Winning the Cold War: The Latest Scientific Findings on Fighting the Sniffles and Sneezes
by Rehan Jalali
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Everyone knows how to ward off the common cold, right? Sure� plenty of bed rest, lots of O.J. and a couple bowls of mom�s homemade chicken noodle soup ought to do the trick. Moreover, sprinkle in some echinacea and a hefty dose of that nighttime, sniffling, sneezing, coughing, aching, stuffy-head, fever, so-you-can-rest-medicine, and lookout, virus�you�re dealing with a ruthless cold-fighting commando!
Give me a break. It's time to step into the new millenium!
Such "tips" on fighting the common cold are about as stale as the saltines mom would serve up with her "healing broth." If all those trendy "remedies" really worked, why is it our muscles still are hardly strong enough to snatch another tissue, let alone a bar packed with plates, when we do inhale these supposed remedies?
It�s time for a fresh investigative look at the issue�one that skirts all the chicken noodle nonsense and for a change presents refreshing cutting-edge information on how to successfully fight the cold war.
Indeed, there are reams of new scientific research about fighting colds. But unfortunately, most of it is ignored in favor of the same old fluff you always see in the cookie-cutter common-cold articles� "Drink orange juice �cause it�s got lots of Vitamin C." Well, that�s excellent advice�if you�re up for drinking 2 gallons a day because that�s how much you�d have to down to get the amount of Vitamin C shown effective in almost every clinical study. And echinacea? There are millions of people popping the herbal pills like Pez, on the advice of the cold-fighting "tips" they�re so used to reading, yet new studies and several recent analyses by researchers suggest that the remedy may be greatly overhyped.
Enough of the fluff. If we�re going to put up a good fight against cold viruses, we�re going to need mightier artillery than bed rest and warm soup.
Cold viruses are particularly wily enemies. There are about 200 different kinds of these viruses; the most frequent of which is the rhinovirus�"rhino" from the Greek for nose, where the cold virus commonly enters the body. Other popular points of entry are through tear ducts. People put their hands to their eyes and noses nearly 50 times a day--so if you touch a contaminated surface, it�s easy to inoculate yourself by touching your nose or eyes.
Once these viruses gain access to your body, mucus and hair-like cilia carry them to your throat, where they invade an innocent cell and force it to start churning out viral copies. A qualified immunologist would need half a day, a clean chalkboard and several pieces of colored chalk to diagram what happens next, as scientists estimate that 24 hours after the virus has invaded nose and throat cells, about one million infected cells have been forced to make 90 million new viruses that are sent out to infect other healthy cells (sounds pretty bad).
From there, your immune system starts fighting back, releasing interferon (a protein that stops viruses from multiplying) and hormone-like compounds that help flood the area with disease-fighting antibodies. The flooding, unfortunately, produces the all-too-familiar side effects: congestion, runny nose, aches, and pains.
So what�s a person to do for protection against these pests? Walk around in an anti-contamination suit as if some cast member straight out of the movie Outbreak? Jack Gwaltney, M.D., chief of epidemiology and virology at the University of Virginia School of Medicine, says the key to warding off potential infection is understanding how these viruses are spread�and thwarting the conditions. Dr. Gwaltney stresses four things:
First, avoid absently touching your nose or eyes. As mentioned, viruses usually invade through nasal mucous membranes and can easily travel down through tear ducts.
Second, wash your hands often. After you shake hands with someone, rub your hands under warm water, ideally with soap. But be wary of bar soap, however, as viruses can live on it.
Third, avoid standing in a sneezer�s or cougher�s direct line of fire. When someone with a cold sneezes, he or she sends thousands of virus-filled droplets into the air. If you breathe those droplets, you might catch a cold.
And fourth, use disposable tissues, not handkerchiefs, which are fertile grounds for all sorts of nasty critters.
Unfortunately, no matter how careful you are (eccentric billionaire Howard Hughes used to open doors with tissues, wear gloves indoors and disinfect everything in sight), it�s nearly impossible to avoid at sometime or another coming into contact with a virus. Therefore, a second line of defense is in order.
Bolstering the Body�s Defense
A weakened immune system is often to blame for a person�s susceptibility to colds. "When your immunity system is low, you are more prone to catch a cold," says Dr. Sri Mishra, of the University of California Center for Complementary and Alternative Medicine. "Not sleeping well, not relaxing well, being stressed out, those factors can weaken your immune system and therefore may account for you catching a cold."
Indeed, adults who face interpersonal or work-related stress, several studies suggest, are far more likely than the "less stressed" to catch a cold after exposure to viruses. In a landmark study published in the New England Journal of Medicine, psychologist Sheldon Cohen, of Carnegie Mellon University, gave 394 people a questionnaire designed to quantify the amount of stress they were under.4 He then exposed them to nose drops containing cold viruses. About 90 percent of the stressed subjects (vs. 74 percent of those not under stress) caught a cold. According to Dr. Cohen, the findings suggest that stress-triggered changes in the immune system may create greater vulnerability to infection. He advises taking better care of yourself than you would usually when you know you�re under stress. Most people tend to do just the opposite. Meditation, warm baths and a good eight hours of sleep a night will build the immune system and reduce stress.
