Patients and caregivers can be advised on general supportive measures for winter ailments that can provide symptom relief. This includes pharmacological treatments, over-the-counter or home treatments, and advice on maintaining adequate fluid intake, rest and time at work or school, and a warm, dry, smoke-free environment. First, information should be obtained about the possible duration of the symptoms. A discussion of the expected duration of symptoms can help to reassure the patient that the course of their illness is normal. The natural course of symptoms associated with common winter sickness is generally as follows:
Three to five days for fever
A week for headache or sore throat
One week to ten days for nasal congestion
• Two weeks for a runny nose
Two to four weeks for cough
Paracetamol may be recommended to relieve pain and discomfort associated with respiratory infections such as headache and sinus pain. A mild fever does not need to be treated unless it causes discomfort; fever is a beneficial immune response. NSAIDs may also be suitable for some patients, depending on the comorbidities and hydration status.
Nasal congestion may occur as a result of increased mucus in the nasal cavity and enlargement of the large vessels leading to swelling of the nasal tissue. This swelling is affected by sympathetic activity and signals such as adrenaline or noradrenaline. Oral decongestants such as pseudoephedrine *, which is a sympathomimetic, can therefore be reasonably helpful in reducing nasal congestion. Phenylephrine may be a less effective oral decongestant, but is readily available as an ingredient in several over-the-counter ‘cold and flu tablets’. The use of oral decongestants can cause increased blood pressure and tachycardia and may contribute to insomnia.
Sprays for Nasal Congestion
Intranasal ipratropium is fully subsidized and approved for the treatment of rhinitis or rhinorrhea associated with the common cold. Evidence from clinical studies suggests that intranasal ipratropium is effective in reducing rhinorrhea but does not improve nasal congestion. Adverse effects include nasal dryness, nosebleeds, and bloody mucus.
Xylometazoline (Otrivin), a topical nasal decongestant, is available over the counter. It is sympathomimetic and reduces edema of the nasal mucosa through vasoconstriction. Patients should be told that it is only suitable for short-term (no more than 5-7 days) use due to its rebound potential.
Nasal saline rinses are available over-the-counter, or a solution can be prepared at home and applied with a suitable device (see below for more information). Saltwater irrigation thins and increases mucus flow and is not usually associated with side effects. However, the evidence for benefit is weak, as a number of studies have found that patients, on average, experienced either little or no improvement. Saline irrigation, along with other treatments, can provide some benefit for patients with sinusitis. Saline rinse or spray is one of the few treatments that can be used safely on babies.
Intranasal corticosteroids, such as fluticasone nasal spray, may improve symptoms in patients with sinusitis but are unlikely to affect symptom duration and may cause systemic side effects. There is no evidence that intranasal corticosteroids improve rhinitis symptoms associated with the common cold.
Throat Lozenges and Sprays
Patients may find over-the-counter lozenges or throat sprays containing analgesics, NSAIDs, or antiseptics helpful; however, the effects of these drugs may be small and short-lived. 8 A number of lozenges and throat sprays containing different active ingredients have been evaluated in clinical studies, but there is insufficient evidence to determine which of these is better. Lozenges containing flurbiprofen, an NSAID, provide some reduction in pain, however, 30-50% of people are more likely to have side effects than other lozenges, including taste disturbances, numbness, dry mouth or nausea.
There is no evidence for or against the effectiveness of liquid cough medications for acute cough. This is largely due to the lack of quality trials that could show clinically relevant results. Cough and cold medicines are contraindicated in children under six years of age, and some products containing codeine are contraindicated in children under 12 years of age.
Oral corticosteroids have been investigated in some clinical trials as a treatment for patients with sore throat, but are not recommended in guidelines due to uncertainties about long-term safety. The cumulative results from numerous studies suggest that oral corticosteroids can reduce pain duration by about 14 hours and the NNT is 4; however, studies to date have been conducted on patients with severe symptoms presenting to emergency departments, and there is little evidence of possible long-term side effects.
Complementary and Alternative Therapies
There are many remedies for winter ailments available in pharmacies or supermarkets that offer various degrees of benefit. It is likely that part of the perceived benefit of using these products is due to a placebo effect; For example, if patients believe that echinacea is working, they are more likely to report improvement in their symptoms with echinacea treatment.
Can CRP Levels Be Used To Diagnose Bacterial Infection?
In bacterial infection, C-reactive protein (CRP) increases within four to six hours after infection and peaks at about 36 hours. The level of escalation usually corresponds to the severity of the infection. Bacterial respiratory infections usually cause more elevations in CRP than viral infections; CRP <10 mg / L likely indicates a viral infection or a very mild bacterial infection. However, there are some exceptions to this, for example, a CRP of 10--80 mg / L is not unusual in people with influenza. A person with a severe bacterial infection is likely to have a CRP> 100 mg / L.
Therefore, CRP can be used to assess the severity of infection, and the higher the value, the higher the likelihood of bacterial infection, but there is no specific “cut-off” that predicts bacterial infection with full accuracy. In practice, if a CRP level is requested for a patient, it is likely that other parameters, including neutrophil, lymphocyte, and platelet levels, will be investigated that may add information to the overall clinical picture, such as complete blood count.
Bedside testers that combine CRP with other infection biomarkers such as procalcitonin (PCT) and myxovirus A (MxA) are currently being evaluated for their accuracy in predicting viral or bacterial infection.
Author: Ozlem Guvenc Agaoglu