Evo Terra (Host): Welcome to UK HealthCast, a podcast presented by UK Healthcare. I'm Evo Terra. And with me today is Dr. Michael Hall, a family medicine physician. Our topic, over-the-counter-medications during cold and flu season. Thanks for being here, Dr. Hall.

Michael Hall, MD: Thank you for having me.

Host: So it is cold and flu season. I know because so many people I know have both the cold or the flu. Who knows? Now, me personally, I'm all vaxxed up, but what else should we know about protecting ourselves and the ones we love?

Michael Hall, MD: So a big part from a protection standpoint is a lot of times with cold and flu season, we see viruses will start first and then we can see them turn into bacterial infections. And so from a viral standpoint, we do see they tend to be a little bit more contagious. So hand hygiene, making sure cleaning surfaces.

So I have three young girls and so three starting school, this is the season for everyone to get sick. And so we end up seeing a lot of viruses kind of passing around the park related to this. And this is definitely that season.

Host: Yeah, all those things we were supposed to learn from five years ago, still at play today. Wash your hands, people.

Now misinformation spreads really, really fast these days, and we've had misconceptions and myths about the cold and flu. Well, for longer than I've been alive. What should we be looking for? What's making the rounds these days? Or what is the thing that just people keep thinking is right, but you know, it's wrong?

Michael Hall, MD: So one of the parts I usually kind of like talking about is from a over-the-counter aspect what have you tried over-the-counter that's helped. I think some of the myths that end up coming up is related to the cold and flu mass combined over the counter medication portion. Often people don't really know what they're taking. And they'll come in saying they're taking one of the cold and flu versions but they don't realize they're actually taking Sudafed and they're taking a few other things they actually didn't think they were taking.

I also like the conversation of, we do see with cold and flu, we can get sinus or really lung bronchitis symptoms. So the lung bronchitis symptoms actually have a different treatment than the sinus symptoms, and so I've seen some scenarios where people are taking medicines to cover the sinuses, and the one they're using actually makes some of their symptoms worse.

Host: So now the last time I checked, we still do not have a cure for the common cold, but there seems to be a dizzying array of over-the-counter medications that are there for treating colds. My question to you is, which ones work?

Michael Hall, MD: I think a big part comes into the symptoms. So if you're having more sinus symptoms, actually something to dry the sinuses up do help more for the nighttime cough, they do help more along those kind of lines. From a fever aspect, we tend to see ibuprofen or some of the NSAID medicines working a little bit better than kind of like Tylenol or acetaminophen.

But a lot of the cold and flu medications will have those hidden in there. So I think the idea of what's the names of some of the medicines are in the cold and flu treatments and then what they end up doing. And so one of the ones that's called guaifenesin, this actually helps to make things runnier.

So it helps you get out the junk that's in your chest for example, and that can actually build up and turn into a pneumonia. And so some of the other things, like I mentioned with the sinuses. We tend to see things that dry it up, or even some of the nose sprays that can actually help reduce the inflammation process that's happening.

 Those can actually have a good benefit and just, I guess every cold and flu is not always the same, and it does depend on where your symptoms are.

Host: Now I know that when we think about cold and flu medicine, I mean, we got two different things, right? The cold is one virus. The flu is a different virus that keeps mutating all the time, which is why I have to get shots all the time. So are there particular flu medicines over-the-counter that are actively good for people?

Michael Hall, MD: So from a, a flu prescription standpoint or a medicine standpoint to help reduce the I guess, ability to catch it or even to treat it, not necessarily. Those are usually two different medications. One is called Tamiflu. It was actually called XOFLUZA. XOFLUZA started coming out actually a little bit before COVID ended up hitting.

And it's actually a one dose medication that generally within 24 hours people have significant improvements. It tends to be a little bit more expensive, so it just depends if it's covered. Tamiflu is actually a five day course and it actually tends to decrease the symptom by about a day. From the over-the-counter part, we do see, you know, vitamin C, vitamin D, zinc.

