It is well known that smoking is an important cause of COPD.  Now data from a large national health and nutritional survey (the NHANES study) shows that people who ate bacon more than three times a week had significantly lower lung function than non-bacon eaters.  Bacon is high in calories, salt, saturated fat, nitrates, and preservatives.  All of these factors have been linked to heart disease, high blood pressure, obesity, and even cancer.  This report offers another reason to limit bacon intake.

It has always been a challenge to pick the right cold care product for your individual needs.  Now that 34 states have recently restricted the sale of the most popular decongestant, pseudoephedrine, relieving congestion has become more complicated.

The states were moved to limit the sales of the products containing pseudoepepherine because it can be used to cook–up crystal meth in home labs.  Where it is restricted, it is still available from behind the pharmacists counter.  It also means that these decongestants are not available in grocery, convenience or discount stores. Some  manufacturers have completely removed pseudoephedrine from their cold care products, especially in combination formulations.  Other companies like Pfizer have substituted another FDA decongestant, phenylephrine, in their products such as Sudafed PE. 

Consumers and vendors are confused and concerned about these changes in cold care products. Are they safe?  Do they cause more side effects?  Do they work?  The good news is that the substitute ingredient phenylephrine is safe and does not cause increase in  unwanted symptoms  (e.g., insomnia or palpitations).  The bad news?  A letter published in the Journal of Allergy and Clinical Immunology reviewed a number of studies that showed that phenyephrine is less effective than the now restricted pseudoephdrine. 

One study showed that, when taken by mouth, only 40% of phenylephrine reaches the blood stream.   By comparison  90% of  pseudoephdrine gets into the blood stream.  Two other studies by two different investigators found that phenylephrine was no more effective than a placebo in relieving congestion.

So what do these findings mean to you and  your stuffy nose?  If your doctor believes that you have sinusitis or an ear infection and feels that a decongestant would both be needed and safe, select a decongestant with the now restricted pseudoephedrine from your pharmacist.  If the congestion is part of a common cold, start with a saline nasal spray to relieve symptoms.  If you still feel congested, use a nasal decongestant spray like Afrin which contains another type of decongestant.  But remember use the spray  for no more than 3 days to avoid rebound congestion. You can also ask your physician for a prescription for nasal decongestion  such as Atrovent that contains  ipatropium.  This is a different form of decongestant called an anti-cholinergic and usually has fewer side effects. Antihistamines such as Benedryl and Claritin  may also relieve some of these symptoms.  

When the congestion is due to allergies, nasal corticosteroid spray such as Flonase or Nasocort will  provide needed relief. 

Every year Americans get approximately 1 billion colds.  Influenza, a cold’s evil twin, effects up to 60 million Americans annually. There are five steps that you can do to take to get ready for cold and flu season this year:

1. Prevent Colds & Flu with Simple Precautions

Viruses and bacteria can live for hours on inanimate objects such as hand rails, telephones, pens, computer keyboards, countertops, and doorknobs. To keep yourself safe, wash your hands frequently, carry a hand sanitizer with you to work or school and disinfectant wipes or sprays household sanitizers in your kitchen and bathroom. 

2. Get the Vaccinations You Need

With all of the recent talk about flu vaccine shortages, it’s hard to know just who should receive an annual shot. According to Dr. Schachter, very young children, the elderly, pregnant women and anyone with an underlying health problem, such as asthma or diabetes, should be vaccinated annually.

3. Know Your Temperature

When a sick patient calls their doctor, the doctor’s first question is, “Do you have a fever?” This is because a fever is the key indicator as to whether an infection is severe and helps your doctor determine the best medication. “If I can give my patients one good piece of advice, it’s to have a working thermometer in their home,” says Dr. Schachter. “It will help you and your doctor determine the best next step.”

4. Feel Better Until You Are Well

When viruses and bacteria attack the cells in your body, they release inflammatory compounds that cause fever, congestion, body aches, headache and throat pain. To prevent discomfort, take an over-the-counter anti-inflammatory medication, such as Tylenol or Advil at the first sign of infection. And don’t forget that hot tea and chicken soup also have anti-inflammatory properties and will help you feel better.

