White Coat, Black Art

Advice For the Common Cold: Nothing to Sneeze At

There may be help on the horizon for those suffering from the common cold. A new article just published in the Canadian Medical Association Journal has the latest science on how to prevent and tame the virus.
  There may be help on the horizon for those suffering from the common cold. A new  article just published in the Canadian Medical Association Journal has the latest science on how to prevent and tame the virus.

  Researchers from the University of Alberta and the University of Auckland reviewed the scientific evidence on how to prevent colds.  It's not sexy advice, but the best way to prevent colds is hand washing.  Colds are caused by rhinovirus, which are highly prevalent and highly contagious. 

  A review of sixty-seven controlled clinical trials shows that hand washing helps prevent colds. Many of those studies used different techniques - soap and water alcohol hand rubs, hand-wipes, gloves, masks, and gowns.  There isn't enough evidence to say whether one technique is better than the others.  What we can say is that your mother was right: hand washing helps prevent colds.
  It's a lesson that should be applied in the workplace. According to a  report by the Conference Board of Canada, in 2011, the average worker in this country took nine and a third days off during the entire year.  Not surprisingly, absenteeism rates are higher during cold and flu season than at other times of the year.  When it comes to colds, as a society, we tend to focus on absenteeism. But the real problem may be worker  presenteeism - the tendency to go to work even though you have a cold.  The fact that worker abseentism rates aren't going up suggests that workers aren't getting the message to stay home.  To avoid getting a cold at work, it's smart to avoid common areas like lunchrooms during outbreaks.  If co-workers are sick, wash hands or use a hand sanitizer before eating or touch your eyes, nose or mouth. 

  Beyond hand washing, zinc lozenges may work for kids. At least two controlled clinical trials found that kids who take ten or fifteen milligrams a day of zinc sulphate have lower rates of colds and fewer absences from school.  There are no studies using zinc in adults, but the authors say there is no reason why zinc would work in kids but not in adults.  The other thing you can consider taking are probiotics - which are often give to patients receiving antibiotics to maintain normal bacteria in the gut.  The authors of the article in CMAJ say probiotics (for example, lactobacillus) reduces the number of upper respiratory tract infections.  The main limitation of these studies is that several different kinds of probiotics were used - making it difficult to draw solid conclusions.
  Many people turn to herbal and other remedies to try and ward off the symptoms of a cold. COLD-FX is made from the root of North American ginseng.  The authors of the article in CMAJ cited a study that looked at the results of four controlled clinical trials (four using COLD-FX and one of Asian ginseng) provided mixed results. The clinical trials of COLD-FX had more than ten percent of subjects dropping out before a single dose was taken.  The more drop-outs from a study, the greater the risk that the results are biased. The results of studies involving ginseng were mixed.  In some cases, the analysis of these studies focused on laboratory outcomes as opposed to whether or not colds were prevented or at least shortened in duration. 

  Studies of garlic showed no clear evidence of benefit.  Vitamin D and Echinacea showed no benefit.  I can remember when Echinacea was heralded by some as a breakthrough. Vitamin C may benefit marathon runners and people under extreme physical stress, but not you and me.

  When preventive measures fail, the the other option is treatment.  Decongestants like pseudoephedrine (found in Sudafed(R)) and other remedies) produce small improvements in nasal congestion but do not shorten the duration of illness.  Health Canada recommends against topical decongestants in young children.  A nasal spray containing ipratropium has been shown to reduce runny nose.  Over the counter cough suppressants are not recommended in kids six years of age and younger.  They are permitted in older kids and adults but even then, the benefit in older kids is unclear. 

  Ibuprofen and acetaminophen relieve aches and pains.  A single night time dose of honey may reduce cough and improve sleep in kids over the age of 1 year. Zinc lozenges may reduce the duration and severity of the common cold in adults. 

  Vapour rubs that contain camphor, menthol and eucalyptus oil are rubbed onto the neck and chest.  These have no effect on runny nose but do improve cough. Kids have been shown to sleep a bit more soundly with vapour rub but at an increased risk of skin rashes and redness. 

  The fact there are so many remedies on pharmacies shelves tells me that science is a long way from a cure - quite the indictment of modern medicine that this is the best we can offer.