About Cough & Cold Management

Although there are many health and medication related topics to discuss, there are a few topics that seem to lend themselves to reprinting. How to take care of yourself and/or your family when facing a cold is one such topic.

There are three different conditions that have similar symptoms, to some extent, and are often mistaken for each other: colds, influenza (flu) and allergic rhinitis. Colds are generally characterized by nasal congestion with thick discharge, a sore or scratchy throat, a cough (productive or dry) and a tightness in the chest. The flu usually involves an overall malaise ("feeling bad") with associated fever, chills, body aches and pains, and a sore throat. People with allergic rhinitis commonly exhibit symptoms such as sneezing, watery eyes and nasal congestion with. clear, more watery discharge. The onset is often predictable and there is rarely a fever associated with this condition.

There are four basic classes of agents available in Canada to give relief of cold symptoms.

1. Nasal Decongestants. There are oral andtopical decongestants available.

Oral decongestants (e.g. pseudoephedrine - Sudafed®, Drixoral®) are fairly common and can relieve congestion within 15-30 minutes. The duration of action is generally 4-6 hours, with some long-acting brands lasting up to 12 hours. They should not be used for more than 3-5 days at a time, and may cause some difficulty sleeping if taken within 4 hrs or so before bedtime. They will increase nasal discharge as congestion is relieved. These items should not be used by people with severe or unstable high blood pressure. Topical decongestants (e.g. xylometazoline Otrivin® - oxymetazoline - Drisfan®)have a faster onset of action, usually being effective within 5-10 min of use, and generally last up to 12 hours. Again, these agents should not be used for more than 2-3 days consecutively, as there is a good chance of developing rebound congestion that leaves the patient caught in a vicious cycle of compounding the congestion while trying to treat it.

2. Antitussives. These items are used to control non-productive coughs,because they suppress the cough reflex in the couch centre of the brain. Common products contain dextromethorphan (any produce with "DM" in its name) or codeine. The usual doses of dextromethorphan (used 3-4 times daily as required) are: adults 15-30 mg; children 6-12 yrs 6.75 mg; and infants >1 yr old 3.75 mg. Products containing dextromethorphan should not be used by people taking certain antidepressants, so it is wise to speak to a pharmacist or your doctor if you are taking other medications.

3. Expectorants. These products decrease the viscosity of secretions from the lungs and respiratory system, helping to lubricate irritated areas and promoting removal of mucus. The only expectorant approved by the Expert Advisory Committee is guaifenesin, so any cough syrup chosen as an expectorant should have this as the main ingredient. The recommended dose is 200 mg four times daily, taken with plenty of water.