Are there evidence-based strategies for recovering from colds, influenza and upper respiratory inflammation or infection faster?
The review by Allan & Arroll (2014) found that there is a need for more high-quality research on treatments for common colds. This is largely due to current evidence often being low-quality or unreliable.
Preventing the Spread of Cold and Flu
To prevent the spread of infection people are encouraged to:
- Stay home whilst sick with the flu – do NOT go to work;
- Participate in correct hand hygiene (e.g. use the 5 moments);
- Participate in other hygiene practices such as waste disposal (e.g. immediately place used tissues in bins);
- Do not share items that may be contaminated (e.g. bed sheets, plates, forks, clothes);
- Perform correct coughing/sneezing practices (people should aim to cough into a tissue which is then placed into the bin);
- Use a tissue rather than a handkerchief;
- If you do not have access to tissues, cough/sneeze away from other people – you may need to aim into your upper clothing sleeve;
- Wear a face mask if you have to go near other people;
- Take a plastic bag with you to act as a bin for your used tissues;
- If you cannot access a sink with soap and running water, use alcohol hand gel/sanitiser;
- Remember that you are likely to be infectious for a week after being sick.
(Better Health Channel n.d; SA Health n.d.)
One of the mainstays of treating the cold, flu and associated complications (e.g. bronchitis, pneumonia) is to get the annual flu vaccination. Better Health Channel (n.d.) states that flu vaccinations are ‘recommended for all people from six months of age’.
Each year, the very contagious influenza virus infects many people (Better Health Channel n.d.). The flu is spread by contact with fluids from coughs and sneezes, and may show symptoms such as a dry cough, fever, aching body, decreased appetite, sore throat, runny nose, nasal congestion, chills or tiredness (Better Health Channel, n. d.).
Generally the flu symptoms may take around eight days to subside, however, the fatigue and coughing may remain for another week or longer.
Further information on flu vaccinations and its recent updates can be found on the NSW Health website, which states:
‘Flu shots are available for free under the National Immunisation Program to members of the community who are pregnant, over 65 years of age, are Aboriginal or have medical conditions such as severe asthma, diabetes and heart problems. We are advising anyone who is yet to have the vaccine to call ahead to their GP to ensure the correct formulation for their age is in stock before they attend for vaccination.
The NSW Government this year purchased vaccines for children up to five years of age which we are providing for free this year, in addition to vaccines for all public health facility staff. NSW Health can confirm that the supply of vaccine for children six months to under three years of age is not affected, and due to controls in place for the vaccine for three and four-year-old children, expect that supply will be sufficient to meet demand.’
(NSW Health 2018)
Evidence-Based Cold and Flu Treatments
Better Health Channel recommends resting up, hydrating, using saline nasal spray/drops (for congestion), gargling warm water for sore throats, not smoking, using lozenges and checking with your GP and pharmacist before taking any medications or if you have any concerns.
For non-traditional treatments for children with colds (aged older than one year), honey may be provide effective relief for coughs when given at bedtime (Allan & Arroll 2014).
Allan and Arroll (2014) also point to physical interventions (e.g. correct handwashing) and zinc supplements as some of the best-evidenced prevention techniques for a cold.
For treatment support, they found the use of acetaminophen (paracetamol) and nonsteroidal anti-inflammatory medicines (for pain and fever), and possibly antihistamine-decongestant combinations and intranasal ipratropium, to be effective, with ibuprofen appearing to be ‘superior to acetaminophen for the treatment of fever in children’ (Allan & Arroll 2014).
The systematic review by Grande, Reid, Thomas, Nunan and Foster (2016) evaluated whether exercising before the flu vaccination could help to prevent adults from getting the flu or further complications. They found no benefits or harms in exercising before the flu vaccination More research is needed on this topic, with higher quality evidence that includes larger sample sizes.
