George A. Sprecace M.D., J.D., F.A.C.P. and Allergy Associates of New London, P.C.

The Uncommon Common Cold

Much is written about medical conditions which we cannot figure out and/or  for which we do not have a cure, or treatment or prevention.  The "URI"  is one of those conditions.  Of course, it is common for the general population.  But there is nothing common about its actions and risks in patients with bronchial asthma, chronic bronchitis or pulmonary emphysema.

In these patients, a respiratory tract infection (yet another name for the same thing) requires prompt and effective action by the patient - and often by the doctor.  Anyone can benefit from prompt institution of an "initial treatment for a cold", as described below.  Persons without the above conditions or other chronic conditions will usually resolve their problem without need for antibiotics.  But in patients with the above conditions, the onset of a cold (malaise, myalgias, sore throat, fever, headache, cough, a change in the color, quantity, or consistency of their mucus from head or chest - what one of my patients calls "earth tones": yellow or green mucus) requires initiation of the "Cold Regimen".  Furthermore, persistence of "earth tones" for 12 to 24 hours requires initiation of antibiotic treatment by the physician.  This can almost always be done over the phone for an established patient.  Delay of 24 to 48 hours in these patients often makes the difference between an unpleasant interlude at home or at work and an otherwise avoidable hospitalization.  And remember:  hospitals are risky places unless you really need them.  ( The main reason for this is that persons who would never drop their basic defenses under ordinary circumstances do exactly that when they enter a hospital.  Big Mistake.  Ask questions.  Understand what's going on.  Don't assume.  And identify one person who is involved with your care who will be your intermediary with the hospital staff.  Of course, that person should be your personal physician, if he or she is doing the job correctly.  But it could be a nurse or a medical student if need be.)

Initial Treatment of a Cold - Cold Regimen (all instructions should be continued for three days):
Warm saline gargles ( 8 oz. warm water, teaspoon of salt); steam inhalation treatments; Neosynephrine 1/4%  nose spray, two sprays each nostril three times daily for three days- then stop; Robitussin, plain, two teaspoons with water three times/day for three days; no "cold tablets";  only Claritin or Allegra as antihistamines.  And all persons should be aware of a special kind of "cold" that is promptly associated with a persistent hacking cough - with or without wheezing, even in non-asthmatics.  That often represents a condition, caused by certain specific particularly inflaming viruses, which can lead to "post-viral hyper-reactive airways syndrome" which can last weeks or  months, or which can actually be the beginning of Bronchial Asthma or Chronic Asthmatic Bronchitis, even in non-allergic persons.  To avoid this sequence of events, with a lot of associated misery, both patient and physician should be on the look-out for this particular "uncommon common cold" and treat it aggressively from the outset with bronchodilators, usually antibiotic, and often a steroid ( cortisone) in some form for at least one month. Many people were afflicted with this problem during the recent winter season.  And some still have it.


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