Help Patients Shorten the Duration of a Cold

The pharmacy community is justifiably skeptical of many products that claim to treat the common cold. A paucity of convincing evidence suggests that any of these options have better success than a placebo or the old standby of plenty of fluids and rest. But we all dread waking up with a scratchy throat and a stubbornly stuffed-up nose. Who knows how long it will last? Not forever, of course, but any length of time with a cold is too long. The mainstay products, such as antihistamines, decongestants, and cough suppressants, have at least some benefit when it comes to reducing pesky cold symptoms, but patients will still experience several days of congested misery. Luckily, relief might come from a few unexpected products.

To this day, the data showing that cough suppressants such as dextromethorphan work better than a placebo are inconsistent at best. However, honey is a common household item that might actually have some effect.¹ This natural product contains many vitamins, including A, B, C, E, and K, as well as amino acids and proteins. As a compound, honey possesses antimicrobial and antioxidant properties, which vary based on geographical location. Added to comforting hot beverages such as tea, honey has the potential to decrease inflammation and inhibit any microbes that might be festering in the throat. Although no high-quality studies have evaluated the effect of honey compared with commonly marketed cough treatments, the CHEST expert panel makes a cautious statement suggesting honey as reasonable option for adults and children with a common cold and cough.² No one can say with evidenced-based certainty that honey is better than other products, but adding honey to a soothing mug of tea could provide a needed boost.

The mineral zinc is another interesting option for treating a cold. Zinc is thought to inhibit rhinovirus replication, which theoretically can not only treat a cold but also minimize symptoms. Enough studies have been done to conduct systematic reviews, yielding mixed results. Zinc lozenges are the dosage form of choice of most investigators. In a large meta-analysis of 13 individual studies comparing zinc lozenges or syrups with a placebo, results showed that zinc significantly reduced the duration of a cold by 1.65 days.³ A day less of being sick is certainly nothing to sneeze at. Although zinc lozenges are an easy and quick solution, no official recommendations support the use of zinc. However, the lozenges are rarely associated with negative events other than tasting terrible, so those who can stomach them may find zinc to be a viable way to shorten a cold’s duration by a day or so.

For those amenable to a nasal spray, cromolyn offers another promising option for faster recovery. In a placebo-controlled, randomized study comparing nasal cromolyn with placebo, participants rated their symptoms for 7 days of treatment.⁴ Reported symptoms declined significantly by day 5. This is a promisingly consistent trend toward improvement, especially with cough and the raspy voice associated with colds. The benefit was maximized if the cold symptoms were particularly nasty. The adverse effects of nasal cromolyn are mild, making this a relatively risk-free option.

Despite sparse evidence to support many OTC cold remedies, we can glean from the available information that at least a few options could shorten the duration of the misery caused by a cold. However, nothing can replace old-fashioned fluids and rest, but remember to tell patients to add a little bit of honey to that soothing mug of tea.

REFERENCES

• Meo SA, Al-Asiri SA, Mahesar AL, Ansari MJ. Role of honey in modern medicine. Saudi J Biol Sci. 2017;24(5):975-978. doi:10.1016/j.sjbs.2016.12.010.
• Malesker M, Callahan-Lyon P, Ireland B, Irwin RS; CHEST Expert Cough Panel. Pharmacologic and nonpharmacologic treatment for acute cough associated with the common cold: CHEST expert panel report. Chest. 2017;152(5):1021-1037. doi: 10.1016/j.chest.2017.08.009.
• Science M, Johnstone J, Roth DE, Guyatt G, Loeb M. Zinc for the treatment of the common cold: a systematic review and meta-analysis of randomized controlled trials. CMAJ. 2012;184(10):E551-E61. doi: 10.1503/cmaj.111990.
• Aberg N, Aberg B, Alestig K. The effect of inhaled and intranasal sodium cromoglycate on symptoms of upper respiratory tract infections. Clin Exp Allergy. 1996;26(9):1045-1050.