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Treating “Colds” with the ABCDE Program
What causes "colds"?
Colds, called Upper Respiratory Infections or URIs by most doctors, are caused by viruses which attach themselves to the linings of the nose and throat, enter the body, circulate, and most often return to their entry sites to multiply. When they do, they destroy normal lining cells in the nose and throat, create irritation, and trigger the your child's immune system to resist their continuing invasion. The blood vessels dilate and the linings swell making breathing difficult. Glands in the nose and throat produce mucus to help "flush" out the virus-laden dead nasal lining cells and debris as well as the fallen warriors of the body's own immune system, the white cells. This mucus itself, particularly when dry and thickened, may become a breeding ground for a secondary bacterial infection.
During sleep, when the body's natural decongestant adrenalin is produced in lower quantities, the nasal linings tend to produce a nighttime "river" of secretions which runs down the back on the throat and sneaks into the voicebox and the windpipes. Breathing is also more difficult since the nasal linings are also more swollen.
What is the normal cycle of "colds"?
Upper Respiratory Infections have normal cycles which may be lengthened by secondary bacterial infections or shortened by good local care to the nose and throat. A normal cold will peak with maximal symptoms 3-5 days after onset and will be gone by 5 to 7 days. There are four normal phases which I have named as follows: Twitchy nose (days 1-2), Stuffy-Runny nose (days 3-4), Recovering nose (days 5-7). During the Twitchy phase, the virus attacks the nasal linings during its entry and after its distribution causing sneezing and the beginnings of congestion and drainage. During the Stuffy-Runny phase, the nasal linings swell and block the free passage of air through the nose and into the sinuses and through the eustachian tubes into the middle ears. Finally, during the Recovering phase, the linings return to normal. If a bacterial infection occurs during the early phases of the URI, it will prolong the symptomatic phases and slow the recovery.
What is the ABCDE Program for "cold" treatment?
The ABCD name stands for:
Bacterial killer, topical
Decongestants. systemic and topical
Other important components of the program include humidification, and, for selected patients, prophylactic oral antibiotics.
Start the program at the FIRST sign of a cold, use the agents aggressively to keep the nose clean,decongested, and free of excessive secretions. Above all, DO NOT BLOW THE NOSE. Nose blowing irritates the nasal linings and forces infected material up into the sinuses and up into the ears via the eustachian tubes leading to sinus and ear infections.
If your child begins to sniffle, sneeze, get some nasal dripping, run a slight fever, and complain of throat pain, a cold is on its way. Immediately begin begin to use the 4 components of the ABCDE Program THREE times a day or every 4-5 hours during a childs or adolescents waking hours.
If the “cold” is starting during the colder weather while the heat is on, you should already be using a warm mist or clean-clear mist humidifier to create a 40 to 50% relative humidity level. These appliances should be used in the child's bedroom and playroom.
If so directed by me, begin the use of the prescribed prophylactic antibiotic. The antibiotic need only be used during the symptomatic phases, which would be limited to a one week period.. It may be stopped before completing a full 10 day course as it is being used to PREVENT an infection and not TREAT an established infection.
The 5 components of the ABCDE program are as follows:
Anti-inflammatory agents such as the ibuprofen-containing products Advil or Motrin neutralize many of the tissue changes driven by the virus including lining swelling, lining weeping, and blockage of the passages through the nose and into the sinuses. Ibuprofen also desensitizes the nasal and airway linings leading to control of sneezing and coughing. This type of medication mimics many of the advantagous properties of aspirin but lacks the risk of inducing the dreaded liver inflammation Reye's Syndrome.
As the body's immune system is fighting off the cold viruses, bacteria which populate the nose and throat are often able to increase in numbers. To prevent this, I recommend the introduction of an anti-bacterial ointment into the front portion of the nasal cavity three times daily. I prefer the use of a compound agent such as Neosporin™ or the generic triple antibiotic ointment, which contains three antibiotic agent polymyxin, bacitracin, and neomycin. This should be introduced into the front portion of an infant's or young child's nose using a cotton applicator (Q-tip) or into the nose of an older child, adolescent, or adult using their fingertip.
Since excessive mucus and other debris accumulates in the nasal cavities during colds, cleansing is needed. Since the nasal cavities are designed for all flow to move backward, the best liquid "whisk broom" is a saline spray for nasal irrigation. I recommend normal saline in an aerosol bottle, and the most available brand is Simply Saline™. The term normal indicates a concentration of saline identical to that in the body. The aerosol delivery system avoids back flow of contaminated mucus into the bottle. The saline mist irrigation clears the nasal linings and the nasal cavities of excess debris and mucus. At the risk of being repetitious, do not encourage your child to blow the nose. This action irritates the linings and forces infected material up into the middle ears and sinuses.
