HJBR Jan/Feb 2020

COLD OR SINUS INFECTION 16 JAN / FEB 2020 I HEALTHCARE JOURNAL OF BATON ROUGE   E valuation for cold symptoms is one of the most common rea- sons for doctor’s visits in the United States, accounting for an estimated 17 billion healthcare dollars (and thereby contributing to rising health- care costs). However, the vast majority of common colds are caused by self-limiting viruses and do not require medical evalua- tion or treatment.An often unnecessary time burden can be placed on both patients and physicians when people carve out time to come to the doctor’s office for a viral upper respiratory infection for which no testing and treatment is indicated. Your doctor will be more than happy to reassure you and offer you suggestions of over-the-counter symptomatic remedies, but individuals can also become empowered to use a bit more discernment when deciding whether or not to seek medical attention for their cold symptoms.  The term common cold refers to a viral upper respiratory infection. Over 200 types of viruses have been identified as a cause of the common cold, and rhinovirus (rhino derived from Latin for nose) is a group of viruses that are themost commonly associ- ated with cold symptoms. These infections can be spread by hand contact (via direct contact with an infected person or with a surface containing infected particles), small particle droplets in the air (e.g., from a person’s sneeze), and large particle drop- lets (which requires closer contact with an infected person). Cold viruses can remain viable on surfaces for many hours. However, antibacterial home cleaning products have not shown to have an advantage over reduc- ing transmission of the common cold. This is not too surprising, as antibacterial agents are ineffective against viruses. A person is most contagious to others on the third day after inoculation with the virus, which often coincides with the peak of their symptoms. However, low levels of viral shedding (and thus infectivity) can be present for up to two weeks. The time between contact with infec- tious material and the start of symptoms is generally 24-72 hours but can occur as early as 10 hours after exposure. Symptoms usu- ally persist for 3-10 days, but can last as long as two weeks. The symptoms of a common cold include runny nose, nasal congestion, sneezing, coughing, low-grade fever, sore throat, mal- aise (feeling weak and generally ill), head- ache, head and ear pain and pressure, and body aches. The first symptom is often a dry or scratchy throat. It is a commonmyth that yellow or green nasal discharge (mucus) is a sign of a bacterial infection. Colored nasal discharge is a normal phase of a viral upper respiratory infection, and should not alone prompt a doctor’s visit or prescription for antibiotics.  The number one reason peoplemay want to see a doctor when they have symptoms of a common cold is that they want their doctor to rule out more serious infections, such as pneumonia. This will also be your doctor’s goal when you are in their office. However, if your symptoms are limited to the aforementioned common cold symp- toms and have been occurring for less than 10 days, your doctor will not have much to offer you beyond recommendations for over-the-counter coldmedications that can manage your symptoms (and importantly, do not treat the underlying infection or alter the natural course of the illness) and generic advice to rest and hydrate.  If you come to the doctor with cold symp- toms during the late fall and winter, youmay be tested for the flu, which is caused by the influenza A or B virus. A sign that you have the flu is if your cold-like symptoms are notably more intense than regular colds you’ve had in the past and are interfering with your ability to function normally. Peo- ple with the flu often have an abrupt onset of fever andmalaise in addition to respiratory symptoms such as sore throat and runny nose. If you test positive for the flu, you will likely be offered an antiviral medication (generally Tamiflu), which can shorten the duration of your symptoms by 1-3 days if it is started within the first 24-30 hours of symp- tomonset. It is estimated that there is little to no benefit of takingmedication for influenza if it is initiated two days or more after the onset of symptoms. It is important to note that the flu will not be effectively treated with antibiotics (because it is a virus), and most cases will gradually resolve without treatment within five days. Despite timing of symptom onset, treatment is necessary for those hospitalized with influenza, people with severe or progressive symptoms, those at high risk for complications, and those in close contact with individuals at high risk for complications, such as the elderly and immunocompromised people. The flu vaccine is highly recommended for everyone in order to both reduce your risk of catching the flu, and your risk of “The number one reason people may want to see a doctor when they have symptoms of a common cold is that they want their doctor to rule outmore seri- ous infections, such as pneumonia.”