Loading...
 

Respiratory Infections

It is often said "there is no cure for the common cold." This is true, but there are some things that can make you less likely to catch a cold or flu, and which we have reason to believe may decrease the risk of other respiratory viruses. There are also things that we know can shorten the course and decrease the severity of a respiratory infection once you have one.

While there are many different remedies recommended and sold for these purposes, I have focused on those that are supported by research. My slides from a Grand Rounds presentation when I taught at the residency are Here: Image Tis The Season URI Flu Talk For Grand Rounds

In the Time of Covid-19
For avoiding exposure to begin with, "social Distancing" is the best idea. I recommend staying home, and when you have to go out of course washing hands and using hand sanitizer, avoiding touching your face, etc.
My 19-year old son shared the Lady MacBeth edit to the handwashing poster here(external link).

I have been ambivalent about the face covering advice, but new data is persuasive: see my post on Masks. By all means wear one, and see the post on best materials, but DO NOT TOUCH IT CONSTANTLY and be careful removing it(wash your hands and the mask!), and do not use wearing it as a justification to relax any of the other measures you are taking.

Testing for Covid-19: there are issues with the current tests, though we still encourage doing them.

See my notes on treating the 2 phases of Covid-19 below as well.

Should you change your blood pressure pills? NO! Looks like mortality was LOWER(external link) from Covid-19 among those on ACEI's and ARBs (my favorite classes of meds for high blood pressure)

Table of contents:

Treating Covid-19 - 2 Phases

Take all advice (mine and others') with a grain of salt - we do not know yet for sure what works and what does not.
If you are sick - CALL US. We do have Covid-19 testing available for those with symptoms , though there continue to be delays with receiving results, as I am sure you have been hearing on the news. Call ahead so we are expecting you and we can determine whether testing is appropriate and which kit to use.
We also have pulse oximeters to loan, so you can monitor your oxygen levels at home while you are self-isolating. This is helping people safely stay home in other parts of the country.

For now, we think there are two different phases of this infection:

1. The initial phase (rapid viral replication) - day 1-5

(and actually, starting a couple days before symptoms)
My usual advice about Pelargonium sidoides (V-clear or Umcka) or Andrographis (immune-boosting supplements) MAY be appropriate - see below

I would recommend one of those along with
Vitamin C 500 mg three times a day
Vitamin A 10,000 - 25,000 IU per day
Zinc 60 - 100 mg per day if tolerated without nausea - lozenges may be ideal
These doses should not be taken long-term unless you are also supplementing copper
Quercetin 500 - 2000 mg per day
Vitamin D 1000 - 5000 IU per day (more the higher your body weight)
Thyme steam inhalations
AVOID STEROIDS


IFM also believes the following may be helpful for both phases:
Curcumin 500-1000 mg twice a day
EGCG - 4 cups green tea per day or 225 mg per day
Resveratrol 100 mg twice a day

2. The inflammatory second phase - day 6 and beyond

Inflammation or "Cytokine storm" seems to be the problem, that is the immune system's reaction to the virus, so in theory things that boost that may be detrimental
STOP Pelargonium (V-clear, Umcka), andrographis, Elderberry
Increase vitamin C to 1000 mg three times a day or higher, if tolerated
Continue D, Zinc, Quercetin
Add magnesium 500 - 1000 mg per day if tolerated
Consider adding melatonin 3-6 mg at night(but may increase hallucinations/vivid dreams)
Thyme steam inhalations
Steroids may be helpful

Caution - dangerous or unproven "Cures"


I think the jury is still out on pharmaceuticals- I certainly hope Remdesivir, or other remedies turn out to be helpful, but until there are CONTROLLED studies, we could be giving things that are harmful in our desperation. (For one historical example, check out the CAST trial - we were using a medicine to prevent arrhythmias that actually turned out to cause MORE sudden death.)
Keep your eye on convalescent plasma, though - that looks promising to me.

Evidence vs. Anecdote

Evidence - half of patients were given X and half were given placebo, and the patients given X did better.
Anecdote - "so-and-so took remedy X and got better"
Please remember 80% of people have mild illness, 14% are severe, only 5% are critical. So most people will get better even without an effective remedy. Some may be getting better DESPITE whatever they are given, not because of it.

Some of my patients who are most suspicious of mainstream medicine are requesting things that are unproven and might be expected to be counterproductive or harmful. PLEASE do not try unproven things like nebulized peroxide (which I believe may be quite dangerous) without checking in with me. I will do my best to research what you are requesting and give you a science-based opinion about it.

