Before your sniffles morph into a nasty sinus, chest or ear infection, here’s how to fight back.
By Sari Harrar
Mugs of tea, a bottle of ibuprofen and a truckload of tissues won’t get you through every case of the sniffles. Too often, the common cold turns into something more serious, zeroing in on your personal weak point to become a sinus infection, a sore throat, a nonstop cough, an attack of bronchitis or an ear infection. And if you’re prone to a particular complication—thanks, perhaps, to an anatomical quirk (such as sinus obstructions), an underlying medical problem (early asthma, for example) or a history of a particular illness (childhood ear infections)—your odds of getting sicker, faster, can skyrocket.
But complications aren’t inevitable, new research shows. “With the right strategies, you can cut your risk significantly,” says Gailen D. Marshall, Ph.D., M.D., director of the division of clinical immunology and allergy at the University of Mississippi Medical Center in Jackson.
The trick: Act quickly. “The problem isn’t the virus replicating in your respiratory tract. The congestion and thick, trapped mucus that lead to complications are caused by the immune system’s response to the infection,” says pioneering cold researcher Jack M. Gwaltney, M.D., professor emeritus in the department of internal medicine at the University of Virginia School of Medicine. “It all begins within 10 to 12 hours after infection starts. You should take action the minute you feel the first symptoms of a cold—the scratchy throat, runny nose and sneezing.”
If you’re prone to sinus infections
Once a cold virus latches on to cells in your respiratory tract, immune system responders cause blood vessels in your nasal passages to swell and leak fluid. They also boost mucus production and slow down cilia—the microscopic hairs that normally sweep secretions out of your sinuses, ears, and lungs. “This sets the stage for a sinus infection, because viruses and, to a lesser extent, bacteria thrive in trapped mucus,” says Dr. Marshall. The best approach is to keep your nose open. “I preach to my patients all the time: If you can breathe through your nose, the likelihood of developing secondary complications will be much, much lower.” Here’s how:
Use a decongestant. Sprays containing phenylephrine (Neo-Synephrine) or oxymetazoline (Afrin) shrink swollen blood vessels in the lining of your nose, allowing mucus to drain. “Sprays work almost instantaneously,” says Dr. Marshall, “but you can’t use them long-term. After three to five days, they can cause rebound congestion—stuffiness returns just a few hours after each dose, tempting you to use the spray more and more frequently.” To avoid this, spray for no more than two or three days, then take two to three days off, he advises. “You’ll be able to use it safely for another two to three days if necessary.”
Try a pill. If you hate sprays, decongestant tablets can also clear your stuffiness, a recent Australian review of cold-remedy research has found. And they can work fast, reports a British study of 238 women and men with stuffy noses: Those who took 60 milligrams of pseudoephedrine (brand name: Sudafed) reported a 30 percent drop in congestion after just one dose. The downside is that decongestant pills make some people very jittery and they can keep you awake, so you shouldn’t take them late in the day. (Sprays don’t have these side effects because they’re topical—only a little is absorbed into the body.) Ask for pseudoephedrine at the counter: Because its ingredients can be used to make the street drug methamphetamine, federal law requires stores to keep pseudoephedrine-containing products behind the counter or locked in a cabinet. Choose one that’s just a decongestant to make sure you get the recommended 60-milligram dose—combination remedies may contain too little decongestant for maximum benefit.
Consider an antihistamine. In recent studies, antihistamines (the old-fashioned kind, like Chlor-Trimeton, not the new non-drowsy formulas) reduced nasal secretions by about 50 percent, says Dr. Gwaltney. The less gunk in your nose, the less there is to become trapped in your sinuses. He suggests taking antihistamines for up to a week; if these make you sleepy, be careful about driving and similar activities.
Thin that mucus. As a cold progresses, nasal secretions grow thicker and thicker because they are carrying away viral particles and sloughed-off respiratory and immune cells. To keep things moving, try an over-the-counter mucus thinner that contains guaifenesin (such as Mucinex), Dr. Marshall advises. “You’ll know within 48 to 72 hours whether it’s helping you,” he says. “Your mucus will be thinner, and it’ll be easier for you to blow your nose.” It’s OK to take one along with a decongestant.
Honk with finesse. Vigorous nose blowing propels nasal fluids up into your sinuses, which can actually cause an infection, Dr. Gwaltney’s studies have found. Hard blowing also triggers “reflex nasal congestion”—more nasal-passage swelling. It sounds silly, but “fewer than half the people we see know how to blow their noses the right way,” says Dr. Marshall. Here’s how: With a tissue over your nose, close one nostril and gently blow the other side for three to five seconds. Switch sides. “It may take several blows, but it works.”
Sip chicken soup. In one lab study from the Nebraska Medical Center in Omaha, researcher Stephen Rennard, M.D., discovered that his grandmother-in-law’s chicken soup recipe might help relieve some of the inflammation behind cold symptoms. In the test tube, the soup inhibited movement of white blood cells called neutrophils by 75 percent; researchers suspect that in your upper respiratory tract, this curtailed movement could translate into a reduction in cold symptoms.
Warm your sinuses. Placing a comfortably hot washcloth on your cheeks or drinking a cup of hot tea—or doing both—feels good if sinus pressure is building. Warmth may also nudge cilia, which become sluggish when you have a cold, so they sweep back and forth more briskly to whisk mucus along. Inhaling steam in a warm shower also helps, or drape a towel over your head and a basin of very hot water and breathe deeply.
Try andrographis paniculata. This herb is less well-known than other botanicals purported to fight colds, but in one Chilean study of 158 cold sufferers, nasal secretions dried up significantly for those who took 1,200 milligrams of andrographis extract daily for five days. It’s available at natural foods stores; if you try it, follow package dosing directions.
