By Dr JK Bhutani
Our respiratory system is formed by the airways or air passages and the lungs. The airways play an important role in the conditioning of air to the appropriate healthy temperature in a variety of environments. The airways also humidify, filter and remove various particulate pollutants and pollen present in the air. The lungs work best when the airways are able to provide a clean, conditioned, warm and humid air for them.
COMMON COLD – Every year before the onset of winter, the human body prepares itself for the harsh ‘cold-dry-wintry’ air by shedding the old respiratory airway mucosa and other defense cells and getting a new set. The nature perhaps helps, by sending some common viruses, (Rhino and Adeno Viruses) to hasten this process of changeover. This intervention by the nature sometimes leads to issues like sneezing, running-stuffy nose (rhinorrhoea), sore throat, cough, low-grade fever, headache and body aches. The term ‘common cold’ refers to such mild upper respiratory viral infections which, in a way, are the nature’s way of shedding the old cells and rejuvenating the respiratory airways with the new army of defence cells to last for adverse onslaughts of winter weather. Such ‘non-Influenza’ viral respiratory infections are innocuous and require simple common-sense tips on the part of the patient to manage the same.
1. Symptomatic treatment remains the mainstay of common cold treatment. In the absence of convincing evidence of a secondary bacterial infection, antibiotics are not effective in the treatment of the common cold and should be avoided. Even analgesics (pain-killers) and anti-pyretic (fever medicine) can be avoided and adequate rest, hot-fluids, steam and good
nutrition must be the preferred way to go. Most patients do not require any intervention as the illness is brief (3-5 days) and self-limiting. The role of the medical personnel / help should be of a facilitator of the natural healing and s/he must ensure renewal of ability of the human organism in such settings.
2. The common over-the-counter available ‘decongestants-anti-histamine’ combinations (Vikoryl, Recofast, Coldrin etc.) generally hamper the clearance of secretions and nasal debris of cells and should be best avoided. They may block or thicken the secretions, thus predisposing to super-added bacterial infections of throat, sinuses and the ear.
3. PREVENTION of common cold – No vitamin, nutritional supplements, probiotics, Face-masks or herbal product have been shown to impact the incidence or the outcomes of common cold. Additionally, Adenovirus vaccines have not been found effective in protecting against the common cold. Hygienic measures such as hand washing and clean unclogged airways can hasten recovery and prevent the spread of respiratory viruses in closed environs.
Swine-Flu or H1N1 influenza (‘swine influenza’) is another respiratory viral infection which strikes like a ‘common-cold’ infection but is more sinister in symptoms and the outcomes. The influenza virus mutates extremely fast and is highly infectious. The typical symptoms of Swine-flu are cough, sore-throat, fever, headache chills and fatigue. The severe infections, especially in patients who have co-morbid conditions like Diabetes, Heart disease, Asthma/COPD, compromised immune system and old age, may also include blue lips, blood in sputum, difficulty in breathing, pneumonia and respiratory failure.
The spread of Swine-Flu is very rapid and epidemic. The people having flu infection, on move or at home, often cough or sneeze, thus spraying tiny drops of the virus into the air. When a person comes in contact with these drops or touches a surface (such as a wall, door, tap, sink or any articles like phone/keyboard etc) that an infected person has recently touched, the infection spreads.
Despite the name, one cannot catch swine flu from eating bacon, ham, or any other pork product.
The diagnosis of swine flu is often on strong suspicion, after contact with a proved patient and when the severity of cold symptoms is turning worse and ominous. The H1N1 influenza virus detection by polymerase chain reaction (rRT-PCR) or culture is the only proven method used by the government approved labs. Certain rapid influenza antigen tests are also commercially available which can give result in 4hrs.
Treatment – The milder infections in apparently healthy individuals can be managed with bed rest, warm fluids, proper nutrition and symptomatic treatment with analgesics (pain-killers) and anti-pyretic (fever) drugs. The mainstay is to isolate the patient at home for mild cases and in hospital for the serious cases, to halt the spread of disease. Proper hand-nose hygiene and the disposal of wipes containing nasal secretions are equally important. The use of the antiviral drugs like Oseltamivir (Tamiflu) is avoided in milder cases and should be best guided by the medical personnel’s advice. The close contacts of the proved Swine flu cases and the vulnerable exposed people can have prophylactic treatment in up to 48 hrs of exposure, after medical advice. Excessive use of such drugs when not required is already causing drug resistance and should be best avoided. The serious patients having pneumonia or other complications are best managed in hospital setting.
Prevention – The best treatment for Swine-flu is to have the vaccine before the onset of the winter season. The CDC and other national bodies recommend the vaccine for use in ages 6 months to the elderly (65 plus) including pregnant woman. High-risk individuals, their close contacts, and healthcare workers should remain high-priority populations in vaccination campaigns. The vaccine is safe, effective and has minimal side effects at the time of delivery. The vaccine can be administered in the muscle (intra-muscular injection), skin (intra-dermal injection) or the nasal inhalation route. The popular vaccines available in India are Fluair, Nasovac, Fluarix, Influvac and Vaxigrip. The choice of vaccine formulation depends upon several factors, including age, comorbidities, pregnancy and risk of adverse reactions and the options should be discussed with the physician.
H1N1 influenza vaccine is already popular as FLU-SHOT in the west and shall soon have universal acceptance in India too. The governments are trying to bring down the costs (from Rs 600 to 100), to make it affordable for all. The Flu-shot needs to be given annually as the virus of swine-flu is quick to ‘shift and drift’ its structure, necessitating the new vaccine which is made available to the world every year around August-Sept.
Last year’s Swine flu outbreak in India showed inadequate preparedness, poor testing facilities and non-availability of drugs and vaccines. The number of deaths was 2123 out of the total number of 34656 cases reported by the health ministry. This year, the government is geared up and the Delhi government has already provisioned for isolation beds in hospitals (both govt and private), adequate Tamiflu and vaccines stocks and use of media for education/prevention. The government is using media for awareness of hand-hygiene and plans a sanitation awareness drive for a month starting from Oct-15 to Nov-14. The burden of the morbidity and mortality of the Swine flu can be negligible if all the citizens practice good hand-nose hygiene and implement other common sense measures of sanitation. It is not too much to ask for, at least from the Delhi residents who have one of the highest literacy rates in India.
Dr J.K. Bhutani MD is a protagonist of preventive and promotive health care based on austere biology and facilitating self healing powers of human organism.
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