Upper Respiratory Viral Infection
W. Ali H. MD Medicine (I), Bruce Barrett, MD, PhD
Overview: Upper Respiratory Viral Infection
Viral infection of the upper respiratory tract causes the common cold, humanity's most frequent illness.
Acute viral respiratory infections are often categorized as being caused by influenza, the most serious of the viruses, or all others.
Noninfluenza upper respiratory infection (URI), or common cold, accounts for more than 25 million doctor visits and 40 million lost days of school and work each year in the United States alone.
Total annual economic costs are estimated at approximately $40 billion in the United States, thus making noninfluenza URI the seventh most expensive illness.
Although colds are often considered a nuisance rather than a major public health threat, even rhinovirus, the least pathogenic of the common cold viruses, causes death among older and immunocompromised patients.
On average, children experience four to six symptomatic colds per year, along with several asymptomatic infections.
Day care attendance is a reported risk factor.
For adults, the average is two to three symptomatic colds per year and perhaps one or two asymptomatic infections.
Some people are especially prone to colds; others get them infrequently.18 We do not really know why.
Despite numerous investigations, both biologic and psychosocial determinants of susceptibility are poorly understood.
Important Points to Consider: Upper Respiratory Viral Infection
No effective cure exists for the common cold. Even the best positive trials report only modest symptomatic benefit and little or no duration benefit.
Healthful exercise, nutritious diet, positive attitude, and healthy relationships are important.
Several trials support the use of Andrographis. This is one to watch.
Actually, more evidence is available on echinacea and vitamin C than on any single conventional therapy. Unfortunately, for every positive trial result, a negative one has been reported.
Of a dozen trials of zinc, half the results are positive and half are negative.
Belief in a therapy—positive expectation—should usually be supported rather than discounted.
Conventional treatments such as antihistamines, decongestants, and cough remedies may help slightly with some symptoms, but they do tend to have side effects.
Prevention Prescription
Eat a nutritious diet with foods rich in vitamin C (fruits and vegetables) and zinc (meat, nuts, cereals, seafood, and pumpkin seeds).
Do not smoke. Maintain regular exercise and movement, and be careful not to overstrain.
Maintain supportive social relationships.
Reduce exposure to people with colds.
Reduce stressors, and foster positive emotions.
Wash your hands frequently.
Obtain an annual influenza vaccine.
Vitamin C (200 to 500 mg daily)
Panax ginseng (100 mg daily)
Probiotics have some effectiveness for the prevention of colds and flu.
Therapeutic Review: Upper Respiratory Viral Infection
Botanicals
Andrographis: 300 mg four times daily as soon as symptoms appear and continued for 3 to 4 days
Echinacea: No one formulation appears to work better than another. Consider one of the following three to four times daily for the first 3 to 4 days of a cold:
1 to 2 mL of extract in juice or water sublingually
150 to 300 mg powdered extract
1 to 5 mL of tincture (1:5 in ethanol)
Pelargonium/umckaloabo: EPs7630 is an 11%aqueous ethanolic extract in which 100 g of finished product corresponds to 8 g of extracted plant material.
This was the formulation used in the clinical trials but may be difficult to find in the United States.
Dosage used in clinical trials:
Those older than 12 years old: 30 drops three times daily
A 1 × homeopathic formulation is produced by Nature's Way called Umcka ColdCare.
The dose is 1 mL of the tincture three to five times a day for those older than 12 years.
Nutrition
Vitamin C: 500 to 1000 mg three times daily for the first 3 to 4 days of symptoms
Zinc gluconate or acetate: 23-mg tablets every 2 hours while awake
Pharmaceuticals
First-generation (sedating) antihistamines may decrease nasal congestion, but they may cause drowsiness.
Diphenhydramine: 25 to 50 mg every 6 hours
Clemastine: 1 to 2 mg two to three times daily as needed
Chlorpheniramine: 4 mg every 6 hours Intranasal decongestants appear to be effective in decreasing nasal congestion and drainage, but quite often they cause nasal dryness, irritation, or nosebleed, and, rarely, insomnia, palpitations, or elevated blood pressure.
Intranasal decongestants appears to be effective in decreasing nasal congestion and drainage, but it may cause headache, nasal irritation, or nosebleed.
Nasal ipratropium 0.03%: two sprays in each nostril two to three times daily. It is also effective for nasal congestion.
Biomechanical Techniques
Hot moist air: Consider adding 5 to 10 drops of eucalyptus oil or chamomile tea to the water, and inhale deeply for 10 to 15 minutes.
Nasal Irrigation
Consider twice daily nasal irrigation with normal or hypertonic saline with a bulb
syringe, nasal spray, or neti pot.Astragalus, chamomile, garlic, ginseng, peppermint, and chicken soup are all unproven but probably safe, supportive therapies.
Key Web Sources
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