In recent weeks, so many people have been coughing in the Observer newsroom that it’s sounded like an infirmary.
Although this has been a mild year for influenza, the circulating cold viruses have been vicious. And one of the signature symptoms seems to be a long-lasting, hacking cough.
“Sometimes the cough will be the last thing to resolve,” said Dr. Ryan Shelton of Mecklenburg Medical Group SouthPark.
“It can last up to a month,” said Dr. Dino Kanelos of Carolina Family Healthcare in Ballantyne.
Even though that’s annoying to people who are sick – and to people around them – it’s not necessarily something to worry about.
“That means you’re coughing things up,” Kanelos said. “Four to six weeks is not surprising. … I just tell the patient, ‘You’re sick. It’s OK to cough.’ ”
There’s no perfect treatment for a cold and cough. Antibiotics should not be used unless the viral infection lingers and turns into a bacterial infection, such as bronchitis, sinusitus or pneumonia.
The virus will run its course, typically in five to seven days, and they’ll feel good again.
Dr. Roy Lewis of Charlotte Eye Ear Nose & Throat Associates
You’re pretty much stuck with treating the symptoms. But with so many choices in the drug store aisles, that can be confusing.
Kanelos and several other doctors I talked with last week suggested taking over-the-counter Mucinex, which contains the expectorant guaifenesin to loosen and clear mucus from the airways, or Mucinex DM, with added dextromethorphan, a cough suppressant.
If the cold is accompanied by nasal congestion, Shelton suggested using saline spray or steroid nasal sprays, such as Flonase or Nasacort, to reduce inflammation and relieve mucus buildup. Using the neti pot to rinse the nasal passages with warm salt water can also offer relief. And there’s always ibuprofen to help with achiness, Shelton said.
I just tell the patient, ‘You’re sick. It’s OK to cough.’
Dr. Dino Kanelos of Carolina Family Healthcare in Ballantyne
Kanelos advises patients to do what he does – tackle symptoms at the earliest sign by taking vitamin D supplements and drinking plenty of fluids. Kanelos, who just got over a cold, said he also used an over-the-counter nasal spray and started feeling better after six days, without ever developing a cough. He said patients are most contagious during the first 72 hours of a viral infection.
None of the doctors I interviewed was enthusiastic about a treatment that is popular with some patients –prescription cough medicines that contain hydrocodone, a narcotic that causes drowsiness and is potentially addictive.
“I refuse to write cough syrups,” Kanelos said. “I don’t think they’re safe. … It could suppress your breathing. It could make you too sleepy.”
But the desire for a good night’s sleep could be one of the main reasons for taking hydrocodone. “It helps people sleep,” Shelton said. “If you can get better rest, that’s better for your body so you’re immune system can work.”
But Shelton and other doctors said they’d only prescribe it if a patient has been suffering for a while with severe symptoms and can’t seem to get relief with anything else.
“It’s big guns,” said Dr. Genevieve Brauning of Novant Health SouthPark Family Physicians. “It can be helpful, but I think we have to use it with caution. If you come in on Day Two and you’ve missed a night of sleep, I’m not going to jump to a narcotic.”
Dr. Roy Lewis of Charlotte Eye Ear Nose & Throat Associates said he rarely prescribes cough medicine with hydrocodone because it “covers up the cough and doesn’t help you resolve it. … It just tells your body not to cough.” He said he’d rather patients take the 12-hour Mucinex DM to “thin the mucus.”
“The virus will run its course, typically in five to seven days,” Lewis said, “and they’ll feel good again.”
That’s hard for some people to accept, and doctors know it.
“It’s really simple to say, ‘If you’re sick, stay home from work,’ but it’s not always practical or do-able,” Shelton said. “Sometimes we really can’t call out of work sick. We push ourselves. We want a quick fix. But sometimes, there just isn’t one.”
Cold and flu season facts
▪ At the end of January, North Carolina flu trackers estimated only 1 percent of residents had flu-like symptoms, compared with about 10 percent at the same time last year. Eight people had died from complications of the flu at this time last year. So far this season, two have died.
▪ Last week, emergency departments in Carolinas HealthCare System reported 337 patients with influenza-like illnesses, down from 681 for the week that ended Jan. 2. The system also reported declines in respiratory and gastrointestinal illnesses.
▪ Paper towels or jet air dryers? A study published in the Journal of Hospital Infection in 2014 concluded that warm air dryers “may be unsuitable for use in healthcare settings” because they could increase the spread of germs by blowing microscopic drops of water containing bacteria around the bathroom. An Australian study, published in Mayo Clinic Proceedings in 2012, concluded: “From a hygiene viewpoint, paper towels are superior to electric air dryers.”
▪ For many years, Joe and Terry Graedon of The People’s Pharmacy have shared their readers’ unusual recommendation for calming a nighttime cough – smearing Vicks VapoRub on the soles of the feet and then pulling on a pair of warm socks.