DO NOT USE HYDROXYCHLOROQUINE

REMDESIVIR may be a little helpful, but it is not a game changer. A trial in China(external link) showed a non-statistically significant shorter time to recovery but no difference in death rate. An American trial(external link) also showed a few days' faster recovery but no statistically significant difference in mortality rate

Recognizing the difference between a cold and the flu

Common ColdInfluenza
Gradual onset of symptomsAbrupt onset
Low-grade feverSignificant fever, usually >100 degrees F
Chills sweats, fatigue
Less achinessMuscle aches
Sore, itchy throat, stuffy and/or runny noseSore, itchy throat, runny nose
SneezingPhotophobia (pain with bright light)
Very AnnoyingPotentially Life-threatening

Treating the flu

Pharmaceuticals - Tamiflu etc

If you have the flu, and are considered high risk, there are some antiviral medications (Tamiflu and others) that can shorten the course and decrease the severity of your illness, but they must be started on the 1st or 2nd day you are sick, so call us immediately!!

Elderberry

Elderberry extract has also been studied for treating influenza
Elderberry extract – 1 tablespoon 4 x daily. J Altern Complement Med 1995 Winter;1(4):361-9. Improved flu recovery time to 2 days from 6 days in the placebo group.

NOT Antibiotics

Antibiotics do not affect the course of influenza, but some people may develop pneumonia as influenza is resolving. If you start to get better but then develop high fevers, chest pain, or shortness of breath, come back to see us, since you may need antibiotics if you develop this complication. Giving antibiotics during the initial course of the flu does not prevent this, but may cause you to develop secondary infection with more resistant germs.

Shortening the course/decreasing severity of a cold or other non-flu respiratory infection - and maybe Covid-19?

Pelargonium

Pelargonium(Umcka over the counter or V-clear from our office) 30-60 drops three times daily reduces the duration of colds, bronchitis, sinusitis and other syndromes and decreases the severity of symptoms. Overall, it looks like it shortens the course by up to 50% and lowers symptom scores by 1/3. It is more effective the earlier it is started.

Andrographis

Andrographis 400 mg three times daily reduced symptoms at 2 days, even more dramatic difference by 4 days. Phytomedicine 1999 Oct 6(4):217-23 Also effective in sore throat. J Med Assoc Thai 1991 74(10):824-9

Zinc

Zinc acetate lozenges can shorten the course (dissolve in your mouth every couple hours for the first few days) – watch for nausea as a side effect Ann Intern Med 2000 Aug 15;133(4):245
If taken long-term, it should be taken with a multivitamin containing 2-3 mg copper per day

Vitamin C

Vitamin C 2 -5 grams/day: 9% -37% decrease in symptom days in studies with 1 gram per day or more;works better if you start in the first 24 hours or are already taking it before catching cold. Cochrane 2000; 2:CD000980

Quercetin

There is some preliminary research suggesting Quercetin may inhibit viruses from entering cells, and a clinical trial has been planned to test this against Covid-19. Doses range from 50-1000 mg per day; absorption is improved by bromelain.

Decreasing symptoms of colds and other respiratory infections

Steam Inhalations

Steam inhalations using essential oil:
Boil some water and pour in a bowl or mug. Add 1-2 drops of essential oil (eucalyptus/thyme oil) and breath the steam for 5-10 minutes twice daily
Apply a few drops of essential oil to the edge of the bathtub and run the shower very hot with the bathroom door closed. Spend 10 - 20 minutes in the bathroom breathing the steam (this method works best with kids)

Thin secretions

Guaifenesin up to 2400 mg per day can thin secretions - it has been shown to decrease relapse rate in sinusitis and to help symptoms in acute URIs as well as chronic bronchitis
OR
Bromelain 500 - 1000 mg 2-3 x per day on an empty stomach can help with symptoms of sinusitis Otolaryngol Head Neck Surg October 2006 vol. 135 no. 4 496-506

Rinse the nose

Use salt water or other things in the nose to thin secretions or even introduce antimicrobials
Nasal saline:
1/2 tsp salt
2/3 C water (use distilled water or boiled water)
Pinch of baking soda
Use 1 mL in each nostril three times daily
OR
Consider commercial saline sprays (Ayr and others)
OR
Consider Xlear spray - has xylitol, grapefruit seed extract, and the Rescue version has essential oils as well

Address cough

Suppress cough at night to sleep better, but we recommend actually allowing the cough during the day to clear out infected mucus.
Honey was as effective as medications to suppress cough in a study in children
Dextromethorphan is also helpful in adults, but avoid in children

Vaporizer

Use a vaporizer at night, or a "cool mist humidifier"

Soup and Tea

Hot drinks and Chicken Soup may actually be helpful as well. Rhinology. 2008 Dec;46(4):271-5. Chest. 1978 Oct;74(4):408-10

What doesn't work

Antibiotics

Antibiotics won’t help your cold (they are effective against bacteria, not viruses), and taking them for colds may cause resistance to develop so they won’t work when you actually need them.

