Pulmonology focuses on diagnosing and treating lung and airway conditions such as asthma, COPD, and pneumonia, as well as overall respiratory health.

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Common Cold: Treatment and Management

Because the common cold is caused by a virus, there is no medicine that can cure it. Antibiotics do not work against viruses and are not used for simple colds. Treatment is aimed at easing symptoms while the body fights off the infection. This includes both medicines for specific symptoms and supportive care like rest and fluids. At Liv Hospital, we help patients understand which over-the-counter medicines can help, what their limits are, and how to avoid side effects.

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Pharmacological Interventions

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A wide array of medications is available to manage cold symptoms. Selection should be tailored to the specific symptoms the patient is experiencing.

  • Analgesics and Antipyretics: Acetaminophen (paracetamol) and non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are the mainstays for treating headache, sore throat pain, and fever. Aspirin should be avoided in children and teenagers due to the risk of Reye’s syndrome.
  • Decongestants: These medications, such as pseudoephedrine (oral) or oxymetazoline (topical spray), constrict blood vessels in the nasal mucosa. This reduces swelling and creates more space for airflow. However, topical sprays should not be used for more than three days to prevent rhinitis medicamentosa (rebound congestion). Oral decongestants should be used with caution in patients with hypertension or heart disease.
  • Antihistamines: First-generation antihistamines (like diphenhydramine) can help reduce sneezing and rhinorrhea, not primarily by blocking histamine, but through their anticholinergic drying effects. Second-generation antihistamines (non-sedating) are generally less effective for cold symptoms because histamine is not the primary mediator of viral rhinitis.
  • Antitussives and Expectorants: Cough suppressants (like dextromethorphan) act on the cough center in the brain to reduce the urge to cough. Expectorants (such as guaifenesin) thin mucus, making it easier to clear. The efficacy of these agents varies, and they are not recommended for young children.
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Non-Pharmacological Management

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Supportive care, such as rest and fluids, can be just as helpful as medicine and usually has fewer side effects.

  • Hydration: Maintaining adequate fluid intake is crucial. While “flushing out” the virus is a myth, hydration prevents the dehydration that can occur with fever and mouth breathing. It also helps keep respiratory secretions less viscous and easier to expel.
  • Humidification: Breathing air with added moisture helps soothe irritated nasal passages and the throat. Cool mist humidifiers or steam inhalation can loosen mucus and reduce congestion.
  • Saline Irrigation: Nasal saline drops or sprays help mechanically flush out thick mucus and moisten the nasal cavity. This is the safest and most effective intervention for infants who cannot take decongestants.
  • Rest: Adequate rest directs the body’s energy reserves toward the immune response. Staying home also prevents the virus from spreading to others.

The Role of Zinc and Vitamin C

Many people use dietary supplements for colds, but the scientific evidence for their benefits is mixed.

  • Zinc: Studies suggest that zinc lozenges or syrup, if taken within 24 hours of symptom onset, may reduce the duration of a cold by about one day. Zinc is thought to inhibit viral replication in the nasal mucosa. However, intranasal zinc should be avoided due to the risk of permanent loss of smell (anosmia).
  • Vitamin C: Regular supplementation does not prevent colds in the general population, though it may slightly shorten the duration. Taking Vitamin C after symptoms start has not shown consistent benefit. It may be more effective in people under extreme physical stress (e.g., marathon runners).
  • Echinacea: Research on Echinacea has been inconsistent, with most rigorous studies showing no significant benefit in preventing or shortening the course of a cold.
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Pediatric Management Protocols

Treating children requires a conservative approach due to safety concerns with cough and cold medicines.

  • Medication Restrictions: Health authorities generally advise against using over-the-counter cough and cold medicines in children under the age of four (guidelines vary by country, sometimes up to age six) due to the risk of serious side effects and lack of proven efficacy.
  • Safe Alternatives: For young children, suctioning the nose with a bulb syringe, using saline drops, maintaining hydration, and using a cool-mist humidifier are the primary management strategies. Honey (half to one teaspoon) can be used for coughs in children over one year old, but must never be given to infants due to the risk of botulism.
  • Fever Management: Acetaminophen or ibuprofen (for children over 6 months) can be used for comfort if the child is distressed by fever.

Antibiotic Stewardship

It is important to explain to patients why antibiotics are not given for a cold. Many people expect antibiotics if they have green mucus or a cough that lasts.

  • Viral Nature: Antibiotics kill bacteria, not viruses. Using them for a cold provides no benefit and exposes the patient to risks like allergic reactions, diarrhea, and Clostridioides difficile infection.
  • Resistance: Unnecessary use contributes to the development of antibiotic-resistant bacteria, making future bacterial infections harder to treat.
  • Delayed Prescribing: In cases where bacterial co-infection is uncertain but possible, doctors may prescribe a “wait-and-see” regimen, advising the patient to fill it only if symptoms worsen or do not improve after a set number of days.

Alternative and Complementary Therapies

Many patients seek relief through traditional remedies.

  • Honey and Lemon: Warm liquids with honey and lemon can soothe a sore throat and suppress cough through demulcent (coating) action.
  • Chicken Soup: While often considered a folk remedy, chicken soup may have mild anti-inflammatory properties and provide hydration, electrolytes, and warmth, which can improve mucociliary transport.
  • Menthol and Eucalyptus: Topicals containing these aromatic oils can create a sensation of improved airflow through the cooling effect on nerve endings, providing subjective relief even if actual nasal patency doesn’t change significantly.

Monitoring for Deterioration

Management involves instructing the patient on when to seek further care.

  • Red Flags: Patients should return if they experience difficulty breathing, persistent high fever, chest pain, confusion, or if symptoms improve and then suddenly worsen (suggesting secondary bacterial infection).
  • Chronic Conditions: Patients with asthma, COPD, or heart failure need closer monitoring and may require adjustments to their chronic maintenance medications during a cold.

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Assoc. Prof. MD. Engin Aynacı Assoc. Prof. MD. Engin Aynacı Pulmonology Overview and Definition
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FREQUENTLY ASKED QUESTIONS

Why won’t the doctor give me antibiotics?

Antibiotics treat bacteria, but viruses cause the common cold. Taking antibiotics won’t cure the cold and can cause harmful side effects and antibiotic resistance.

No, cold medicines only mask the symptoms (like stopping a runny nose or lowering fever) to make you more comfortable while your immune system fights off the virus.

Generally, mild exercise is safe if your symptoms are “above the neck” (runny nose, sneezing). If you have a fever, body aches, or chest congestion, you should rest.

Taking Vitamin C after you start feeling sick has not been proven to be very effective. It works best as a daily supplement to slightly shorten colds before they happen.

Since babies can’t blow their noses, use saline drops to loosen the mucus and a suction bulb to remove it, especially before feeding and sleeping, gently.

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