Vigorous aerobic exercise may also put you at risk of catching a cold, as studies show there is an increased risk of infections in athletes undertaking prolonged, strenuous exercise regimens.7 And there is also evidence that cells of the immune system are less able to mount a defense against infections after such exercise.2
Numerous studies show exhaustive aerobic exercise may lower the plasma level of the amino acid glutamine, which is an important fuel for some cells of the immune system; this may contribute to the impairment of the immune system at a time when the athlete may be exposed to opportunistic infections.3
A 1996 Oxford University study investigated levels of infection in more than 200 runners and rowers.2 Athletes participating consumed two drinks, containing either glutamine or a placebo immediately after and two hours after exercise. The percentage of athletes reporting no infections was considerably higher in the glutamine group (81%) than in the group receiving placebos (49%).
Now, this isn�t to mean you should stop exercising. Not hardly. In fact, one review of 629 studies dealing specifically with exercise and immunology concluded that immune function is superior in highly conditioned people vs. sedentary individuals.7 The review, published in the International Journal of Sports Medicine, went on to suggest that exercise such as vigorous weight training for less than an hour a day boosts your level of natural killer cells, which help destroy viruses and bacteria.
The key to take from this is don�t overdo the cardio. Exercising above and beyond your level of fitness for prolonged periods of time may breakdown both the functioning and production of immune cells, while short, intense bouts of resistance training seems to bolster them. Further, using two-three grams of a glutamine supplement three times a day (including and especially after working out), may also rev up your immune system and help ward off pesty viruses.
Treating a Cold
Even extreme diligence may not be enough to fend off every virus or bacteria that comes your way. So what can you do if you do catch a cold? Well, first of all, don�t run to the doctor�s at the first sign of a sniffle. "You should be better in a week to ten days," says Gwaltney. "If you�re no better or getting worse, then see your doctor." Other reasons to contact your doctor include a fever that lasts more than three days, unusual aches and colored nasal secretions. When it�s just a cold, antibiotics can�t help as they do not affect viruses but are used only in treatment and prevention of secondary bacterial infection.
In addition, don�t bother stocking up on those multi-symptom cure-alls unless you have all the symptoms. Gwaltney says treating each symptom individually may be more effective, but if you do opt for an all-purpose cold remedy, he says you can pretty much choose any one. "Most all the cold products that you buy in a drug store essentially contain the same ingredients," says Gwaltney. "So a lot of selling cold products right now is similar to selling soap� It's just, how good is your marketing?"
And what about treating each symptom individually? Here�s what the experts recommend:
A stuffy nose can lead to many a sleepless night, but this symptom can be rapidly relieved with nasal sprays containing medications such as oxymetazoline (Afrin or Dristan) or xylometazoline. Nasal congestion is caused by swelling of the large veins in the lining of the nose, as inflammation causes an increased blood flow in the nose. Nasal sprays such as oxymetazoline rapidly diffuse the nasal veins, causing them to contract and therefore open up the nasal airway.
In general, oral decongestants such as pseudoephedrine and phenylpropanolamine are not as effective as nasal spays in treating congestion. However, they are quite effective when combined with pain killers such as ibuprofen and paracetamol for the simultaneous relief of pain-related symptoms and nasal congestion.
Menthol, used for hundreds of years for treating common colds, doesn�t actually open up nasal airways like decongestants, but it may prove beneficial as it causes a pronounced sensation in the nose of nasal clearness and coolness.
Runny Nose and Sneezing
Antihistamines such as chlorpheniramine and doxylamine are widely touted and included in cold medications for their supposed ability to relieve stuffed-up noses. However, when administered alone, antihistamines are of no value in reducing nasal stuffiness. Histamine is responsible for many of the symptoms of hay fever, but there is no evidence that it has a major role in common cold symptoms.
That�s not to say antihistamines aren�t beneficial, though, as their usefulness is not related to their antihistamine effects. Antihistamines are particularly effective in helping to relieve the symptoms of sneezing and runny nose as they help to dry up secretions and also have a sedative action.
A dry, fruitless cough is an irritating symptom many cough medications purportedly relieve through active ingredients such as dextromethorphan and codeine. But there is little evidence to support their effectiveness in treating coughs associated with the common cold. Some relief may be obtained with hot drinks and lozenges containing menthol. Hot fluids have a demulcent and soothing action. Spicy foods and hot soups are also beneficial as they promote airway secretions, which have a calming action on an inflamed throat. Hot drinks in combination with paracetamol provide long-lasting relief from pain-related symptoms and fever.
