UPPER RESPIRATORY DISORDERS
COMMON COLD
Keep the victim warm and dry. For persons ages 6 years and older, treat nasal congestion with an oral decongestant and nasal spray (use the latter for 3 days maximum). Be aware that an oral decongestant can make a child hyperactive. For an infant, use saline nose drops (¼ tsp, or 1.3 mL, of table salt in 1 cup, or 237 mL, of water) in a dose of two to three drops in each nostril a few times a day; the child will sneeze, or the drops can drain via gravity or be sucked out with a “baby bulb” syringe.
Do not attempt to “sweat out” a cold with vigorous exercise. Such harmful behavior causes worsened fever, debilitation, and dehydration. It is a method guaranteed to convert a common cold into pneumonia. A person with a cold should see a doctor if he is ill for more than 3 weeks, his temperature elevation becomes extreme (see page 167), he develops a cough productive of yellow-green or darkened phlegm (see pages 48 and 205), or he develops chest pain associated with breathing, shaking chills, a severe earache, or a headache with a stiff neck (see page 174). Since colds are spread by contact, take particular care to wash your hands after contact with an infected person.
The most common complication of a cold in a child is a middle ear infection. If a child with a runny nose and cough begins to pull at his ear(s) or if a fever returns near the end of the course of a cold, consider treating the child for otitis media (see page 175). Pneumonia can also be a complication (see page 48). It should be suspected in a child who appears short of breath (respiratory rate above 30 per minute in a child, or 40 per minute in an infant).
INFLUENZA
Elderly or infirm individuals are at greatest risk for becoming severely debilitated or developing complications, such as pneumonia. General therapy is the same as that for a cold: rest, adequate nutrition, increased fluid intake, and medicine for fever. Vaccines are prepared each year that are somewhat effective in the prevention of types A and B influenza (see page 456). Oseltamivir phosphate (Tamiflu) is a drug that is used for treatment of influenza types A and B in adults who have been ill for no more than 2 days. It is given in an adult oral dose of 75 mg twice daily for 5 days. The pediatric dose is based on age and weight. For a child age 1 to 12 years: weight less than 15 kg, 30 mg twice daily for 5 days; 15 to 23 kg, 45 mg twice daily for 5 days; 23 to 40 kg, 60 mg twice daily for 5 days; weight greater than 40 kg or age greater than 12 years, 75 mg twice daily for 5 days. An alternative is zanamivir (Relenza) 10 mg inhaled twice a day for 5 days for all ages.
Avian influenza A (H5N1, which exists in at least 8 subgroups, or “clades”) may be resistant to the adamantane drugs (rimantadine and amantadine), so would be treated with zanamivir or oseltamivir, the former in a dose of 75 mg and the latter in a dose of 150 mg by mouth twice a day for 10 days. This form of influenza is carried and spread by birds, notably poultry and perhaps wild birds. It has been found in other species, such as cats, tigers, leopards, pigs, ferrets, rabbits, rats, and emus, from where it might more rapidly mutate to a form more infectious to humans. Avian flu has a very aggressive profile, with a high (up to 60%) overall mortality rate in human victims. Infected humans show “typical” flu symptoms, followed rapidly by respiratory and multiorgan failure. There is little evidence for mild or asymptomatic human infections. With regard to protective masks, an N95 respirator mask is supposed to have at least a 95% filtration capability at filtering a 0.3 micron droplet, which carries the virus, but not the virus particles individually.