A user's guide to the common cold

Here's what you need to know to stay healthy during cold and flu season

As cold and flu season approaches, the Johns Hopkins Health Review has assembled a guide to soothing the aches, pains, and sniffles that go along with it. Below are answers to common questions and highlights from the guide, including recommendations from Johns Hopkins health experts for getting through the season as healthily as possible.

OK, I have a cold. Now what?

Get rest, drink fluids, use over-the-counter meds to control symptoms (see "The Cold Aisle Demystified" below for more information), cough and sneeze into tissues, and wash hands often to reduce spreading the virus. Then ride it out.

When should I call my doctor?

  • Your symptoms last longer than two weeks
  • Your symptoms worsen or you develop new symptoms
  • You have a sore throat or fever higher than 100 degrees for longer than three days
  • You're experiencing intense chest pain and shortness of breath

Do I need antibiotics?

For viruses, no. They work only against bacterial infections. "People want antibiotics when they start to get a runny nose or sore throat," says Kimberly Peairs, a doctor of internal medicine and the clinical director of the Johns Hopkins Health Care & Surgery Center at Green Spring Station. "For the vast majority, antibiotics are not indicated because their infections are viral not bacterial."

Should I get the flu shot?

Maybe you've heard the flu shot is never a perfect match for the strain of flu circulating in a given year. Get it anyway. "Always get the flu shot, as there is very little downside to it," Peairs says. "When a patient tells me they got the flu from the shot, I tell them that's impossible because it doesn't contain the live virus."

Go to work or go to bed?

"The thing to consider is how many aches and pains you have," says Andrew Pekosz, an infectious disease specialist at the Johns Hopkins Bloomberg School of Public Health. "It's one thing if you have a little bit of sniffles, which probably means to make sure you have tissues and practice good sneezing and coughing hygiene. But if you have fever or body aches and pains, you should probably call it a day. You're not doing yourself or co-workers any favors."

And if illness does make the rounds at work, before blaming the first colleague who showed up with a cough, consider this: "With cold and the flu, there's a small portion of the population that can get infected and not have symptoms and then spread the virus to other people," Pekosz says.

The Cold Aisle Demystified

Physician Michael Albert breaks it down:

  • An expectorant is helpful because it thins your mucus so it drains better from your nose and sinuses and lets you cough it up more easily. This keeps the mucus from sitting there and festering. Mucinex is a popular brand, but the generic version is guaifenesin. I recommend it a lot to people with congestion and cough.

  • Decongestants reduce the amount of mucus you make and can pair well with an expectorant. The challenge is that most of them can raise your blood pressure and should be used with caution, or not at all, by people with high blood pressure or an underlying cardiac condition. The two principal types are pseudoephedrine—Sudafed—which is now controlled and sold behind the pharmacy counter; and phenylephrine, which is less potent and is still sold on the shelf.

  • Antihistamines also reduce mucus production and are very helpful with allergies. But even a cold can trigger histamines, a chemical in the body that leads to congestion. Two older antihistamines, chlorpheniramine and diphenhydramine (Benadryl), sedate you, so they are the ones often used in nighttime formulations. The newer antihistamines are nondrowsy and include the brands Zyrtec and Claritin.

  • Cough suppressants reduce the urge to cough. Dextromethorphan is a common one, and you will see the abbreviation DM on products. It is actually a very mild opioid derivative. Codeine is probably the most effective cough suppressant, but it is prescription-only and has to be used with caution, as it is a stronger opioid. Robitussin with codeine is my olive branch to patients who come in with a really nasty cough and think they need antibiotics (when they don't). It helps them get a good sleep and feel better in the morning.

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