Dr. Patricia Yarberry Allen is a collaborative physician. This week, she consults with internist Jason S. Kendler, M.D., in order to respond to a woman concerned about respiratory infections: How she can tell a cold from the flu, and what treatments for these conditions are effective? Dr. Kendler, a Clinical Associate Professor of Medicine at the Weill Medical College of Cornell University, is a member of Women’s Voices for Change’s Medical Advisory Board.

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Dear Dr. Pat:

I never know how to treat a cold or if the symptoms I am having are really the flu. I have a tendency to get bronchitis with a touch of wheezing about once a year when I let a “cold” go on too long. If I get the bronchitis, then I have a hacking cough for weeks and trouble sleeping, and I really would like to know how to avoid this. I understand that over-use of antibiotics is a problem too.  I commute to work every day in a crowded train where everyone is coughing and sneezing, so I know I will get something soon. Any advice about treatment of symptoms like fullness in the sinuses, post-nasal drip, sore throat, runny nose, without resorting to antibiotics?  Does Vitamin C help?  What about Mucinex?

 What is the difference between the flu and a bad cold? My GP just prescribes the Z-Pak over the phone when I call after three days of runny nose and sore throat. When should patients generally take antibiotics and when should they take Tamiflu? 

Joanie

Dr. Pat Responds:

Dear Joanie:

These questions are certainly timely. We are in the midst of the “cold and flu” season now and everyone wants to know how to avoid an upper respiratory infection (cold, sinusitis, throat infection) and certainly a lower respiratory tract infection (bronchitis, pneumonia).  Prevention is key:  Stop social kissing and hugging.  I am adopting the elbow bump for the rest of this dangerous season!  When people come toward you with outstretched arms, back away and hold up your hand.  “Sorry . . . bad colds are going around my office, and I know you don’t want one,” should be warning enough.  

Correct cough technique should be taught in the environments over which you have control:  your home, your office, and, whenever possible—delicately, of course—in social settings. Travel is a situation over which most of us have little control: Buses, trains and planes are closed environments where the transmission of respiratory viruses is rampant.  I do take masks with me on planes, and I sometimes wear them.  I would rather look odd for three hours than become ill for my short vacation!  Hand-washing with soap and water and the liberal use of hand sanitizers such as Purell, which markets itself as “kills 99% of germs,” seems like a good idea as well.  

Patients call me frequently asking for Tamiflu and the ubiquitous Z-Pak.  I certainly insist on seeing the patient (with a mask for the patient) to evaluate the need for these over-prescribed antivirals and antibiotics before making a decision to treat. We have asked Dr. Jason Kendler, a member of the WVFC Medical Advisory Board who is a specialist in infectious disease, to discuss your important question further. While we offer guidelines, do remember that your health care professional is the person who must evaluate your symptoms.

Patricia Yarberry Allen, M.D.

Dr. Kendler Responds:

Dear Joanie:

You bring up so many important issues that I would like to address them separately!

Cold versus Flu

“The flu,” an illness caused by the influenza virus, is generally more severe than a bad cold, and often comes on quite suddenly. Some patients with influenza have told me that they can recall the exact moment when they started to feel ill. Patients may complain of high fever, headache, widespread muscle aches, and fatigue.  In addition, there is often sore throat, a dry cough, and a runny nose.  Illness generally lasts for about a week, much of which is spent in bed.  Doctors are now able to diagnose influenza by sending a nasal swab to the lab for rapid analysis.  Interestingly, only about 10 to 15 percent of patients with symptoms that are suggestive of flu will test positive for influenza.  The remainder will have an infection caused by other viruses.

In contrast to the flu, a head cold, caused by different kinds of viruses, generally leads to a much milder illness.  Patients with colds will often describe the gradual onset of a sore or scratchy throat, nasal congestion, runny nose, and cough.  Fever is less likely than in patients with influenza.  Symptoms usually resolve within 5 to 7 days.

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