Ibuprofen and other NSAIDs

There is some data that ibuprofen may aggravate symptoms of Covid 19 - use acetaminophen instead, or maybe ride it out and let the fever do its work

OTC Medications

Over-the counter cold medicines are not particularly useful. Antihistamines make no difference in the course of a cold compared to placebo(sugar pill.) Decongestants can help some symptoms but can also elevate blood pressure and cause circulatory problems. Nasal zinc can cause some people to lose their sense of smell – use the lozenges instead.

When to call the Doctor

We need to see you if you develop chest pain or shortness of breath, if you cough up blood, if fevers persist more than 3-4 days, or if you are not improving after 2 weeks of illness.

How do you know if your shortness of breath is severe enough you need to be seen? Here is a great test: Counting to assess shortness of breath(external link)

Prevention - Staying Healthy

How can you keep yourself from getting a cold or flu?

Wash your hands

Wash your hands carefully and frequently during cold and flu season. Sch Nurs. 2001 Oct;17(5):258-65
This is especially important before touching food or touching your face. When you are not able to wash your hands, use hand sanitizer.

Probiotics

Probiotics (acidophilus, bifidus) decrease the frequency and severity of respiratory infections in children. and adults. Pediatrics. 2009 Aug;124(2):e172-9. Clin Nutr 24:481–491
In one nursing home study, 1/2 cup kefir per day decreased the risk of influenza by 40% during an outbreak

Vitamin D

Regular Vitamin D may decrease the frequency and severity of respiratory infections. 1200 IU per day in schoolkids, 800 – 2000 IU per day in adults. Cannell JJ et al Epidemic Influenza and vitamin D Epidemiol. Infect. (2006), 134, 1129–1140 Am J Clin Nutr. 2010 May;91(5):1255-60

Garlic

Eat garlic regularly or consider a garlic capsule with allicin. Adv Ther 2001 Jul-Aug. 18(4):189-93 Those taking garlic had fewer colds (24 vs. 65), and shorter symptoms with colds (1.52 vs. 5.01 days)

Zinc, Vitamin C

Regular zinc also can be preventive (15 – 40 mg per day) Cochrane 2011 Feb 16;2:CD001364 as can Vitamin C (2 grams/day) though mostly in people under physical stress, such as runners or soldiers. Cochrane 2007,3: CD000980

If zinc is taken long-term, it should be taken with a multivitamin containing 2-3 mg copper per day

NAC - N-acetylcysteine

N-acetylcysteine 600 mg to 1200 mg per day in people with chronic lung disease

Practice other self-care

Get enough sleep

Manage your stress

One study showed that job stress was one of the biggest risk factors predicting severity of illness in volunteers exposed to equal amounts of cold virus, and epidemiology shows that those with more stress have a 3-4x higher chance of catching cold. Behav Med 1992 Fall;18(3):115-20, N Engl J Med 1991 Aug 29;325(9):606-12, Epidemiology 2001 May;12(3):345-9

Eat well

Eat well, including at least 5 servings of fruits and veggies every day, and eat fermented foods (Yogurt, Kefir) or take a probiotic supplement. If you cannot, consider taking a multivitamin with minerals, or, preferably, a fruit/vegetable extract if you are not able to eat right. Public Health Nutr. 2010; 13(2): 276–282. British J Nutr 2010 104(7):998-1006; Archives of Internal Medicine 1999 159(7):748-54, Children’s research study, 2002, www.childrensresearch.org.(external link)

Immune tonic herbs

There are a number of other immune tonics which may be helpful:

Astragalus

Panax Ginseng

Use Panax Ginseng extract(Korean or Chinese) for prevention. Drugs Exp Clin Res 1996;22(2):65-72 Daily Ginseng cut the frequency of upper respiratory infections by 2/3.

Mushroom Extracts

A variety of medicinal mushrooms have been shown to stimulate immune function, though there are not a lot of studies looking at them for preventing cold and flu. Our favorite extract is a Maitake/Reishi/Shiitake blend called M/R/S, but studies have looked at Cordyceps and other fungi for this purpose.