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Glenn D. Braunstein, M.D. Headshot

Cold Facts About Caring for Seasonal Infections and Their Associated Healthcare Costs

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Gesundheit! You'll be hearing that a lot, as surely as the cold season follows the holiday season. But if your head isn't plugged up beyond belief, this time of colds, ear and sinus infections and influenza also can provide a reason for each of us, as individuals, to look at our own health and healthcare and see how our small choices and decisions play a role in contributing to the burgeoning, unsustainable costs of U.S. medicine.

As annoying as those incurable, predictable bouts of sniffles and sneezes are, people can expect to get over a cold in an average of 7.4 days. That's an average, so for some of you less lucky acute rhinosinusitis sufferers, you may need that box of tissues for a couple of weeks. Still, as certain as we are that we'll get colds with some regularity, we can be equally certain that, in their own sweet time, they'll go away.

Only 0.5 percent to two percent of colds progress to bacterial infections, making the vast majority of them viral infections, untouchable by antibiotics. With no small element of hyperbole, physicians have been telling patients for millennia that there is no cure for the common cold.

And yet we get impatient. Americans get 500 million colds a year, the most common illness to afflict human beings.

We're in an ever-increasing haste to feel better, so we keep trying to throw medicine at our symptoms: throat lozenges, cough syrup, nasal sprays. A public health researcher looked at the costs of colds and found that Americans spent $2.9 billion on over-the-counter drugs intended not to cure, but to relieve symptoms.

We spent another $400 million on prescription drugs, also aiming to relieve symptoms. What's most troubling is that Americans received 41 million prescriptions for antibiotics totaling $1.1 billion, even though the medical community recognizes that antibiotics have no effect on the common cold.

Numbers like that are a big part of the reason a consortium of specialty care physicians released a list last year of 45 treatments or tests that doctors should use far less often or not at all. It surprised no one that prescribing antibiotics for common upper respiratory infections was on the list of no-no's.

Antibiotics have no doubt saved millions of lives, but like all drugs, they have potentially harmful side effects, too. Every year, some 140,000 people are taken to emergency rooms to treat adverse effects from antibiotics. About 80 percent of those adverse events are allergic reactions, and children under a year old had the highest rate of adverse events.

Reduce the misery

We know we can't cure a cold. But that doesn't mean we must sit back and suffer. With all that nose-blowing and leakage of nasal fluids, we need to drink a lot of fluids to avoid dehydration. Make those liquids clear, like tea and, yes, chicken broth. You can gargle with warm salt water to temporarily relieve a sore throat. A humidifier or a steamy bathroom can provide moisture for your dry membranes.

Nonprescription remedies, including pain relievers, may offer some relief, but they're not a cure, and they won't shorten the length of your illness. And read the labels. Acetaminophen (like Tylenol) must not be taken in doses higher than recommended because of the risk of serious liver damage. Many cold remedies contain acetaminophen, so be sure you're not taking too much by adding the common pain reliever on top of a cold remedy. (If you want more information about over-the-counter pain relief medications and their risks, I've written about this topic, and you can see that post here.)

Health officials are reporting that 2013 appears to be a year in which influenza or the flu appears to be striking the nation hard. While both it and the common cold can feel mighty bad, the sudden onset of aches, fatigue and often fever can be clues that you’ve got the flu. Both are caused by viruses. If you think you’ve got the flu and you’re not getting better in a few days, especially if you have chronic health conditions such as asthma or heart disorders, please get in touch with your physician. The flu, as I’ve written before, can be pandemic and has a history as a major global killer. In some instances, with sick youngsters and others at high risk, your physician may treat your flu with antiviral medications. And, for all of us in California, there’s still time and benefit — particularly for the young, elderly and high-risk individuals — to get a flu shot.

