- The Washington Times - Sunday, December 3, 2000

Sometimes it hits by surprise. Other times, it creeps up slowly. Either way, it makes you miserable once, twice, even a half-dozen times a year.

It is the common cold, and chances are, one is headed your way.

In the course of a year, Americans suffer a billion colds, say researchers at the National Center for Health Statistics. That means 24 million days of restricted activity; 20 million missed school days; and countless throat lozenges, boxes of tissues and cups of tea.

Why must people suffer from something that seems so basic?

For starters, colds are more complicated than people think. What seems like one illness actually is many different ones.

"The most common type of cold virus is the rhinovirus, and there are more than 100 different types of those," says Dr. Owen Hendley, a professor of pediatrics at the University of Virginia and a cold researcher for more than 30 years. "Even if you become immune to one type, there are still 99 others."

Still, researchers are working on finding the common denominator for all the viruses. National Institutes of Health scientists are looking at how a virus gets into cells and how best to block the virus from entering the cells as key to stopping the illness, says Linda Lambert, cold and flu program officer for NIH's National Institute of Allergy and Infectious Disease.

From the time a cold virus enters the nasal cells, it takes eight to 12 hours for the virus to reproduce and for a new virus to be released in nasal secretions, Dr. Hendley says. Cold symptoms begin about 10 to 12 hours after the virus is produced in the nose, and symptoms peak about 36 to 72 hours later.

Those symptoms the runny nose or stuffy nose, sore throat, sneezing, cough and headache are the result of the body's immune response to the viral invasion, Ms. Lambert says.

"All viruses have to get into cells and get out," she says. "We have several investigators looking at the way viruses interact or are attached to the host cells of the respiratory tract. We have several investigators trying to block that interaction."

Another approach researchers are taking is to look at how the virus gets into cells, replicates, then releases a progeny virus, Ms. Lambert says. Those experiments are still in the early phases, she adds.

"In the near future, I don't see a common cold vaccine," she says.

Researchers in the past looked at using interferon (a substance produced in the body that can enhance immunity) and steroids to limit a cold virus's impact, Dr. Hendley says.

"We thought we could reduce a cold with interferon," he says, "but we found we couldn't alter the symptoms. Our guess was the symptoms were an inflammatory response to the viral infection. So we tried to treat the inflammatory response with steroids. We gave steroids to patients before and during a cold. We found a dampening of the symptoms, but then they got worse. The symptoms were just as bad as if [the patients] had not gotten steroids."

Dr. Hendley is testing an approach of giving anti-viral drugs and anti-inflammatories together to prevent a cold or lessen its symptoms. He is cautiously encouraged by what he has seen so far.

"That work is still in progress, but it is promising," he says. "We're discovering that just [attacking] part of the cold virus doesn't settle it. It used to be that anti-virals were not effective without causing other damage to people, but there are some new anti-virals that have virtually no toxicity. So I am impressed we are finally getting Somewhere."

Until a vaccine or cure for the common cold is found, it is important to understand how best to avoid catching a cold, Ms. Lambert says. Because catching one is unavoidable sometimes, it also is helpful to know how to manage symptoms.

Colds are spread mainly through contact with an infected person's nasal secretions. That means if he sneezes into the air or touches his nose and then another surface, such as a toy or doorknob, others around are vulnerable.

Frequent hand washing is the best way to kill cold germs, Ms. Lambert says. Persons with a cold should try to sneeze or cough into a tissue to keep virus particles contained. If someone in the home has a cold, surfaces can be decontaminated with disinfectant.

Even with the best cleaning efforts, however, the rest of the household might pick up the germs.

"Washing hands is the best way to prevent germs from spreading," says Dr. Larry Cohen, chief of pediatrics at Holy Cross Hospital in Kensington. "The other way is to hibernate, but most people can't do that, so they get sick and develop immunity to that particular virus."

Most cold sufferers arm them-selves with a variety of over-the-counter medications to relieve their symptoms. A wall of options usually is available at the corner drugstore, but none works better than others because cold relief is quite subjective, Dr. Hendley says.

"There is also a modest placebo effect with medications. About 40 percent of cold sufferers will feel 40 percent better, even with sugar water," he says.

Dr. Cohen agrees that relief is in the opinion of the sufferer.

"Various people have philosophized about what works better, antihistamines or decongestants," Dr. Cohen says. "There is almost a psychological benefit rather than a physiological benefit. There is certainly not a reliable cause-and-effect way of looking at cold relief other than if it makes you feel better, take it."

The U.S. Food and Drug Administration recently requested that all drug companies discontinue marketing products containing phenylpropanolamine (PPA), a substance found in some over-the-counter and prescription decongestants and cough medicines.

The FDA issued its warning after scientists at Yale University found an increased risk of hemorrhagic stroke in women who took the drug for as little as three days.

There are many medications that do not contain PPA, Dr. Hendley says. Antihistamines may have a modest effect of reducing mucus production, he says. Analgesics such as Tylenol can alleviate achiness, headache and what he calls the "feel bads," but will have little effect on cold symptoms.

"So why do people take all these drugs?" Dr. Hendley asks. "They feel they have to do something."

After more than three decades of searching for cold prevention and relief, Dr. Hendley is not immune to catching a virus. When he gets sick, he takes aspirin and nothing else, he says.

"If I do that, I can go about my business," he says.

He gave his own children an antihistamine such as Benadryl about 30 minutes before bedtime.

"In my heart, I knew it helped them sleep better," he says.

Overall, the best remedies are time, rest and fluids, Ms. Lambert says.

"Medication won't shorten the duration," she says.

Dr. Hendley's latest advice to cold sufferers? Avoid blowing your nose.

After testing more than 100 University of Virginia students, Dr. Hendley and his colleagues found that blowing out may increase the possibility of a cold's turning into a sinus infection. He found that in four out of five subjects, the increased pressure in the nose helped propel germs into the sinuses, setting them up for infection.

So what is a stuffy nose sufferer to do?

"The main thing is to be a little cautious when blowing your nose," Dr. Hendley says. "I am saying now it is OK to sniff back, which is exactly what our mothers told us not to do. It is actually the appropriate direction of flow."

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