A new respect for an old drug
“Take two aspirin and call me in the morning.” This phrase is an old cliché, but aspirin is truly an extraordinary and effective medication. Chemically, aspirin is a salicylate, originally derived from willow bark. The therapeutic value of this natural remedy has been known for centuries by many different cultures. In eighteenth-century England, the Reverend Edmund Stone wrote to the Royal Society that the bark of the willow will cure “agues” or fever. He reasoned that because the willow grew in damp areas, it would probably possess curative therapeutic properties opposite to the dampness.
The active ingredient in aspirin is salasin. It was first isolated in 1829, when its fever-reducing properties were demonstrated.
It was introduced commercially in 1899 by a chemist working for the Bayer pharmaceutical company. The name aspirin was derived from spirea, a plant from which salicylic acid was once prepared.
Aspirin is inexpensive and available everywhere in the world, but it is not without a few drawbacks. As an acid, it can be irritating to the lining of the stomach. This can produce a burning sensation, acidity, and reflux (the regurgitation of stomach acid into the esophagus). If you take large amounts of aspirin over several months, it can cause a peptic ulcer. Aspirin has additional toxicity. If you take more than the daily recommended dosage, you can develop gastrointestinal problems. Aspirin should be avoided by asthmatics because of the frequency of serious allergic reactions it can cause in them. It should not be used in children or young adults during a viral infection, due to increased risk of Reye’s syndrome, a severe neurological syndrome that can follow a viral infection.
Acetaminophen, commonly sold under the trade name Tylenol, was introduced in 1955, originally intended for relief of pain and fever in children. It proved so safe and effective it was soon recommended for adult discomfort as well. It is characterized as a nonnarcotic antipain, antifever medication. Strictly speaking, it is not considered an anti-inflammatory agent, al-though it is believed to inhibit prostaglandins. Tylenol does not cause gastric upset and bleeding problems like aspirin, but can cause liver damage if taken in high doses. Tylenol can safely be taken during pregnancy, by people with aspirin sensitivity and ulcers, as well as by those on medications that thin the blood.
Because of the link to liver damage, Tylenol should be avoided by those with a history of alcohol abuse or hepatitis.
Adults can safely take five hundred to a thousand milligrams of Tylenol up to four times a day. Relief of pain and fever usually lasts for three to four hours. When choosing cold-care products, keep in mind that many combination drugs contain acetaminophen, and if they’re taken together with acetaminophen, it is possible to ingest excessive amounts of this drug. Reading labels will be helpful. But a number of products list acetaminophen in ways that are not easily recognizable. To avoid potential problems, if you take a combination cold product, don’t take additional acetaminophen, or other combination drugs.
Ibuprofen, found in Advil and Motrin, relieves fever, head-ache, and body aches by inhibiting inflammatory prostaglandins. This effective, widely used drug is characterized as a nonsteroidal anti-inflammatory, or NSAID. Ibuprofen was originally introduced as a prescription drug and was later made available over the counter. Considered as effective for pain relief as aspirin and acetaminophen, it causes less bleeding problems than aspirin. Unlike with narcotic pain relievers, happily, you don’t develop a dependency on it. However, peptic ulcers and kidney damage can occur with chronic use. For these reasons, doctors warn that people with peptic ulcers, a history of alcohol abuse, or those over age seventy use acetominophen to avoid complications from ibuprofen.
When colds do strike, you can take four hundred milligrams of ibuprofen up to three times a day. Keep in mind that NSAIDs decrease kidney blood flow, which can lead to fluid retention and hypertension. If you have congestive heart failure or kidney problems, your doctor may suggest avoiding ibuprofen.
As mentioned, cold and flu viruses cause the body to release different cell mediators that produce different types of inflammation. The prostaglandins are felt to be responsible for fever and pain. Fever is a natural defense against disease, but it is a double-edged sword. Fever increases free radicals (harmful chemicals that form as the result of tissue damage and inflammation), raises blood pressure, increases dehydration, and increases headaches and body aches. When a fever exceeds one hundred degrees Fahrenheit, its drawbacks outweigh its defense benefits.
We are better able to fight disease if we don’t also have to deal with inflammation and fever, and it is in our best interest to take acetaminophen, aspirin, or ibuprofen to reduce fever.