5. Know When to Call A Doctor

A cold and the flu can feel very similar when you’re sick, but there are four key signs to look for that indicate it is time to call your doctor; fits of coughing, rusty sputum, chest pain and shortness of breath. If you suffer from any of these symptoms, Dr. Schachter recommends calling your doctor to arrange an appointment.

I’m often asked about old wives tales or myths about colds and flu. I’d like to look at the most common ones and attempt to separate fact from fiction.

Myth #1: You can get the flu from a flu shot.

Truth: I hear this stated frequently as an excuse to avoid the shot. The truth is that you may get a bit of fever and feel a bit achy for 24 hours after a flu shot, but this is just a sign of immune response to the vaccine. By the next day, you will feel perfectly well  and will be able to avoid the intense discomfort of a full-blown influenza infection.

Myth #2: You’re not contagious without a fever.

Truth: When and how long a cold or flu is contagious is an intriguig question. Fever  is not a good guideline. Most colds have very little fever. Children are actually infectious up to 2 days before they develop a single sniffle. Adults are most contagious at the peak of sneezing and coughing, which is usually the first two days. However, you will continue shedding virus, albeit in lesser amounts for up to a week.

Myth #3: Kissing spreads colds.

Truth: With colds, just about the safest contact is a  kiss, because there are few viral particles in saliva. By contrast, secretions from the eyes and nose have high titres. If you rub your eyes then shake hands, your cold will spread much faster than with a kiss.

Myth #4: Cold weather will give you a cold.

Truth: Colds are caused by a virus, not by environmental temperature. Scientists in England did some harrowing studies with volunteers who were soaked with water, sent outside, and watched for signs of a cold. In spite of this treatment, they stayed healthy. However, the cold virus loves cold gray windy weather, so it is more likely that you will pick up a cold virus in blustery wintery weather.

There  are five easy tips  that we can all  follow to improve our immunity.

1. Cigarette Smoking

There are of course  many reasons  not to smoke cigarettes.  They are linked to cancer, heart disease, and  even diabetes.  But if those problems seem  too far off to worry about in your 20’s and 30’s , let me point out that  cigarettes paralyze the cilia in the airways, alter mucus production and damage a phagocyte’s ability to eat up bacteria. As a result, mucus builds up in the airway and offers bugs a wonderful breeding ground to multiply. Not  only are respiratory infections more frequent in smokers,  they tend to be more severe and last longer.

2. Exercise

We’ve all heard about the benefits of exercise – weight control, cholesterol decrease, better diabetes control, and  improvement of  both depression and  high blood pressure.  To these benefits we  can  now add improved immunity. Studies have shown that  moderate regular  exercise  can  improve  antibody response to  flu vaccination, especially in older adults.   Other research has shown that people who  engage in moderate levels of exercise  have  improved T cell numbers as well as function -  a good measure of  how well  a body can defend itself. 

Interestingly, too much exercise  can actually have  the opposite effect. Adults who exercised more than 90  minutes a day, several times a week    actually had depressed immune profiles.  Elite athletes and marathoners  were found to have  reductions both T  cells and Natural Killer cells.

3. Weight Control

Doctors have found that  excess weight  is also a factor  that effects immunity.  Clinically  we know that  obese people have a higher incidence  of bacterial infections and slower wound healing. Research studies have found that  people who meet the definition of obese have lowered levels of lymphocytes  and natural killer cells. But the good news is that when obese individuals lose weight, their lymphocyte levels and function improves.

4. Alcohol Consumption

Excess alcohol,  like cigarette smoke, paralyzes the cilia and increases mucus  production.  Too much alcohol also dampens the senses and makes swallowing more difficult and inefficient, so that food and microbes can easily find their way into the respiratory system. This accounts for why  many people who abuse alcohol are so prone to pneumonia.

However, a daily glass of wine, rich in anti-oxidants, has actually been linked to improved resistance to infectious disease.  Keep your intake to a maximum of  five servings a week and you will  give your  immune system a boost. In fact people who abstain from alcohol altogether have a lower immune profile than those who drink in moderation.

5. Emotional Health

For the past twenty years we have been accumulating  research evidence that links mood and  immunity.  Studies  on stress have shown that  life events such as  marital discord, divorce,  and job loss  can depress  levels of both NK and T cells, thus lowering immunity.   Even routine daily stresses such as deadlines, traffic jams and long lines at Starbucks can  cause changes in immunity.  It is very easy to tell  people not to get upset or take it easy—but not very effective.  We cannot always control our lives but   we can help our body  cope with it.  Just taking a break, at least once a day, will break the cycle of stress and  help your immune  system  regain equilibrium.  Try to carve out a 30 minute slot each day for you to  do something you enjoy.  It can be reading a book, taking a walk or  meeting a few friends  to talk.

