Cough and the common cold

Cold and cough are the two most common issues faced by those treating children. It is more common in preschool children than in older children(1) Morrell DC. Symptom interpretation in general practice. Journal of the Royal College of General Practice 1972; 22(118):297–309. Acute cough is most commonly associated with the common cold. The Association of American Family Physicians recommends that if the cough is due to the common cold, a first-generation antihistamine plus a decongestant should be prescribed. It has been shown that naproxen favorably affects cough. Newer-generation non-sedating antihistamines are not effective for reducing cough(2)Coughlin L: American Family Physician, 2007 Feb 15;75(4):567-575.

Expected Recovery Time

Both doctors and parents tend to underestimate recovery times. Most believe that uncomplicated coughs will resolve in two weeks. Prospective cohort studies have found that only 50% of children with coughs recovered in 10 days, while 10% of children were still coughing at 25 days(3)Hay AD, Wilson A, Fahey T, Peters TJ. The duration of acute cough in pre-school children: a prospective cohort study. Fam Pract. 2003;20(6):696–705. Several studies have also revealed another interesting finding – if the parent expects to receive an antibiotic prescription, or the physician believes that the parent expects one, there is an increased likelihood that such a prescription will be written. On the other hand, if the parent thinks the child has a viral respiratory tract infection, the child is only half as likely to receive antibiotics(4)Vinson DC, Lutz LJ: The effect of parental expectations on treatment of children with cough: a report from ASPN. J Fam Pract. 1993;37(1):23–7.

The Use and Uselessness of Antibiotics

These unrealistic expectations often lead doctors and parents to use antibiotics. Although warranted in some cases, antibiotics are greatly overused. The American Academy of Family Physician (AAFP) cautions that one should remember that common cold is a mild, self-limited upper respiratory tract infection with symptoms of runny nose, sore throat, cough, sneezing, and nasal congestion. It is a heterogeneous group of viral diseases, and therefore does not respond to antibiotics. AAFP does not recommend use of antibiotics for acute bronchitis and tracheitis, acute rhinosinusitis, common cold, laryngitis or influenza(5)Zoorob R et al: American Family Physician, Volume 86, Number 9, November 1, 2012.

Research studies point to the fact that antibiotics have no effect on viral infections; indeed they might cause side effects that are more distressing than the cough. Most parents will not be too concerned about increasing antibiotic resistance; however, most should be told that antibiotics are at least as likely to cause side effects as they are to produce improvement in their children. They should also be told that serious adverse events and accidental poisonings have been recorded in children from exposures to over-the-counter medications(6)Gunn VL, Taha SH, Liebelt EL, Serwint JR: Toxicity of over-the-counter cough and cold medicines.Pediatrics. 2001;108(3):E52 .

It has been found that mostly, acute coughs in children are due to acute viral infections (common colds, acute bronchitis, croup, and influenza). Although children are far less likely to be suffering from the chronic respiratory and cardiac conditions that affect some adults, acute cough can be indicative of conditions that the physician should not miss, such as asthma, bronchiolitis, whooping cough, pneumonia, and foreign body aspiration.

Alarm signs

If the child looks ill (with pneumonia or influenza) or is short of breath with tachypnea (with asthma or foreign body aspiration), or, the child is working hard to breathe (perhaps with chest retractions) – there is cause for alarm. There might be a high fever (with pneumonia, but some children can run sudden high fevers with otherwise innocuous viral infections). Therefore, parents must look out for fast breathing, chest retractions, and wheezing as danger signs. This is so because children with neither fever nor chest signs had a probability of complications of only 6%, for children with chest signs it was 18%, with fever it was 28%, and when both fever and chest signs were present the probability was 40%(7)Hay AD, Fahey T, Peters TJ, Wilson A: Predicting complications from acute cough in pre-school children in primary care: a prospective cohort study. Br J Gen Pract. 2004;54(498):9–14.

A Homeopathic perspective

In addition to understanding the physiological and pathological findings with regards to the cough, a homeopathic approach requires collection of all subjective symptoms – in other words, a narrative of how the complaint is felt and perceived by the sick person. Symptoms are the person’s individual response to the disease. That is why those symptoms which are peculiar or typical to named disease will score lower in the hierarchy of importance in the selection the remedy.

Such details include, for example, what are the sounds – wheezy, hacking, croaking; does the cough come in paroxysms, and if so, how many paroxysms; is it violent, gagging, leads to vomiting, or is it hollow, dry, incessant. The next important point to know is when do we see an aggravation – is it cold breeze, night, day, lying down, sitting, climbing stairs etc. that make the person feel worse. What makes the person feel better – is it warmth, fanning cold air, lying down etc. What are the changes in the demeanor and temperament – is the person averse to noise, company, or desires caressing and clinging? Also, what else is going on with the cough – is there pain in the abdomen, sweat on hands, feet or forehead. Also observations like the person bending over, stamping feet etc. The pace and onset of the disease is also relevant – was the onset slow, over a few days, or was it sudden. Changes in mood and attitude are of great importance too.These facts are important because they help us to complete the portrait of the remedy required.

The next important thing is to have a close follow-up – you must report any changes to the symptom picture as that will help the homeopath to give remedies that follow well or which compliment the first remedy.

Research points to effectiveness of homeopathy in helping treat cold and cough(8)Cucherat M, Haugh MC, Gooch M, Boissel J-P: Evidence of clinical efficacy of homeopathy-European Journal of Clinical Pharmacology, April 2000, Volume 56, Issue 1, pp 27-33.

References   [ + ]

1.  Morrell DC. Symptom interpretation in general practice. Journal of the Royal College of General Practice 1972; 22(118):297–309
2. Coughlin L: American Family Physician, 2007 Feb 15;75(4):567-575
3. Hay AD, Wilson A, Fahey T, Peters TJ. The duration of acute cough in pre-school children: a prospective cohort study. Fam Pract. 2003;20(6):696–705
4. Vinson DC, Lutz LJ: The effect of parental expectations on treatment of children with cough: a report from ASPN. J Fam Pract. 1993;37(1):23–7
5. Zoorob R et al: American Family Physician, Volume 86, Number 9, November 1, 2012
6. Gunn VL, Taha SH, Liebelt EL, Serwint JR: Toxicity of over-the-counter cough and cold medicines.Pediatrics. 2001;108(3):E52 
7. Hay AD, Fahey T, Peters TJ, Wilson A: Predicting complications from acute cough in pre-school children in primary care: a prospective cohort study. Br J Gen Pract. 2004;54(498):9–14
8. Cucherat M, Haugh MC, Gooch M, Boissel J-P: Evidence of clinical efficacy of homeopathy-European Journal of Clinical Pharmacology, April 2000, Volume 56, Issue 1, pp 27-33

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