| Diagnosis of Influenza |
A doctor's exam may be needed to tell whether you have developed the flu or a complication of the flu. There are tests that can determine if you have the flu as long you are tested within the first 2 or 3 days of illness.
A rapid flu test can be performed by the physician in the office with a simple and painless nasal swab. The results are available in 30 minutes. Although this test is not 100% accurate, it is frequently utilized in emergency rooms and medical practitioners' offices to decide whether to start an antiviral medication such as Relenza or Tamiflu. If the test turns out to be positive, the physician will usually start an antiviral medication, such as Relenza or Tamiflu, then send the swab to the lab at the Health Department for further testing to determine if Swine flu is present.
The xTAG Respiratory Viral Panel was approved by the FDA in early January 2008. This is the first test for the detection and differentiation of influenza A subtypes H1 and H3. Influenza A is the most severe form of influenza for humans, and has been the cause of major epidemics. The viral genetic material is found in secretions taken from the back of the throat with a cotton swab.
Swine flu is Influenza A. Many physician offices can determine by nasal swab whether or not a person has Influenza A. If the test turns out to be positive for Influenza A, the physician will usually start an antiviral medication, such as Relenza or Tamiflu, then send the swab to the lab at the Health Department for further testing to determine if Swine flu is present.
The xTAG Respiratory Viral Panel is also the first test for:
- human metapneumovirus (hMPV), newly identified in 2001.
- influenza B - one of three types of human influenza, less severe than influenza A
- respiratory syncytial virus subtype A and B – both are leading causes of infant pneumonia and bronchiolitis (an infection of the airways leading to the lungs) and often contribute to the development of long-term pulmonary disease
- parainfluenza 1, 2 and 3 – all are leading factors in the croup and the common cold
- rhinovirus – the most common viral infective agent in humans and a cause of the common cold
- adenovirus – a cause of respiratory tract infections often similar to strep throat or tonsilitis (FDA)
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Treatment of the Flu
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- Do Not Give
Aspirin To a Child or Teenager Who Has the Flu or Flu-like
symptoms without first speaking to your doctor.
- Rest & if possible stay
home from work, school or errands while sick to prevent further
spread of the flu to others.
- Drink plenty of liquids
- Avoid drinking alcohol or smoking
- Over-the-counter medication can help relieve the symptoms
of the flu. See below
- Prescription antiviral medications, such as Tamiflu, can
be used to prevent influenza as well as to treat it if started
with the first 2 days of the illness.
- Influenza is caused by a
virus, so antibiotics, like penicillin, don't work
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| Over-the-Counter Medications for the Symptoms of Colds or the Flu |
For children, always check with your pediatrician before giving your child any cold medicines. Do Not Give
Aspirin To a Child or Teenager Who Has the Flu or Flu-like
symptoms.
Elderly should avoid taking any over-the-counter cold medications due to the increased potential for serious side effects.
Be sure to read the labels before taking so you don’t combine the same active pain relief ingredients. This could result in a toxic dose of that ingredient. Many prescription and OTC combination, multi-symptom cold and flu preparations also include pain relievers as active ingredients. (Tylenol) Acetaminophen is the most widely used pain reliever and fever reducer in the United States, and it's readily available in most parts of the world. Acetaminophen causes more overdoses and overdose deaths than any other drug in the United States. Many cold remedies already contain acetaminophen (Tylenol), thus overdoses can easily occur by taking acetaminophen in addition to these preparations. Toxic levels of acetaminophen can result in severe liver damage or liver failure. Your liver is a vital organ--you can't live without it. People who habitually drink excessive amounts of alcohol have a higher risk of liver damage from acetaminophen. Even as few as three drinks at one time may have toxic effects on the liver when combined with certain over–the–counter medications, such as those containing acetaminophen.
| If You Have This Symptom |
Choose a Medicine With This Type of Ingredient |
| Stuffy nose, runny nose |
Decongestants can relieve nasal stuffiness due to allergies, colds, or the flu. They are available in many OTC products in both oral tablets and nasal sprays. The most common ingredients are:
pseudoephedrine (oral), phenylephrine (nasal, and now in oral form), oxymetazoline (nasal), Caution: These products are not recommended for the elderly or young children.
Note: Pseudoephedrine is now stored behind the counter in the pharmacy and is no longer available on the store shelvesUntil recently, pseudoephedrine has been the more commonly used decongestant and the main active ingredient in many popular nonprescription cold and allergy medications. Unfortunately, pseudoephedrine is also a key ingredient in the production of methamphetamine, a highly addictive illegal stimulant. In an effort to combat methamphetamine production, federal law has recently required that all nonprescription medications containing pseudoephedrine be taken off drugstore shelves and be stored behind the counter in the pharmacy. To purchase these medications, you must go to the pharmacy, show some form of government-issued identification, and sign a logbook.
Some drug companies are concerned that this inconvenience may discourage people from buying cold and allergy medications containing pseudoephedrine. As a result they are quietly reformulating these products — removing the decongestant ingredient or replacing pseudoephedrine with phenylephrine. The label has not changed, and many people naturally assume that the product is unchanged as well.
Caution: Decongestants taken by mouth can have a number of side effects. Taking a decongestant may make you feel anxious, have a racing heart or cause insomnia. These medications should be used very sparingly.
Caution: Elderly are often advised to avoid decongestants and combination cold products altogether due to the potential for serious side effects. Saline nasal spray is recommended as an alternative.
Caution: Chronic medical conditions--Check with your doctor if you have chronic medical conditions such as thyroid disease or high blood pressure before using any medication for a cold.