The systematic review by Kenealy and Arroll (2013) found there to be no evidence that antibiotics are beneficial for treating colds or ‘acute purulent rhinitis’ (coloured nasal mucus).
It was concluded that antibiotics for common colds in adults are actually linked to adverse outcomes and that antibiotics can cause adverse effects for participants of all ages when administered for acute purulent rhinitis (Kenealy & Arroll 2013). One of the adverse effects of antibiotics can include diarrhoea.
As colds are viral in nature and there are concerns for antibiotic resistance from overuse, it is clear that antibiotics are not appropriate to treat colds.
There is not enough high-quality evidence to conclude whether over-the-counter cough medicines are effective for acute coughs (Smith, Schroeder & Fahey 2014).
Nasal saline spray was found in the systematic review by King et al. (2015) to ‘possibly’ improve symptoms of upper respiratory tract infections, but there needs to be further research of high quality on this intervention to guide evidence-based practice.
Despite the evidence quality being described as ‘low’, it is still worth acknowledging that the systematic review by (Hao, Dong & Wu, 2015) found probiotics to be beneficial for upper respiratory tract infections. Compared to placebo, probiotic treatment reduced ‘the number of participants experiencing episodes of acute URTI, the mean duration of an episode of acute URTI, antibiotic use and cold-related school absence’ (Hao et al. 2015).
- Allan, GM & Arroll, B 2014, ‘Prevention and treatment of the common cold: making sense of the evidence’, CMAJ : Canadian Medical Association Journal, vol. 186, no. 3, pp. 190-9, viewed 21 June 2018, https://www.ncbi.nlm.nih.gov/pubmed/24468694
- Better Health Channel 2018, Flu (influenza), Victoria State Government, viewed 21 June 2018, https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/flu-influenza
- Grande, AJ, Reid, H, Thomas, EE, Nunan, D & Foster, C 2016, ‘Exercise prior to influenza vaccination for limiting influenza incidence and its related complications in adults’, Cochrane Database of Systematic Reviews, no. 8, viewed 21 June 2018, https://www.ncbi.nlm.nih.gov/pubmed/27545762
- Hao, Q, Lu, Z, Dong, BR, Huang, CQ, Wu, T 2011, ‘Probiotics for preventing acute upper respiratory tract infections’, Cochrane Database of Systematic Reviews, no. 2, viewed 21 June 2018, https://www.ncbi.nlm.nih.gov/pubmed/21901706
- Kenealy, T & Arroll, B 2013, ‘Antibiotics for the common cold and acute purulent rhinitis’, Cochrane Database of Systematic Reviews, no. 6, viewed 21 June 2018, https://www.ncbi.nlm.nih.gov/pubmed/23733381
- King, D, Mitchell, B, Williams, CP & Spurling, GKP 2015, ‘Saline nasal irrigation for acute upper respiratory tract infections’, Cochrane Database of Systematic Reviews, no. 4, viewed 21 June 2018, https://www.ncbi.nlm.nih.gov/pubmed/25892369
- NSW Health 2018, Seasonal Influenza Vaccination 2018, NSW Government, viewed 21 June 2018, http://www.health.nsw.gov.au/immunisation/pages/seasonal_flu_vaccination.aspx
- SA Health n.d., Wash, wipe, cover… don’t infect another! Questions and Answers, Government of South Australia, viewed 21 June 2018, http://www.sahealth.sa.gov.au/wps/wcm/connect/…440ce9004ff8e4298458bf4826472d56
- Smith, SM, Schroeder, K & Fahey, T 2014, ‘Over-the-counter (OTC) medications for acute cough in children and adults in community settings’, Cochrane Database of Systematic Reviews, no. 11, viewed 21 June 2018, https://www.ncbi.nlm.nih.gov/pubmed/25420096
- World Health Organization 2007, My 5 moments for hand hygiene, WHO, viewed 21 June 2018, http://www.who.int/infection-prevention/campaigns/clean-hands/5moments/en/