There are some minerals and vitamins that we do see help from a standpoint of kind of the immune system portion, a lot of times it comes down to making sure you stay well hydrated, making sure you're getting nutrition in and getting kind of substanence to help your body recover.

Host: So my next question has to do with when. When should we take these over-the-counter medications? If we have a cold or if we have a flu, the first sign of a sniffle, when we can't get out of bed with the aches and pains. What's your recommendation?

Michael Hall, MD: I do think from a flu standpoint, it, part of it comes down to testing. You know, it's hard to know whether you have the flu until we do the tests. From a general standpoint though, chief colds are going through the family, the school systems.

And someone does end up getting sick, it is weekend hard to get in to see the provider the next day. There are medications we can use to kind of help with the symptoms as your body does address the virus. And for the vast majority of these instances, your body will take care of things.

It's just how much are you going to suffer while that process is happening. And then are there things that we might do that actually could make things worse? And so especially making sure you're getting plenty of sleep, make sure you're getting nutrition, make sure you're getting fluids. Those are things that definitely help.

From a standpoint of the mucus that ends up being produced, that can actually get stuck in certain areas and actually cause a lot of symptoms. So we can see significant headaches, significant ear pain, and that can come from junk getting stuck in the sinuses and then also in the eustachian tube, for example, and getting into the ears.

 From a lung standpoint, we do see bronchitis and actually flu and COVID are two viruses that do cause bronchitis, but actually a lot of the common cold viruses can do it as well. And so bronchitis part, you notice it a lot more in your chest. You're coughing trying to get something out. It's just really hard to ultimately get that junk out.

And so that's where there are some treatments over-the-counter, such as like Mucinex to help you really get rid of it. Your body's basically producing these symptoms because it's trying to flush out a part of what's there and really try to get rid of some of the, you know, expelling the virus, trying to help those kind of aspects.

I do think there's also the contagiousness portion. The virus is making you do some of this too, with hopes that you will have that airborne or at least uh, droplet, kind of transmission. And so again, that's where making sure you're washing your hands, if you are sneezing or coughing, kinda make sure you're coughing into your arms and it's not moving outwards because we can see just a potential from a passing standpoint.

The other part from least a medication over-the-counter standpoint is cough is a common side effect. And so cough can come or symptom that can come from sinus drainage. It can also come from within the chest. And so from one of the medications that you actually see tends to be a little bit more effective from a cough standpoint is actually something called Dextromethorphan.

So if you've ever seen something like Mucinex DM, Dextromethorphan is the DM within Mucinex. And then D is another version that's actually a decongestant or Sudafed in many instances. There are other options that are actually antihistamines and those do act to dry up fluid. And those are also different versions of decongestants.

But Coricidin and HBP, which is over-the-counter, is actually an antihistamine decongestant. So those tend to work really well from the sinus standpoint because it does help to dry the sinuses up so you don't drain as much. And then that can help to reduce cough along those lines. One of the interesting things is even like Robitussin versus Mucinex, they're both guaifenesin.

They're just brands. And so a lot of times, or one of the things I'm actually seeing a little bit more recently is brands using their name to kind of repurpose some things. So one of the things that I've noticed was actually a Mucinex nose spray. If you look at the ingredient, it's oxymetazoline, that's the same ingredient for Afrin.

And so many people, when they're using the Mucinex nose spray, they don't realize they're using Afrin. But they know it works really well. And so that's one of the things we can see rebound symptoms. We can see side effects related to that. But especially if you're having something more in the sinuses, something that does help to kind of dry things up so you're not having as much of the drainage, can help reduce cough, it can also help with the symptoms you're having but especially if you're noticing it in the lungs, you do not want to use decongestants, that actually risks increases your risk of pneumonia. Having things like guaifenesin, something that's actually an expectorant help you get this stuff out because that will make you feel better.