Chronic depression   can have an even more profound impact on our immune function.  Research has shown that  major depression is linked to an increase in  severe health problems  including  heart disease, hypertension and even cancer.    Immunology  studies have shown that  depression can  lead to immune dysregulation. 

We are just beginning to explore if anti-depressant therapy can reverse the changes in the  immune system and it is certainly  an area  that we will certainly be hearing much more about.

Better immunity  does not come from a pill or a vitamin supplement. The ability to resist infection depends in great part on basic lifestyle choices. We have all heard about the benefits of exercise and weight control, but its impact  on immunity  is an important  reason to  listen  to  good health  care advice.  I feel it is particularly relevant to  adults in their 20’s and 30’s for whom health  care issues such as  high blood pressure and diabetes seem decades away.  But  when we know that  smoking, excess alcohol and stress  can impact on  our day to day  immunity from all to common infections, it  might give new motivation to make  beneficial lifestyle choices.

     I believe  that the more you know about  health care issues, the better you will be able to prevent and  manage  these problems.  The HealthTalk blog will allow me to discuss  current  medical and health care developments  quickly and efficiently.  It will give  me the chance  to address current  issues and  help make them relevant  for the health  of you and your family.  In some cases this  will mean alerting you to  potential problems.  In other cases,  the blog will  take  the alarm out of a troubling news story. 

The current of focus of HealthTalk will be on colds and flu as well as the other respiratory issues. When spring comes, I will start to cover developments in allergies, starting with a guide to help you decide if your  symptoms are caused by a cold or allergy. As time goes by, I will cover a wide range of health topics as future “Good Doctor Guides” are published. If  want to ask questions or share concerns, HealthTalk can be reached at Neil@gooddoctor1.com. I look forward to hearing from you.

February 18,2006

      The American College of Chest Physicians recently issued new guidelines on the treatment of coughs that discourage the use of traditional cough syrups.  This view directly contradicts the evaluations of the FDA which supported their safety and effectiveness. When two respected sources conflict, patients only get confused.

As a pulmonologist, I believe that there is no one size fits all answer to the treatment of coughs. A remedy must be based both on severity and cause. If the cough is due to a simple cold, relief should start by gargling with warm saltwater . When a cold or flu virus strikes, the body mounts a defense that includes the production of inflammatory compounds known as cytokines.  These chemicals, which include prostaglandins, and interleukins, are responsible for fever, body aches and that irritating tickle that triggers a cough. Gargling with warm salt water dissolve cytokine laden mucus that lines a cold-affected throat. A cup of hot tea with honey and lemon also can clear the throat of cytokines while providing a healthy supply of disease fighting anti-oxidants.

Even a simple sugar based cough drop contains demulcents that coat a virus- irritated throat, short circuiting the cough reflex. Keep in mind that all of these simple remedies provide affordable and safe relief without adding unnecessary medications to your system.

If the cold or flu is accompanied by heavy congestion and increased mucus production, the cough is triggered by the body’s efforts to clear  the airways. In this situation, you don’t want to mask the cough response. Instead, the solution is to discourage mucus production with old fashioned antihistamines such as Benadryl and Chlorpheniramine. The newer non-sedating antihistamines which work beautifully for allergies, do not have the same impact when the congestion is caused by a cold or flu virus. Antihistamines are frequently used in over the counter combination cold and flu remedies. In fact, a number of these products base their cough control properties on the inclusion of antihistamines in their formulas.

If a cough lingers for more than 10 days, you may have developed as asthma-like irritability of the airways. The original viral infection has damaged the lungs as that they remain inflamed and irritated.  Substances in the environment that once did not cause problems (ie cigarettes, smoke, perfume, pets or even cold air) now provoke contraction of the airways causing you to cough. I have found that the most effective way to control this type of cough is with a mild bronchdilator.  They work almost instantly to quell the cough for hours. Bronchdilators are available only by prescription, and need to be taken for up to six weeks following a bad cold or flu.