Headache, Sore Throat and Fever
Pain killers such as aspirin, paracetamol and ibuprofen are particularly effective when taken individually for relieving pain-related symptoms such as headaches, sore throats and muscle aches. They�re also effective for treating fevers.
The paracetamol medications are available as liquid suspensions for infants and children. Ibuprofen is suitable for use in children over the age of 1, whereas aspirin is not recommended for children under 12 except on medical advice.
Choosing between the pain killers is up to you, as each effectively controls the pain-related symptoms of common colds. It�s important to remember, however, aspirin and ibuprofen are more prone to cause gastric disturbance than paracetamol and should not be used by patients with peptic ulcers or those who are sensitive to aspirin or ibuprofen.
Hot on the Trail for a Cure
In the 1960s, when researches discovered that nearly 200 different viruses were to blame for the common cold, any hopes of a "cure" seemed bleak. Rhinovirus, coronavirus, adenovirus, Coxsackie virus� there were just too many to get a handle on. And as funding for common-cold reasearch by the National Institutes of Health dwindled to its current level of $2 million per year, a measly 0.02 percent of its total budget, even cure-craving optimists would need the services of the Hubble telescope to see the light at the end of this tunnel.
But after years of bargain-basement, low-profile research, biologists who remained true to the cause believe they have narrowed in on a strategy to stop cold viruses from replicating�a strategy that ultimately may hold promise for a cure.
Agouron Pharmaceuticals in San Diego is testing a new drug called AG7008, which inhibits 3C protease, an enzyme essential for rhinovirus replication. The enzyme, which is shaped like a doughnut, cuts up long viral proteins into its active parts. Scientists discovered that if you can plug the doughnut hole, you can immobilize the enzyme�effectively ending the infection there. AG7088 is similar to the protease inhibitors that have helped battle the HIV virus that causes AIDS, but it works against cold viruses instead.
Test-tube studies have shown that AG7088 can stop the multiplication of all 46 of the rhinoviruses checked so far�a sign that the drug could be effective against all the approximately 100 rhinoviruses. The company is presently performing human clinical studies of the drug, which is delivered in a nasal spray.
Company officials acknowledge that the drug still requires several years of testing followed by a year or more of government review.
"If it works, it is going to be a blockbuster," predicts Donna Nichols, vice president of Agouron.
ViroPharma, a Pennsylvania-based biotechnology company, is testing a different anti-cold virus drug in humans. ViroPharma�s drug, called pleconaril, was shown to be a potent in inhibitor of rhinoviruses in laboratory studies. It works by filling in a crevice or valley in the virus� protein coat.
"It�s like putting a Popsickle stick in a Rubik�s Cube so that it can�t move," says Mark McKinlay, the company�s vice president for research and development. If the coat is locked in place and can�t be removed, the virus cannot multiply. In tests in patients with severe colds, the pills stopped infections in all the healthy volunteers who were deliberately exposed to the virus, says McKinlay.
The company expects to apply for Food and Drug Administration approval for pleconaril in the year 2000.
Other companies have been trying to develop nasal sprays that keep the cold virus from attaching to nasal cells. Scientists now know that the rhinovirus attacks through the nose, attaching to the ICAM-1 receptor (intercellular adhesion molecule-1, a type of glue molecule which holds cells together) before gaining entry to the nasal cells. The new treatment involves a modified version of ICAM-1 in soluble spray form. When put into the nose, the protein saturates the virus with potential targets so that it latches harmlessly onto the decoy rather than the lining of the nose.
This method of preventing the virus from entering the cell works well in the test tube where the concentration of medication can be maintained but does not work very well in the nose, where the ICAM-1 medication is rapidly cleared. In the future, a sustained-release formulation of the ICAM-1 medication may be effective.
So have we finally corralled the common cold once and for all? Well, not yet; but these latest scientific advancements are nothing to sneeze at. By year�s end, more detailed test results for these, as well as other, new treatments are due out. And if proven especially effective and safe by the U.S. Food and Drug Administration, these cutting-edge medications could hit drugstores within a few years.
Indeed, scientists have learned a lot about how cold viruses run amok. And this new understanding is beginning to pay dividends with strategies that may at last fend off this exceptionally wily enemy.
Prevention is the Best Medicine
Why is it that some of us seem to be breeding grounds for cold viruses while others hardly ever are plagued by these ravenous pests? Traditional Chinese medicine practitioners say people with weak "Wei Qi" (defensive energy) are more are more prone to illness. They believe Wei Qi is parallel to the Western concept of the immune system. When we are undernourished or depleted by overwork, emotional stress, or lack of sleep, they argue, our Wei Qi becomes deficient and cannot protect us against the assaults of the environment; thus, we become vulnerable to illness. So it stands to reason that one would be much better off strengthening the immune system and preventing a cold, rather than fighting it once it arrives. Here are some steps you can take to prevent catching a cold:
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