In addition to Simply Saline, suitable aerosol saline is available from Ocean and as a store brand from chain pharmacies such as CVS. One or two sprays should be instilled into each nasal cavity three times a day for the first week of a cold. When instilling the spray, introduce the nozzle into the nostril and aim it upward and outward toward the eye. This will bathe the side wall of each nasal cavity.
Even at the onset of cold symptoms, it is not too soon to begin maximal nasal decongestion using a topical decongestant three times a day for the week of the cold. These topical decongestants effectively shrink nasal linings and by so doing help to prevent the development of bacterial infections within the nose or sinuses. The sprays also diminish post-nasal drainage and the cough which often accompanies it.
Different nasal decongestant sprays are used for children of different ages: for infants birth to 24 months Little Remedies for Noses™ Decongestant Nose Drops instilled as a spray; for children two to six years of age mild Neosynephrine™, and for children six years or older, Afrin. These decongestant medications have been restudied, and the current literature suggests that they may be safely used for more than the recommended seven days in a row. In fact that may be used for two to three times that duration. Rebound effects or dependence on these sprays will not occur if these medications are used in this way.
Little Remedies for Noses Decongestant Nose Drops are not available as a spray. For this reason, I recommend that parents purchase pump spray bottles. They may be obtained at the following site:
Fill the spray bottle with the agent and label the bottle. When empty, wash the bottle with soap and water, rinse, and then rinse again with rubbing alcohol. Allow to dry before filling.
If the use of the topical decongestant three times a day for one week fails to maintain an open and dry nasal airway, it is time to add an oral decongestant. In this category, I recommend that Children's Sudafed Nasal Decongestant be administered up to three times a day along with the topical decongestants. This drug, pseudoephedrine, is safe and effective when administered by weight. As it is a semi-controlled substance, It must be purchased from the pharmacy area by showing identification such as a driver's license. I or your child's pediatrician will provide the proper dosage. Sudafed PE, available over the counter, is not effective, and should not be used. Be sure to use either a topical decongestant or the Sudafed before bedtime, as the decongestion they provide mimics the adrenaline effect, the body's natural decongestant, which is present during the day but missing at night.
Coughing is a sign that you may not have your child well enough decongested as the post-nasal drainage during the day and night may continue to trigger it. You do not wish to merely suppress the cough but to rather suppress what is triggering it. Once the child's nose is dry and decongested, additional coughing may be due to airway irritation from the previous coughing. This may be effectively suppressed by the use of Delsym. used up to twice a day.
As a cold wears on through the week, sometimes it is necessary to add extra medications for management. These include a a TOPICAL NASAL STEROID and an EXPECTORANT-COUGH SUPPRESSANT. They are particularly helpful for managing “cold” symptoms that last for more than a week.
If a child's “cold” symptoms persist beyond a week and discolored secretions are present, a bacterial superinfection is likely following the viral rhinitis. At that point, I ask my patients' parents to call me to discuss the need for either antibiotic “rescue” or treatment with topical anti-inflammatory medications such as topical nasal steroids. Usually this situation involves an early sinus infection. Then, in addition to beginning an oral antibiotic, I suggest that the patient use the topical nasal steroid Flonase along with saline mist nasal irrigation.
If symptoms are persisting a week but the secretions are clear, the nasal linings are merely irritated and require more anti-inflammatory medication. That need can be answered with a course of the topical nasal steroid Flonase. This may be administered once or twice a day.
Often, at the end of a “cold,” the nasal, throat, and airway secretions are thickened from the drying effects of the decongestants. The thickened secretions tend to trigger coughing. The best remedies for these problems are the expectorant-antitussive agents. These include liquid Delsym and Mucinex DM tablets. They may be administered once or twice a day.
IN SUMMARY, the ABCDE program for “colds” is the administration of FOUR things, THREE times a day for ONE WEEK during the cold and the possible use of EXIT MEDICATIONS if the “cold” lingers:
ANTI-INFLAMMATORY: ibuprofen as Advil, Motrin, or the generic equivalent.
BACTERIA KILLER: topical antibiotic ointment as Neosporin or generic triple antibiotic ointment.
CLEANSER: aerosol saline for nasal irrigation as Simply Saline, Ocean, or generic store brands at CVS and other chair stores.
DECONGESTANT: topical Little Remedies for Nose Drops as a spray for infants; Mild Neosynephrine for children 2 to 6 years; Afrin nasal spray for children, adolescents, and adults 6 years or older. If patient has persisting nasal congestion and post-nasal drainage, add oral Sudafed.
EXIT MEDICATIONS: Flonase topical nasal steroid to reverse nasal lining inflammation; liquid Delsym for children, adolescents, and adults; Mucinex DM tablets for adolescents or adults to thin nasal, throat, and airway secretions while suppressing non-functional cough.