometime less runny nose too. |
| Guaifenesin | Thick mucus | Makes your membranes exude more fluid, making mucus less thick and sticky, easier to cough out | Evidence is not clear for colds, with some showing slight benefit and others showing none. Can be helpful in other situations. |
| Saline irrigation | Runny nose, congestion | Rinses mucus out | Possibly. Some studies show help, some don’t. |
I haven’t included herbal / nutraceutical remedies, since the quality of evidence for these is generally not of sufficient quality to be able to say anything definitive about it. These include Echinacea, Pelargonium, and Zinc. Some show some potential minimal benefit, but none of them are a clear fix.
Colds last 7-10 days on average, sometimes longer, and improve without intervention. Antibiotics are not indicated for colds, because they have no effect on viruses. Consider checking in with your primary care provider for symptoms past 10 days, high fevers (over 102 degrees), chest pain, ear pain, facial pain, or shortness of breath – colds can set people up for bacterial infections over time.
Voltaire said, “The art of medicine consists of amusing the patient while nature cures the disease.” Nowhere is this more evident than when we are in the throes of cold season. We cannot cure colds, but God does with the immune system He created for us.
Keep your hands clean, don’t touch your face and you can escape the worst of cold season!