Call the doctor if you have a fever; your face or the area around your eyes is red, swollen or painful; you have a severe headache or neck pain; or your symptoms (sinus pain, pressure, yellowish discharge) haven’t improved after a week’s time.
If you’re prone to acute bronchitis
A few days after cold symptoms appear, you may notice trouble brewing in your lungs. “Upper respiratory tract infections develop in the—no surprise—upper airways and then spread to the lower,” notes Ron Eccles, Ph.D., director of the Common Cold Centre at Cardiff University in Wales. That’s why you start coughing two or three days after a cold begins—a sign your windpipe and the tiny tubes in your lungs are becoming inflamed. These steps can help protect against infection:
Steer clear of cigarettes. Smoking and inhaling secondhand smoke weaken your ability to fight off viruses and bacteria. At the same time, dozens of nasty chemicals in tobacco smoke may cause inflammation in your airways, further slowing the cilia. The result: more coughing, as you try to clear globs of mucus.
Don’t curl up in front of the fire. Breathing in the tiny particles in wood smoke can be especially irritating to airways when you have a cold, says Melvin Pratter, M.D., head of pulmonary and critical-care medicine at Cooper University Hospital in Camden, N.J. One report estimates that emissions from wood fires (as well as coal-fired power plants, cars, and other sources) cause 20,000 cases of acute bronchitis a year. If you use a wood stove for heat, be sure it burns efficiently; best is one certified by the Environmental Protection Agency.
Skip spray cleaners. Aerosol and pump-bottle products contain chemicals that can irritate lungs, says Dr. Pratter. “When you have a respiratory infection, take a brief holiday from cleaning.”
Try ivy-leaf extract. In a German study of 1,350 children and adults with chronic bronchitis, more than 85 percent of those who took this botanical remedy had less pain, coughing and mucus production. Several varieties of the extract are sold in natural foods stores.
Call the doctor if you have a fever, shortness of breath, or a severe cough; you have asthma, emphysema, or COPD; or you get bronchitis often.
If you’re prone to ear infections
They’re not just kid stuff: About a third of adults with colds wind up with negative air pressure in the middle ear caused by swelling or congestion of the eustachian tubes. These tubes normally let air into the middle ear and, if necessary, drain fluid from it. A blockage or swelling can create a vacuum so that when the tube opens up again it may suck in virus-packed secretions from your nose—and lead to an infection.
To prevent it: Start decongestants—stat! Sprays and pills that shrink swollen nasal passages can help keep your eustachian tubes open, says Dr. Marshall. Don’t waste any time: Those tiny tubes can become blocked quickly—within two to three days after a cold begins.
Don’t pop your ears. Taking a big breath, then forcing the air back into your ears while you close your mouth and hold your nose is a good trick to try when your ears need clearing on an airplane. But it’s best not to use that technique when you have a cold—you may push infected mucus into the ears.
Avoid smoke. In laboratory studies, researchers from the University of North Carolina at Chapel Hill found that repeated exposure to tobacco smoke (cigarettes, pipes, cigars) slowed down cilia in the eustachian tubes. “That’s not helpful if you’re trying to move mucus down the tubes and away from your middle ear,” says Birgit Winther, M.D., of the University of Virginia School of Medicine in Charlottesville.
Call the doctor if you have a fever, severe headache, dizziness, worsening pain or hearing, or there’s swelling around your ear.
Help your body heal
Give in to sleep. When you have a cold, high levels of immune system chemicals called cytokines make you sleepier than usual. Don’t fight it: Shorting your sleep for even one night blunts the body’s immune response. If a cough is keeping you up, try Advil, Aleve or another NSAID, says Dr. Gwaltney. These block prostaglandins, which experts suspect trigger the cough reflex.
Avoid intense workouts. They can make symptoms worse. But moderate activity like a 30- to 45-minute walk won’t hurt—and, by boosting immune function, could help you fend off your next cold.
Eat lightly. Your immune system dials back appetite during a cold, presumably to conserve energy and body heat for the big fight against viral invaders. Just be sure to drink plenty of fluids—they help thin mucus.
Relax. In a study of 55 people experimentally exposed to a flu virus, those who reported more stress developed more severe symptoms and released more of the immune system chemicals that cause inflammation. The same happens with cold viruses, say the researchers.
At-home Rx: Sinus Trouble: The Saline Solution
A daily saline rinse may reduce sinus symptoms by as much as 72 percent and even cut the number of infections for those with chronic sinus problems, researchers from England’s Royal National Throat, Nose and Ear Hospital concluded after reviewing a series of studies. This ancient remedy softens and removes crusty mucus, thins nasal secretions, and helps wash away viral particles, bacteria, and irritating immune system compounds. You can purchase a sinus-rinsing tool called a neti pot at a natural foods store, get a special attachment for electric water-jet irrigators (like Water Pik), use a squeeze-bottle sinus rinse (such as NeilMed rinse), or simply cup your hand to deliver the saline solution to your nose.
The recipe: Mix 1/2 teaspoon non-iodized salt, plus 1 pinch baking soda, with 8 ounces warm water.
Rinsing directions: Lean over the sink with your head down (some neti-pot instructions advise tilting your head to the side slightly). Gently squirt the saline into each nostril (or inhale, one nostril at a time, from your palm). Breathing through your mouth at the same time will help keep the solution from entering your mouth. (If it does get in, spit it out.) Gently blow your nose. Repeat until you’ve used the 8 ounces of salt water.
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