In search of a sure-fire cold remedy: “There are no antiviral drugs, we only treat the symptoms” | Health and Wellness

An adult gets two to four colds a year; children from six to eight. These mild upper respiratory tract infections (they mainly affect the nose and throat), which manifest as mucus, sneezing and nasal congestion, are common and usually of little danger, but very unpleasant. So much so that at the first symptoms, at home or in the pharmacy, they persistently searched for sure-fire remedies for their treatment. But so far no therapeutic key has been found to neutralize or prevent these colds. At the moment, the only thing that has strong evidence is medications and lifestyle recommendations to manage the symptoms as best as possible. “There are no treatments that destroy the virus. Antibiotics do not work, there are no antiviral drugs. We only treat the symptoms,” summarizes José Maria Molero, coordinator of the working group on infectious diseases of the Spanish Society of Family and Community Medicine.

There may be more than 200 different viral strains behind the runny and stuffy nose symptoms that signal a cold. The usual suspects are microorganisms from the rhinovirus, adenovirus and coronavirus families (except Sars-Cov-2), so antibiotics are not suitable (these drugs are used for bacterial, not viral infections). There are no preventative vaccines either: “They were stopped due to low effectiveness. It is very difficult to make a vaccine for dozens of serotypes,” Molero suggests. Treatment is symptomatic, for both adults and children, insists Carlos Martin de Vicente, pediatric pulmonologist at the Miguel Servet Hospital in Zaragoza and member of the Spanish Society of Pulmonology and Thoracic Surgery: “There are no medications that can shorten the course of the infection, and this is not prevention, with the exception of the measures we had to implement due to Covid (personal distance, hand washing and wearing a mask).” The scientific community, however, is not giving up its efforts and continues to search for therapeutic alternatives to combat the common cold.

A review by Cochrane, an independent network of researchers that analyzes scientific evidence, suggested a few months ago that zinc (in tablets, nasal sprays and syrup) could shorten the length of a cold from seven to five days, although the evidence was very limited. . The theory is that this mineral has the ability to inhibit viral replication upon contact with viral particles in the nose, mouth and throat. However, the authors of the analysis highlighted the limitations of the available data and cautioned that “more and better studies” are needed to be confident about zinc’s potential effect in reducing and preventing colds: Confidence that it can shorten the duration of symptoms is low, and they also did not find There is no convincing evidence that zinc affects the severity of cold symptoms or that it serves as a preventive therapy if administered before a respiratory infection develops.

“Those considering zinc as a treatment for the common cold should be aware of the limited evidence base and possible side effects (intestinal problems, nausea and bad taste),” said Daryl Nolt, a professor of integrative health at the University of Maryland and an author of the study. review. In a comment to the portal Scientific Media CenterHarri Hemila, a researcher at the Department of Public Health at the University of Helsinki (Finland) and an expert on the study of zinc for colds, assured that zinc is effective and criticized that the Cochrane review did not take into account the dose or type of tablets: “The review does not separate tablets (dissolving) in the mouth) from regular tablets, which is an obvious mistake. “Studies with pills have shown benefits, but not with regular pills,” he stressed.

The US National Institutes of Health also notes that results from clinical trials of zinc supplements have been “inconsistent,” but “in general, zinc supplements in tablet or syrup form appear to reduce the duration, but not the severity, of symptoms.” and cold symptoms if taken soon after a person has a cold.”

Garlic and probiotics

This is not the first time the Cochrane network has looked at data on potential cold treatments. Another investigation in 2020 concluded that there was insufficient evidence that garlic, which is credited with antimicrobial and antiviral properties, serves to prevent or treat the common cold. About the effect of herbal preparations EchinaceaAnother 2013 Cochrane analysis also expressed caution about its potential benefits: The authors warned that consumers should be aware that products under this name vary widely and most have not been tested in clinical trials. The study found “hints” of its potential benefit in adults, but evidence of effectiveness was weak: “Our exploratory meta-analyses suggest that at least some echinacea preparations may reduce the relative risk of contracting the common cold by 10–20%.” . %. A 15% risk reduction would mean that if 500 out of every 1,000 people taking the placebo got a cold, that figure would be 425 out of every 1,000 people taking the echinacea product. This is clearly a small effect of unclear clinical significance. Moreover, we cannot say which echinacea products have an effect of this magnitude, a greater or lesser effect,” the authors explained. The American Association of Family Physicians (AAFP), for its part, considers it no more effective than placebo in reducing the duration or severity of symptoms.

