Posts Tagged ‘cough’

According to a recent public health alert, California is experiencing an epidemic of pertussis. Santa Cruz County has had 20 known cases and probably many more that have not been reported or have yet to be diagnosed.

Pertussis, also called whooping cough, is a highly contagious infection of the lower respiratory tract, involving the lungs. It usually manifests as a mild persistent cough but can advance to a severe cough. Often in children, this cough is followed by a high-pitched intake of breath that sounds like “whoop” — thus the common name whooping cough.

Pertussis is caused by a bacteria germ, not a virus. It is passed from an infected person who sneezes or coughs and therefore spreads by infected tiny droplets into the lungs of anyone who might be nearby. Once in the lungs, the germs can cause an infection, creating inflammation and a narrowing of the lungs’ breathing tubes. This produces the cough and the characteristic whooping sound.

Infants are particularly vulnerable, because they are not fully immune to whooping cough until they’ve received at least three immunization shots. This leaves babies 6 months and younger at greatest risk of catching the infection. Also, the pertussis vaccine one receives as a child wears off in five to 10 years, leaving most teenagers and adults susceptible to the infection during an outbreak.

The diagnosis of pertussis is often delayed or missed in infants, because early symptoms are often mild and the serious cough might not begin until days or even weeks later. A severe infection in infants can be fatal, although thankfully this is rare. Five infant deaths have been reported in California since the beginning of the year.

One must consider pertussis for anyone with a cough that lasts more than two weeks, especially when the cough is worse at night and the patient has prolonged coughing spells but generally feels quite well otherwise.

The vaccine for pertussis comes combined with the tetanus and diphtheria vaccines that are routinely given to children in their first years of life and to adults every 10 years. Talk to your doctor about it.

Besides infants, those who especially need the vaccine’s protection are pregnant women in their third trimester, because they will soon have contact with their unprotected infants. Mothers have been found to be the greatest source of transmitting whooping cough germs to newborns.

Infants can also be protected by vaccinating those people who have close contact with them. This “family” protection has been highly successful with susceptible infants.

Tests are available to diagnose pertussis. The decision whether to test should be left to a doctor, however, as in most cases, the diagnosis can be made on symptoms alone.

Antibiotics can be effective, especially when given soon after symptoms begin. After several weeks of symptoms, they are much less effective. Family members can also be prescribed preventative antibiotics.

Remember that pertussis is caused by bacteria and can usually be treated with an antibiotic, but if you just have a bad cough because of bronchitis, which is caused by a virus, antibiotics will not be effective. Your doctor will be able to determine the proper diagnosis and treatment.

Read Full Post »

Over-the-counter cough and cold medications to alleviate cold symptoms in young children are being largely withdrawn from pharmacy shelves. This is because of unintentional misuse or overdose of these medications causing harm and, rarely, death, especially in children younger than 2.

These medications are frequently used in good faith, even though there is no scientific proof that these drugs are actually effective. This is a case in which the risks outweigh the benefits.

Health care providers are now asked not to advise the use of such drugs for children younger than 6. Some of the most common are PediaCare, Triaminic and Dimetapp.

I know this may sound discouraging when caring for a sick child, but there are useful non-drug treatments for cold and cough symptoms. Try the following, for example:

• Encourage the drinking of fluids to prevent dehydration and to help thin out mucus. Contrary to popular opinion, milk has not been proven to increase mucus formation.

• Control high fever or pain with either acetaminophen (Tylenol) or ibuprofen (Advil), giving doses once every six hours.

• Saline irrigation can be helpful for a congested or drippy nose. For infants, use rubber bulb suction to remove nasal secretions after applying saline nose drops or spray, or try sinus rinsing for older children.

• Use a cool-mist humidifier or vaporizer in the child’s room. To prevent contamination, the water inside should be replaced daily and the machine should be cleansed regularly according to the manufacturer’s recommendations. If possible, maintain indoor relative humidity between 40 percent and 50 percent.

• If a medication such as Tylenol or Advil is given, I do not advise the use of household kitchen spoons to measure doses of medication. Measuring devices that use units of milliliters (mLs,) usually are packaged with the medicine or can be obtained from a pharmacist.

