It starts with a sniffle and can quickly escalate to an exhausting, head-pounding experience coupled with sneezing, congestion, sore throat, and coughing. It’s a cold — scientifically referred to as a rhinovirus, coronavirus, or adenovirus.
All three types are acute viral infections of the upper airway that are transmitted through respiratory droplets and direct, person-to-person contact. It’s also possible to become infected from exposure to a contaminated surface, such as countertops or doorknobs. Common symptoms include nasal congestion, a cough, and a sore throat.
We checked in with Dr. Glenn Vogelsang, a Family Medicine Physician with ThedaCare Physicians-Oshkosh, for answers on cold symptoms and home remedies.
“Most colds are mild and will resolve on their own, but they may cause more problems for certain populations, including people with asthma or COPD,” he says. “They can also become more severe for infants, individuals who are immunocompromised, and the elderly.”
Deciphering the Symptoms
It’s often hard to determine whether your symptoms stem from influenza, COVID-19, or another virus. Here’s what to watch for.
Sore throat
Most sore throats (75-90%) associated with viral illnesses are viral in nature and rarely bacterial. If a sore throat is the only symptom, that would be more likely to be bacterial. In that case, it’s best to come in for a strep test.
Sinus infections
If you’re experiencing the following, you’ll likely want to seek care:
- Pain or swelling in the face
- Fever that lasts longer than three to five days
- Purulent (pus-filled) discharge, congestion, or nasal pressure that lasts longer than 14 days (don’t use decongestants, which could lead to a false prolongation of symptoms, usually without the nasal purulent discharge)
- Symptoms that worsen within 14 days after initial improvement
These could all indicate a bacterial sinus infection, which will require antibiotics.
Influenza
The most common symptoms are severe headache, fever, and cough. You may also have a sore throat and muscle aches.
“People typically experience intense discomfort and exhaustion,” Dr. Vogelsang says.
Most people will recover on their own within three to five days. However, people in the above-mentioned high-risk categories may need to seek care and receive a prescription for an antiviral medication, which can reduce the duration of the illness. It’s best to come in within 48 hours of symptom onset, as antivirals are most effective within that time frame.
It’s important for anyone with influenza to remain home from school, work, and social gatherings, so as not to spread the virus.
COVID-19
COVID-19 symptoms can vary and often include fever, cough, sinus drainage, sore throat, and muscle aches.
“The symptoms seem to be more intense than the usual upper respiratory infection because COVID-19 spreads to all the systems, not just the upper respiratory system,” Dr. Vogelsang says.
If you test positive for COVID-19 and are 50 or older or immunocompromised, you should consider seeking treatment within five days of symptom onset. It’s best to take antivirals such as Paxlovid as soon as possible, but you need to begin them within that five-day window.
For all others, rest and home care are typically all that’s needed, but seek care for symptoms that worsen or that concern you. Follow quarantine and isolation guidelines as well.
“Getting yearly vaccinations is the most important thing you can do as member of the community in attempting to avoid the spread of COVID-19 and influenza,” Dr. Vogelsang says. “The more people who get vaccinated, the fewer people will get hospitalized or die of these illnesses. Remember, this is not only an individual concern, it’s a community health issue.”
Questioning Cold Remedies
Regardless of the virus type, people often reach for over-the-counter (OTC) cold remedies to manage their symptoms. Though widely available, many have been shown to be ineffective.
In fact, the U.S. Food and Drug Administration made headlines in 2023 when it concluded that “scientific data do not support that the recommended dosage of orally administered phenylephrine is effective as a nasal decongestant.” Phenylephrine and pseudoephedrine are active ingredients in many popular OTC cold and cough medications.
Despite its findings, the FDA has not raised concerns about safety issues with the use of oral phenylephrine or pseudoephedrine at the recommended doses. If a certain OTC cold or cough remedy containing phenylephrine or pseudoephedrine has worked for you in the past, you can still choose to take it once or twice, Dr. Vogelsang says.
“However, I do not recommend either oral or nasal decongestants,” he says. “They can cause rebound congestion and swelling of the turbinates — the nasal membrane covered thin, bony plates within the nose, which compartmentalizes the sinuses. They can also lead to a worsening of symptoms, including headaches and stuffiness, as well as cause blood pressure elevations and cardiac arrhythmias.”
OTC Options to Try Instead
It’s always a good idea to talk to your care team about your individual needs, but Dr. Vogelsang offers the following general suggestions.
- Non-steroidal anti-inflammatories. Options such as ibuprofen can help relieve aches and pains and reduce fever. It can also help decrease the swelling and inflammation of the sinuses, upper airways, head, throat, and eustachian tubes in the ears.
- Antihistamines. “Even though some providers do not advocate the use of antihistamines for colds, I have found that chlorpheniramine maleate (such as ChlorTabs or Coricidin) is effective at decreasing sinus drainage and cough,” Dr. Vogelsang says.
- Steroidal nasal spray. Short-term use of steroid nasal spray, such as fluticasone, may help with a sinus-based viral illness. Talk to your doctor about whether longer-term use is right for you.
- Vitamins Research shows that taking large doses of zinc tablets or lozenges can reduce the duration of an upper respiratory illness, Dr. Vogelsang says. Start on the first day of symptoms and continue using for three days. You can also try to boost your immune system through taking large doses of vitamin C or Ester-C for about three days, he says.
Other Care Measures
- Sleep it off. During rest, the body is forced to slow down, which gives it time to repair itself. Processes that take place while you sleep can assist the immune system. This encourages cells to work harder to combat the virus.
- Saline nasal spray delivers a fine mist of normal saline solution into the nostrils to help to reduce congestion. Clearing the nasal passageways can also reduce congestion.
- Cool mist humidifiers and purifiers add and circulate moisture to the air. Just make sure to sanitize your humidifier on a regular basis.
- Honey naturally contains antioxidants and has antibacterial and antimicrobial properties that can treat cold symptoms. Adding it to a cup of warm tea can help quell a cough and soothe a scratchy, sore throat while boosting the immune system.
- Hydration is crucial. Sip on lots of water and choose light meals with a high content of water, such as soup.
- Nutrition is important, especially for those with chronic illnesses. Those with diabetes should adhere to strict diabetic diets in order to decrease the length of time of the illness.
“Enduring a cold is not fun, but with rest and comfort measures, you should feel better soon,” Dr. Vogelsang says. “And when you need care, you have many options available to you.”