Anti-inflammatory agents such aspirin or acetaminophen are the foundation of care for respiratory infections. While they don’t relieve congestion, they target aches, fever, and that general feeling of exhaustion that accompanies respiratory infections. I have found that my patients are reluctant to take them if they don’t have a headache or have little fever. Once they realize that these drugs are not just for headaches, they are better able to care for any type of respiratory infection.
Quelling the Cough
The cough that accompanies most respiratory infection is annoying, exhausting, and even painful. The presence of irritants in the airways, such as mucus or inflammatory agents, triggers the cough reflex. As unwanted as it is, the cough is actually the body’s mechanism to keep the airways clear and open. Rather
than simply suppressing the cough, the key to cough control is to deal with the underlying causes.
When the cough results from excess mucus production (as during a cold), antihistamines and/or decongestants will re-move the underlying cause of the cough. When the cough is part of pneumonia or bronchitis, antibiotics can kill the under-lying bacterial infection, and the cough will end. To relieve dis-comfort as we treat the root of the cough, I may prescribe a cough medicine to help my patients rest.
There are four kinds of cough medicines. Cough suppressants, also known as antitussives, inhibit the activity in the brain that controls the cough reflex. Prescription cough suppressants contain codeine and related medications, while those that are available over the counter are formulated with dextromethorphan.
In some infections, the mucus becomes so hard and dry that it cannot be brought up by coughing. This consolidation of mucus in the chest and airways is an open invitation for bacterial infection to develop. Expectorant cough formulations thin and loosen mucus secretions, allowing them to be brought up by coughing or blowing your nose. Available without prescription, the active ingredient in many expectorants is guaifenesin.
Anesthetic cough sprays and lozenges that contain such ingredients as benzocaine or phenol act by temporarily numbing the irritated nerves in the throat that are triggering the cough reflex. The relief is almost immediate and allows you to get some much needed rest. Even a simple sugar-based cough drop offers a degree of relief. As a group they are called demulcents, and they act by coating the irritated lining of the throat with a gel-like substance. Honey, licorice, glycerin, and even corn syrup are demulcents that can soothe a cough-irritated throat.
You will find that modern cough drops often are a combination of different ingredients. For example, both Listerine cough control and Vicks Formula 44 cough discs contain benzocaine (which dulls the cough nerves in the throat) and dextromethorphan (which quells the cough reflex in the brain). This provides instant as well as long-lasting relief.
Because coughing is actually a healthy reflex, I don’t want you to suppress this symptom without dealing with the under-lying cause. But if you’re treating the cause of the cough, then the right type of cough-care product will help you feel more comfortable. You will be able to get some rest and will recover more rapidly. Cough medicines are often combined with anti-histamines, decongestants, and analgesics, such as aspirin and Tylenol. These products may be less expensive than the same ingredients bought separately, and can be more convenient at work and school. Just don’t mix and match combination prod-ucts or take additional single ingredients, to avoid overdosing from cold-care products.
A cough that lingers for several weeks after a respiratory infection may indicate the development of an asthmalike syndrome. The original infection has sufficiently damaged the air-ways so they are inflamed and irritable. Substances in the environment that once did not cause a problem (such as cigarette smoke, perfume, pets, or even cold air) now trigger contraction of the airways, causing you to cough. The most effective way to manage this cough is to use the same type of bronchodilator that is used successfully for true asthma.
Two types of bronchodilators work well for this type of cough. Each acts on separate factors in the cells that cause air-ways to narrow. Beta agonists such as albuterol (Ventolin HFA) relax muscles in the airways. They work almost immediately and the relief lasts for hours. There are some side effects, including increased heart rate, palpitations, and insomnia. Patients with cardiovascular conditions should ask their physician about any limitation to the use of these agents. For a postcold or postflu cough, the spray may be used up to four times a day for up to six weeks.
The second type of bronchodilators are anticholinergics, which block the action of acetylcholine. This natural body chemical causes smooth muscles to contract. When used as an oral inhaler, anticholinergics (such as Atrovent) prevent irritable airways from narrowing, thus short-circuiting the cough reflex. These medications can cause side effects such as dry mouth.