Ask A PH Specialist

Question: What are the special considerations I should be aware of as a PH patient when I get a cold?

Answer:

This is a good and important question. As much as we all hope to avoid colds, this is simply not always possible and adults in the United States can expect to have two to three colds per year. Therefore, having a plan in place for what you will do when the sniffles inevitably set in will help you to be prepared. When we talk about colds, we are generally referring to an "upper respiratory illness" that may include sneezing, sore throat, cough, runny nose, headache, low-grade fevers and generally feeling poorly, so called "malaise." Colds are almost always caused by a virus. I'm happy to provide questions I get asked most frequently about colds in my clinic and provide my answers below.

When should I call the doctor if I think I have a cold?

Most colds cause symptoms in the nose, mouth and chest and most have passed by 7-10 days. So if the symptoms are outside of those locations or time frame, it would be unusual. Some illnesses seem like colds but might be other, more serious conditions, such as influenza. If you have high fevers (>102°F), aching muscles and it is the winter or early spring, it would be useful to call your doctor's office to determine if influenza might be the culprit and require treatment. If vomiting or diarrhea accompany your nasal symptoms and persist for more than a day or you are getting dizzy, you should contact your doctor's office. If your symptoms last for more than a week, you should contact the doctor's office and decide if a course of antibiotics might be useful in case bronchitis or sinusitis may have developed.

Because PH patients have special considerations, if you can't take your PH medications because of a cough or weakness, you should contact your doctor. Or if you have a worsening of your PH symptoms aside from mild increase in shortness of breath from your cough, e.g. if you have more leg swelling or begin passing out, you should call your doctor.

What can I do or take to feel better when I have a cold?

Colds are usually caused by viruses and, unfortunately, there isn't any medication that will kill the virus. So our treatments are aimed at making people feel better while we are waiting for the virus to pass. Old-fashioned home remedies are still useful, and we recommend rest, adequate hydration and continued use of your PH and other medications, unless directed otherwise. Sometimes patients believe that drinking more liquids such as hot tea or water will help the virus to pass, but this is not true and may lead to too much fluid in the body of PH patients. So, try to drink when you are thirsty and stick to your physician's recommendations of how much fluid to drink in a day. Along these lines, continue to avoid salty foods, especially canned soup that can be a land mine of salt and worsen breathing and swelling.

Sometimes symptoms are uncomfortable enough that patients would like to try over-the-counter medications. For fever, body aches and sore throat, acetaminophen or TylenolTM at the recommended doses are fine. Patients taking blood thinners such as warfarin should be careful with other nonsteroidal anti-inflammatories such as ibuprofen and consult with their doctors before taking them.

For management of coughing and nasal congestion, we have generally recommended that patients avoid decongestants containing pseudoephedrine and phenylephrine as these medications have the potential to interact with PH medications and even increase pressure in the lungs. These medications frequently are marketed with the suffix "-D". Good alternatives include diphenhydramine (BenadrylTM) or guaifenisin (RobitussinTM or MucinexTM) without any pseudoephedrine or phenylephrine added into the preparation. Generic drugs are often more affordable for patients and just as effective, so I recommend their use. Just check the ingredient list closely to avoid the two drugs above. There is some data that zinc lozenges may shorten duration of symptoms, and these are safe for PH patients to take, though the nasal spray preparations should be avoided.

There are no data that vitamin C or other vitamins will prevent colds or make them pass faster and we generally don't recommend these. Physicians may be able to recommend other prescription medications if symptoms are particularly severe or prolonged. Finally, cigarette smokers who quit will decrease the duration of their future colds.

What can I do to avoid getting a cold?

Colds happen to everyone at some point, so they can't be completely avoided. However, good hand hygiene and avoiding close contact with friends and family who have fevers, runny nose or other cold symptoms is reasonable as colds are usually passed from hand-to-hand or hand-to-face contact. Alcoholbased hand gels or washes may be useful for use in public places before eating when hand washing is not feasible. Although it won't prevent colds, annual influenza vaccination is critical for PH patients and worth mentioning.

Just remember, the cold will pass eventually. Patience and taking care of yourself will make it as tolerable as possible.

Answer provided by Anna R. Hemnes, MD, Vanderbilt University Medical Center, Nashville, Tenn.

This article orginally appeared in the Winter 2012 issue of Pathlight.

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