• Honey can relieve coughs by increasing saliva, which coats the throat and relieves irritation. Suggested doses are half a teaspoon for children between 1 and 5 years, one teaspoon for children 6 to 11 years, and two teaspoons for children 12 and older. Do not give honey to a child younger than 1.

Sometimes, a visit to a doctor is called for. See your health care provider immediately for the following cases:

• A child younger than 2 months of age with any fever

• A child younger than 2 years of age with a fever lasting more than two or three days

• A child who complains of an earache or a severe sore throat

• Thick green nasal discharge that continues for more than seven to 10 days

• Mild symptoms that do not improve after 10 to 14 days

• A child who seems very ill to you

By the way, for children who have appropriately been prescribed antibiotics, I am frequently asked whether the drug needs to be refrigerated.

The two most commonly prescribed antibiotics — amoxicillin, which tastes like bubble gum or occasionally is fruit-flavored, and azithromycin (Zithromax), which has a cherry/vanilla/banana taste — can be kept at room temperature for up to 10 days. Refrigeration may improve the taste, but it isn’t needed to maintain potency.

Read Full Post »

Doctors are seeing an increased number of patients with symptoms of respiratory infections such as common colds, bronchitis, sinusitis, ear infections and sore throats. I would like to review some important points regarding these common infections, along with their recommended treatments.

Everyone has, at one time or another, experienced a common cold that carried symptoms such as nasal and sinus congestion, a runny nose, a mild sore throat and cough. This common infection may last from a few days to one to two weeks. It is always caused by a virus — therefore patience, not antibiotics, is the main treatment.

Bronchitis can be thought of as any cough that is not caused by pneumonia or asthma. The main symptom of bronchitis is a cough without a fever. People with bronchitis usually just have a cough and do not feel particularly sick and are able to continue their normal daily activities. One can expect coughing from bronchitis to last from one to three weeks.

Again, this is a viral infection, and antibiotics are not necessary. If a cough lasts more than several weeks or is associated with fever, it would be wise to visit your doctor.

Sinusitis is an infection of the sinuses, which are air-filled pockets around the nose in the skull. This infection is usually preceded by a common cold. It, too, is usually caused by a virus, but after lingering for one to two weeks can turn into a bacterial infection.

One of the key factors in determining the proper treatment for a sinus infection is the duration of the symptoms. If you’ve had a cold for one to two weeks and are experiencing pain or pressure in your sinuses along with yellow or green nasal mucus and perhaps a fever, then antibiotics may be helpful.

A sore throat is often a symptom of a cold, but can sometimes be a bacterial strep throat infection. A good rule of thumb is that if a sore throat is associated with a bad head cold, and especially with a cough, it is usually caused by a virus and needs no prescribed treatment.

If, however, one has a sore throat without cold symptoms or cough but with a fever and a past history of strep infections, then the most likely culprit is the strep germ, which needs to be treated with antibiotics. Strep is much more common in children than in adults. Many people go through life without a single strep infection.

Over-the-counter medications for adults can be helpful in alleviating the miserable symptoms of respiratory infections. The following are the basic ingredients of all the myriad combinations of cold and flu drugs found on pharmacy shelves:

  • Acetaminophen (Tylenol) or ibuprofen (Advil) may be used to reduce fever and to ease aches and pains.
  • Pseudoephridine (Sudafed) is a decongestant to help relieve nasal and ear congestion.
  • Guaifenesin (Robitussin or Mucinex) is an expectorant to help loosen mucus. (Dinking lots of liquids may work just as well.)
  • Dextromethorphan is a cough suppressant, which might help ease a persistent cough.
  • One may purchase a sinus rinsing system called Neil Med, which can be found at all pharmacies. This is a natural treatment using a salt-based solution to flush out the sinuses, helping clear out mucus. I have found this to be one of the very best treatments for bad colds and sinus infections.

See your doctor if you have a fever for more than three or four days, or if your fever is 103 degrees Fahrenheit or higher. Your doctor will determine whether antibiotics are necessary to treat you. At the very least, your doctor may prescribe medication that will help treat your symptoms and make you feel more comfortable.

Read Full Post »