Meantime, for the nasal congestion caused by both colds and flu, some people swear by the device called a neti pot. Looking like something a genie might float out of, it's a long-spouted, teapot-like vessel used to rinse the nasal passages with a salt water solution. An Ayervedic medical device originating in India, neti pots have become popular in this country as a treatment for congested sinuses, colds and allergies.

Research suggests they can be effective. When more than 200 patients used a form of nasal irrigation, they reported statistically significant improvements in 23 of 30 symptoms including postnasal drip, nasal discharge, itchy eyes and sneezing.

But are they safe? Neti pot users had a scare recently when two deaths in Louisiana were linked to nasal irrigation using tap water. The water contained an amoeba called Naegliria fowler, a bug that is easily killed by stomach acid when water is swallowed. But when taken up the nose, it can travel to the brain and cause primary amoebic meningoenephalitis, a rare and fatal brain disease.

Following the deaths, the Food and Drug Administration issued warnings about using neti pots safely. Use distilled water, or boiled and cooled tap water. Don't use water straight from the tap, and don't share a neti pot with anyone. And clean thoroughly after each use.

Used properly, nasal irrigation can provide some relief, in turn reducing the temptation to ask for antibiotics. The overriding concern about antibiotics is that their overuse leads to germs that grow ever more clever at resisting the drugs. Resistance can become so severe that the antibiotics no longer work in treating infections.

Ear infections

Cutting back on the use of antibiotics for ear infections, as well as for colds in children, is a good idea. But for childhood ear infections, acute otitis media, things are a little more complicated.

For babies younger than six months, the guidelines from the American Academy of Pediatrics continue to call for the use of antibiotics for ear infections. For children between six months and two years old, if the child's physician is certain of the diagnosis of an ear infection or if symptoms are severe (a fever exceeding 102.2 degrees Fahrenheit and/or severe pain) an antibiotic should be prescribed.

It's children older than two who might be observed for two to three days first, before taking any medication. Many ear infections will get better on their own. But if the symptoms persist or pain gets worse after a couple of days, an antibiotic should be prescribed.

Every parent and physician knows that ear infections are their own special bane for children; they can be painful, uncomfortable and persistent. Would it surprise you to know, though, that ear infections, according to U.S. data, have ranked as the No. 4 expense for children's healthcare? One out of 10 children saw a doctor and were prescribed medication for an ear infection, and, excluding the cost of over-the-counter drugs, the total spent on this condition in children, according to 2006 statistics: a bracing $2.8 billion.

We might learn a thing or two from the preschoolers in our lives and how they practice their own instinctive infection prevention regimens. When they sneeze, many of them reflexively bring the crook of their elbows to their little noses. Where once we were taught to cover our mouths with our hands when we cough or sneeze, youngsters now get more specific advice. If you don't have a tissue, sneeze into your elbow or your upper arm, not your hand where you can spread germs with the next handshake or doorknob turn. If you do have a tissue, throw it away immediately and wash your hands. Use soap and warm water, and wash for 20 seconds, which, as any kid can tell you, is just about how long it takes to slowly sing all the words to "Twinkle, Twinkle, Little Star."

If you're feeling poorly, by the way, please stay home — and do so early and not grudgingly. You do no favor to yourself at work, with colleagues and employers, by dutifully showing up ill — and getting everyone around you sick. And while I know economics may make it difficult and stressful on parents, children who show signs of illness also ought to be kept home, starting early on. This can make for complicated logistics in a family for care, I know. But your child can't fight an infection, which will only worsen, if you stick, as so many harried parents do, to youngsters' absolutely frantic schedules of school and activities.

Yes, you and your family can, as mentioned, spend and waste money, time and other care resources on stop-gap, feel-better nostrums and remedies. It's a choice. But we're all facing hard decisions to preserve the quality of our healthcare, while reining in runaway, unnecessary costs. The options for greater affordability may mean some levels of discomfort. But know that for the seasonal infections, they should be mostly mild and relatively short-lived, and spending, as we do, billions of dollars for little or no favorable change in outcomes ought to give us collective chills.