Then even things like even baths, steam baths can help really help clear some of the crud that gets stuck in the chest out as well. Personally I, I do like some of the uh, like menthol slash eucalyptus kind of steam, so I think it's a Vicks a vapor, kind of steamer that actually can really help to open up the sinuses and help clear some of the cut out through that portion.

Host: So I'm assuming you don't think people should just go to their doctor at the first sign of a symptom, but at what point or what severity of symptoms level should we consider seeking out our primary care doctor either for ourselves or our children, or even, those that we care for?

Michael Hall, MD: So I think that's a great question. I think part of what I would say is I do think if you are able to get in to see a primary care doctor, I do think those are worthwhile just to get testing from a standpoint of certain things that we can treat. There are some instances where even if we end up diagnosing you with a certain condition, there's not necessarily a difference in treatment in many instances.

I don't think it's a bad idea to go and see a primary care physician if you're able to get in. I'm just noticing lately it's a lot harder to get in. It takes a few days to get in to see the primary care doctor, and in many instances I've had people where they set up appointments, but by the time the appointment happens, they're actually feeling better.

 I think in that interim there are over-the-counter things that can really help. But fevers is going to be a big one, especially if you're having fevers consistently past two days. And you're constantly having to use Tylenol, ibuprofen to keep the fever down. Usually it's about two to three days of fevers in some instances.

And then if you're losing appetite, not getting fluids in, dizziness is actually a big one where we would even have to consider the ER. If you're getting dizzy with standing, feeling faint, that's often of a concern from a low blood pressure standpoint. The other part I'll talk about just because of pneumonia, we often have that data linked with flu just because a lot of viruses can end up turning into pneumonia.

And so flu and COVID are definitely two of them as well. But even the common colds can have that kind of an impact. And so with a bacterial infection, one of the things we often will see is, especially with pneumonia, shortness of breath with activity. We can see people are coughing up more junk, and sometimes it does have a discoloration, but there are viruses that will give you a yellowed cough up or junk that you end up getting out or sputum.

But it's primarily in the morning when it kind of drains and cakes and then it, you get it out and it tends to be clearer, but consistent kind of colored sputum can tie into it. But a lot of times it's kind of the other fever, feeling really run down, shortness of breath with activity, especially if you're having a hard time getting food in and really more the, you're getting dizzy because you really can't keep food down.

Those are areas where I would have a lot more concern and we tend to start worrying or wondering about that transition to a bacterial infection. Speaking a little bit more on the sinus side, so sinus bacterial infections, generally what we see is it always starts out with viral or allergies. After about seven to 10 days, that's really when we start going, yeah, this is probably more bacterial. The viral aspect of it, generally it's about three to five days in many instances, but there are scenarios, especially people who are smoking. We can see symptoms can last for weeks, especially cough, but generally you're feeling better.

You just have these prolonged symptoms afterwards. A lot of times because of fever and your body trying to heat itself up to kill off the viruses; that's really where we see the body aches. You do not feel well. It's hard to get up and do things and really you're just trying to sleep all the time.

 Those are most common symptoms we end up seeing, especially with some of the more significant body reactions to viruses trying to expel it. And that's actually where the ibuprofen, Tylenol does come in to help reduce the fevers. And usually you do feel better at those instances. But I do think from a general standpoint, you know your body, trust yourself, if you don't feel right, I do think getting seen is important. I also recognize it is hard to get in and see someone and in many instances knowing what some of the medicines mean can actually help a little bit more with catering other treatments to your symptoms.

Host: Absolutely. I know I feel much more informed about cold and flus, which should help when that starts hitting my household, which is any day now. But thank you very much for your time today, Dr. Hall.

Michael Hall, MD: Thank you so much. Great to be here.

Host: And thanks to you for listening to UK HealthCast, a podcast from UK Healthcare. For more information, please visit UKhealthcare.uky.edu.