There were also researchers from Cochrane who reviewed the level of evidence on the role of probiotics in colds and concluded that “they may be beneficial,” but here again, more in-depth research is needed to clarify the size of their effect: according to the authors, these products , consisting of live microorganisms that help maintain the balance of the gut microbiome, could reduce the number of people diagnosed with three of this type of infection by 41% and would have the potential to shorten the duration of these infections. episodes for a little more than a day. However, the level of certainty of all these findings is limited, they cautioned.

Regarding vitamin C, the Mayo Clinic warns that this supplement does not help prevent colds, but admits that “some studies have shown that taking vitamin C before cold symptoms appear may shorten the duration of symptoms.” The American Association of Family Physicians, however, calls it “no more effective than placebo” in reducing the duration or severity of symptoms in adults (in children there is little effect on clinical symptoms over time).

What helps relieve, rather than reduce, cold symptoms in adults, Molero says, are paracetamol, ibuprofen and combinations of antihistamines and decongestants. And it also helps to stay well hydrated. “These all help reduce symptoms, but do not cure the cold sooner. Vapors, for example, relieve symptoms in the nose and throat, but do not shorten the duration of the cold,” he adds. Honey also helps adults and children over one year of age relieve cough (not recommended for babies under 12 months due to the risk of botulism).

Colds in childhood “heal themselves”

Regarding childhood colds, the AAFP concludes that analgesics are effective symptomatic treatment for the discomfort associated with fever, and mucolytic acetylcysteine ​​may reduce cough in children two years of age and older, but does not recommend any medications in children younger than four years of age. The Spanish Association of Pediatrics also does not recommend giving children cold medicines (only antipyretics if they are very bothered by a fever) and warns that most of these drugs are actually not approved for use in young children. two years of age. “The common cold will heal itself,” insists the scientific community.

Carlos Rodrigo, clinical director of the department of pediatrics at the German Hospital Trias i Pujol in Badalona, ​​assures that there is “nothing to be done” about colds in children. The doctor admits that while sometimes these symptoms “could be the start of something else,” such as the flu, Covid or bronchiolitis caused by respiratory syncytial virus, in most cases the process is trivial and of little concern. “It’s so trivial that a child gets vaccinated. It is not given more importance because it is a benign infection. It’s annoying, but that’s it,” he says.

What experts agree on is that rinsing your nose with saline reduces nasal congestion. “A lot of attention is paid to nasal rinsing. Whey, which is water and salt in very low concentrations, is used to dissolve mucus. It does not serve to treat or prevent infections, but it cleanses and cleanses,” says Rodrigo.

In that sense, last month during the European Respiratory Society Congress, a group of British researchers presented the results of a study in which they suggested that a hypertonic saline solution administered through nasal drops could shorten the duration of colds in children. “We found that children using seawater nasal drops experienced cold symptoms for an average of six days, while children receiving usual care experienced symptoms for eight days. “Children who received salt water nasal drops also required less medication,” Steve Cunningham of the University of Edinburgh explained in a scientific society statement.

“Salt is made up of sodium and chloride. Chloride is used by the cells lining the nose and trachea to produce hypochlorous acid inside the cells, which they use to protect against viral infection. By giving extra chloride to mucosal cells, it helps the cells produce more hypochlorous acid, which helps suppress viral replication, shortening the duration of viral infection and therefore the duration of symptoms,” he justified. However, the study has not yet been published in any scientific journal.

Martin de Vicente agrees, taking all precautions and awaiting detailed examination and confirmation of the data in other studies, that this is a “quite interesting and promising” study: “It is cheap and has a possible preventative benefit because those who used it had lower wheezing frequency. This may be protective against possible complications such as bronchitis,” he assesses. Rodrigo, for his part, believes this is a “solid” research team, but is cautious: “Instead of using saline, they added a higher concentration of salt to help dissolve the mucus. But I am still surprised that it reduces the duration of the cold and its contagiousness. It is known that serum and saline solutions do not have an antiviral effect.”