Caution: Decongestant nasal sprays may work more quickly but have a rebound effect if you use them more than 3-5 days. They are best for short-lived colds and not for persistent allergies.
Caution: Phenylpropanolamine (PPA) is a decongestant that has been associated with hemorrhagic stroke. Most drugs containing this ingredient have been reformulated, but there are still a small number of cold remedies and weight loss drugs sold OTC with this ingredient. If you find this ingredient in your medicine cabinet, throw it out.
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| Runny nose, sneezing |
Antihistamines relieve symptoms related to allergies. With the exception of loratadine, the antihistamines usually cause severe drowsiness which can be a helpful side effect if sleep is needed. This side effect does wear off fairly quickly, however, with continuous use. The individual response of each of these medicines varies from person to person. Common antihistamines include: brompheniramine maleate (Dimetapp), loratadine (Allavert, Claritin), diphenhydramine HCl (Benadryl Allergy, Tylenol PM), chlorpheniramine maleate (Chlor-trimeton), clemastine (Tavist Allergy). Note: loratadine is non-drowsy in most people. It's very important to read the label before using these products. Elderly should be particularly cautious in using antihistamines, especially on a regular basis. The following precautions usually apply to this category of medication: Asthma and lower respiratory disorders, glaucoma, hyperthyroidism, hypertension, cardiovascular disease, GI obstruction, urinary obstruction, children, pregnancy. Diphenhydramine interacts with: alcohol and other CNS depressants as well as MAOIs. |
| Dry Cough that is not productive of sputum and is keeping you awake at night |
Cough suppressant-- Coughing is necessary to clear the lungs. Cough suppressants should be used sparingly, mostly to allow sleep. If the cough is due to asthma symptoms, cough suppressants may not relieve the cough.
For children: always check with your pediatrician before giving your child any over-the-counter medication. The most effective cough remedies are available only by prescription. The following over-the-counter remedies are mildly effective:
-1/2 to 2 tsp of buckwheat honey before bedtime has been found to be helpful in suppressing a dry cough during sleep. A recent study compared the effectiveness of dextromethoraphan (the active ingredient in OTC cough suppessants) to 1/2 to 2 tsp of buckwheat honey, and the honey was found to be more effective. (Honey should never be given to children less than 1 year old.)
-Diphenhydramine (Benadryl) and/or the decongestant pseudoephedrine (Sudafed) is recommended by the American College of Chest Physicians, for the relief of a mild cough related to a cold. There are important contraindications for all of these medications, particularly pseudoephedrine in the elderly. Always read the label and know what you're taking.
(Dextromethoraphan is commonly the active ingredient in over-the counter cough suppressants and is no longer recommended for the the symptomatic relief of a cough associated with the common cold. It has been shown to be effective in relieving a mild cough, and when taken in large amounts, dextromethorphan can produce hallucinations or "out-of-body" experiences similar to those caused by the hallucinogens phencyclidine and ketamine. Because of it's availability in the medicine cabinet, an alarming number of teens are abusing this medicine and causing serious, irreversible damage to their bodies.) |
| Dry Cough |
Expectorant to help bring up the sputum (guaifenesin) This is a very useful medication used by physicians to help manage respiratory infections. Mucinex is a brand often recommended by physicians and is frequently used in the elderly. Not recommended for children < 6 years. For children: check with your pediatrician before giving your child cough medicines or expectorants. |
| Fever, headaches, body aches and joint pains |
Pain Reliever--Children and teen-agers suffering from flu-like symptoms, chickenpox and other viral illnesses shouldn't take aspirin because of the possibility of Reye syndrome. Be sure to educate teen-agers, who may take OTC medicines without their parents' knowledge.(10)
The most common ingredients for pain relief are acetaminophen (Tylenol), ibuprofen, naproxen sodium or aspirin. Many prescription and OTC combination, multi-symptom cold and flu preparations also include one of these pain relievers as active ingredients. Be sure to read the labels before taking so you don’t combine the same active pain relief ingredients. This could result in a toxic dose of that ingredient.
Acetaminophen (Tylenol) Many cold remedies contain acetaminophen (Tylenol), thus overdoses can easily occur by taking acetaminophen (Tylenol) in addition to these preparations. Toxic levels of acetaminophen can result in severe liver damage or liver failure. People who habitually drink excessive amounts of alcohol have a higher risk of liver damage from acetaminophen. Even as few as three drinks at one time may have toxic effects on the liver when combined with certain over–the–counter medications, such as those containing acetaminophen.
Ibuprofen (Advil) Useful for minor arthritic pain, fever, headaches, minor aches and pain. Always take with food and fluids as it can cause stomach irritation, ulceration or even GI bleeding. Contraindicated in people with aspirin allergy, 3rd trimester pregnancy. Precautions dehydration, pregnancy, nursing mothers. Increased risk of GI bleeding wtih alcohol. Do not take aspirin or other pain relievers with ibuprofen. For children: Ask your pediatrician if it is safe for your child to take ibuprofen. (11,12)
Naproxen Sodium (Aleve) for minor arthritic pain, headaches, minor aches and pain. Should be taken with food and fluids as it can cause stomach irritation, ulceration or even GI bleeding. Increased risk of GI bleeding wtih alcohol. Do not take aspirin or other pain relievers with naproxen. Not recommended for children. Contraindicated in people with aspirin allergy, 3rd trimester pregnancy. Precautions gastrointestinal disease, liver or kidney disease, dehydration, pregnancy, nursing mothers.(11)
Aspirin (salicylate or salicylic acid) is used to relieve pain, fever, and the inflammation associated with arthritis. Aspirin may also be used to lessen the chance of heart attack, stroke, or other problems that may occur when a blood vessel is blocked by blood clots. