Cough, cold and flu treatments

We clarify the over-the-counter and natural remedies and outline effective strategies for treatment.

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01 .Introduction

More than $250 million worth of cold, cough and flu remedies are sold in Australia every year, in spite of the fact that there’s not a lot of convincing clinical evidence they work any better than a placebo. On the other hand, there’s also no conclusive evidence that they don’t work!

Confused? CHOICE outlines the most effective strategies for treating your next cold, flu or cough.

What you should definitely do

Save your energy Resting helps you fight the virus in the first few days when you are most affected and most contagious.
Drink plenty of fluids to loosen congestion and prevent dehydration. A warm honey and lemon drink soothes your throat, while chicken broth appears to have anti-inflammatory properties. Avoid dehydrating caffeine drinks and alcohol.
Flush your nose with saline nose drops twice a day to ease congestion and help prevent bacterial infection. Saline doesn’t cause the rebound effect of nasal decongestants and is safe for children.
Gargle with salt water (half-a-teaspoon in a glass of warm water) to relieve swelling in the throat.
Humidify with steam from a shower or kettle - a dry atmosphere exacerbates a cold by drying out the throat and nasal passages.
Suck sugar-free lozenges to ease a dry, sore throat and reduce tickling that causes dry coughing. Medicated lozenges aren’t necessary, although menthol or eucalyptus may help your head feel clearer.
Suppress a dry cough with one or two teaspoons of honey - a useful remedy for children over one year old.

What you might consider

Over-the-counter cold and flu treatments and cough medicines may help alleviate some symptoms, for some people, some of the time . You may experience adverse side effects to some ingredients. Check labels carefully and choose a product with only the active ingredients you need. Many cold and flu treatments are combination products, and you may not have all the symptoms they are designed to treat; or, more commonly, you may not have all the symptoms at the same time. See Over-the-counter remedies for information about the different medications on offer.

Natural alternatives

Vitamin C, zinc and echinacea have been variously promoted for reducing the severity and duration of colds and the likelihood of catching one. While some studies have found some benefit, findings are inconsistent and reported effects could come down to the quality of the study or the particular preparation used.

What you should avoid

Antibiotics won’t help a viral infection. However, they may be required if a bacterial infection such as sinusitis or bronchitis develops. You should not give aspirin to children or teenagers as it can cause a serious illness called Reyes syndrome.

When you should see your doctor

For most people, a cold is a short-lived, albeit miserable condition, although for some it can trigger more serious problems such as asthma attacks, worsening emphysema or potentially fatal pneumonia.
You should see your GP if your fever is unusually high (over 38.5°C) or prolonged (more than a few days), or symptoms of bacterial infection occur. A severe cough that produces mucus may indicate bronchitis or pneumonia. In children, a cough could indicate croup, bronchiolitis or asthma.
Pain in the ears can indicate a middle ear infection. Severe headache, facial pain or pain in the teeth can indicate a sinus infection. Antibiotics won’t treat a cold or flu, but may be useful for these secondary bacterial infections.

02.Over-the-counter remedies

Pharmacy shelves bear a bewildering array of cough, cold and flu relief products that typically claim to treat various combinations of symptoms. If you're prepared to give them a try, the following list of key symptoms and the drugs designed to address them may help.

For a loose, chesty cough: Expectorants and mucolytics

Loose coughing is a good thing, as it removes mucus from your chest. Expectorants increase mucus production in the lungs, making secretions easier to remove by coughing , and include guaiphenesin, ammonia and senega . Bromhexine is a mucolytic, which has a slightly different action to expectorants – they thin mucus in the lungs rather than stimulate production.

Cough liquids indicated for “chesty” coughs (such as Duro-Tuss Chesty Cough , Bisolvon Chesty and Benadryl Chesty Forte ) contain expectorants and/or mucolytics.

For a dry cough: Suppressants

Suppressants such as codeine, pholcodine and dextromethorphan are designed to act on the cough centre in the brain to reduce coughing. However, the effect is little better – if at all – than a placebo. Suppressants should only be used if you have a painful, dry and persistent cough. Using suppressants for chesty coughs could delay recovery.

Many cough, cold and flu tablets contain cough suppressants – look for the ingredients listed above on the label. Cough liquids labelled for “dry cough” also contain suppressants.
We found some medications, including Robitussin Cough & Chest Congestion, which contain both an expectorant and a suppressant. "If", as one expert pointed out, "these combinations were actually effective, the patient's airway would rapidly fill up with secretions while their ability to cough these secretions out of the airway was suppressed!"

For a blocked nose: Decongestants

Decongestants constrict blood vessels in the nose, throat and sinuses, which reduces swelling and mucus formation. They’ve been shown to be only somewhat effective, meaning you may or may not experience any noticeable difference.

Pseudoephedrine, as found in Demazin Cold & Flu and Cough, Cold & Flu as well as in Duro-Tuss Cough Liquid & Nasal Decongestant (both Dry and Chesty formulas), is a decongestant, but it’s kept behind the counter because it can be used to make methamphetamine. If you want to purchase it you will have to ask the pharmacist for it and show ID.
Phenylephrine (look for PE on the label of products – eg. Sudafed PE) has been marketed as a substitute for pseudoephedrine, but is not as effective .
Side effects of decongestants may include increased blood pressure, sleeplessness, anxiety and dizziness. If you have heart disease, diabetes, high blood pressure or thyroid conditions, check with your doctor before taking them.

Topical decongestants are faster-acting than oral decongestants and have fewer side effects. They should only be used sparingly – continued use can cause a rebound effect, where your congestion becomes worse.

Nasal sprays containing topical decongestants include Dimetapp, which contains oxymetazoline, and Otrivin, which contains xylometazoline.

For a runny nose: Antihistamines

Antihistamines such as diphenhydramine, brompheniramine, doxylamine and chlorpheniramine are often present in night-time formulations. They help dry up a runny nose and make sleeping easier, and may help counter the stimulating effects of decongestants. However, they may also make your eyes and mouth feel dry and cause drowsiness during the day. People with narrow-angle glaucoma or an enlarged prostate should avoid using them.

Codral Day & Night, Dimetapp Daytime/Nightime, Sudafed PE Sinus Day & Night and Demazin Day & Night Cold & Flu tablets all contain antihistamines in their night-time preparations.
Tablet products not specifically marketed for night-time use that contain antihistamines include Demazin 6 Hour Relief and Cold & Flu tablets, and Amcal Cold Relief tablets. Bear in mind that these may cause drowsiness.
Liquids containing antihistamines include Demazin Cold Relief Syrup and Cough & Cold Elixir; Dimetapp Elixir and DM Cold & Cough Elixir; and Benadryl Original Cough Medicine and Nightime Cough Suppressant + Antihistamine.
Atrovent Nasal Spray contains ipratropium bromide (which is an anticholinergic), which can help dry up a runny nose and is also recommended for allergies. Otrivin Plus nasal spray contains ipratropium bromide to aid symptoms of a runny nose as well as a decongestant (xylometazoline) to reduce stuffiness.

For aches, pains and fever: Paracetamol

Many cough and cold medicines contain paracetamol for pain relief and to reduce fever, so check the ingredients before use to avoid the risk of overdose if you are also taking regular paracetamol. Mild fever doesn’t need to be “treated”; in fact, it may help your body fight the infection.

Children: a special case

A recent review of worldwide research into children’s cough and cold medicines has not found robust evidence that these medicines are effective for children, and has found that using them creates unnecessary risks. Some countries, including Canada and the UK, have labelling laws requiring manufacturers to state that these medicines should not be used for children under 6 years of age.
At present in Australia, cough and cold medications are not recommended for children under 2. However, a Therapeutic Goods Administration (TGA) report recommended that cough and cold medicines be restricted for children aged under 6, and administered to children aged 6-12 only on the advice of a doctor or pharmacist. The TGA is currently reviewing stakeholder responses to these recommendations with the view to changing existing guidelines.

03.Cold vs flu

Colds and flus produce very similar symptoms, which is why medications aimed at treating them often have “cold and flu” in their name. To confuse things, the influenza virus is responsible for at least some colds . The main differences are :

Onset of severe flu symptoms is sudden; with a cold, the build-up is more gradual.
Flu starts with a dry sensation in the nose and throat and a dry cough; colds cause a runny nose and sneezing, and eventually a productive cough.
Flu causes a high fever; a cold sometimes causes only a mild fever.
Muscular pains, chills and extreme tiredness occur with the flu, but not with a cold.

Preventing colds

Wash your hands often Cold viruses are transmitted through contaminated surfaces, such as handrails, doorknobs and especially other people’s hands. If you then touch your eyes or nose, the virus may infect you .
Get lots of sleep People who sleep less than seven hours a night are more likely to get colds than people who sleep eight hours or more .
Relax Stress can increase your susceptibility to colds, because of its general impact on decreasing resistance to infection .
Keep your nose warm! Rhinoviruses thrive in the slightly cooler atmosphere of the nose (about 33°C). Cold weather also dries out the nasal passages, making them more susceptible to infection . Theoretically then, keeping your nose warmer in winter should help make it a less attractive environment .

Preventing and treating flu

Every year thousands of Australians are hospitalised by complications of the flu, such as pneumonia, and almost 3000 people die each year. Vaccination is a very successful means of preventing infection and spread of influenza through the community. Your best bet for avoiding the flu is to have an annual flu shot. Flu vaccines are reformulated each year to address the most prevalent flu viruses around, and are about 70-90% effective in healthy people.

The government has expanded eligibility criteria for free flu shots to the following groups considered to be high-risk:

People aged 65 years and over.
Aboriginal and Torres Strait Islander people aged from15 years.
Pregnant women.
People aged six months to 64 years with chronic medical conditions including cardiac disease, respiratory conditions and impaired immunity.

It’s recommended that health care workers and people who work in aged care facilities also get vaccinated against seasonal flu, for the benefit of the individual and to help prevent the spread of disease. These shots aren’t free (unless the individual meets the eligibility criteria above) and if not made available through workplace programs, must be purchased on prescription.

While this year’s seasonal flu vaccine includes the H1N1 swine flu virus, a swine flu-only vaccination is also available for free, and authorities recommend everyone over 6 months who doesn’t get the seasonal flu shot be vaccinated against swine flu to limit its spread through the community.

Ask your doctor for more information about eligibility and costs. Note, while the seasonal flu shots are free for eligible people, and the swine flu shot is free for everyone, you may have to pay the Medicare gap charge if your doctor doesn’t bulk-bill.

If you’ve come down with the flu, the anti-viral medication oseltamivir (Tamiflu) can reduce the severity and duration of the virus, and the likelihood of complications such as pneumonia. It must be taken within 48 hours of the onset of symptoms and is only available on prescription.

04.Why haven't they cured the common cold yet?

There are more than 200 different viruses that cause the common cold. More than half are rhinoviruses, thought to be responsible for about 30-35% of colds. Coronaviruses are also responsible for a large percentage of colds, but are less understood because they’re difficult to grow in labs . You can’t identify the virus responsible for a particular cold by its symptoms because they’re so similar, and different people react to one virus in different ways.

Unlike the flu, the common cold is not highly contagious, and even if you’re infected you may not have much in the way of symptoms – you may have multiple viruses sitting in your nose creating no more than the odd sneeze . Your immune response, which can be affected by stress and fatigue, determines the severity of cold symptoms.

White blood cells, which battle the virus, cause most of your misery. They release kinins - chemicals that cause swelling and inflammation of the blood vessels in the nose, throat and lungs, resulting in symptoms such as stuffiness, congestion and a sore throat. Excess proteins and fluids leach from blood and lymph vessels, creating mucus. Fever, fatigue, aches and pains are the body’s way of telling you to rest up and save your energy for fighting the virus. Antibodies are not produced until towards the end of the cold cycle, so they can’t do much more than hang around until you get the same virus again.

Not only is there a large number of viruses to contend with, but the viruses also tend to mutate quite frequently, making it hard to keep on top of them.
Another problem for scientists is that animals (with the exception of the chimpanzee) don’t react to the viruses the same way we do . This makes laboratory testing of potential treatments difficult and costly. However, scientists have now developed a genetically-modified mouse that can be infected by rhinoviruses, potentially leading to treatments that could prevent some of the more serious complications of colds.

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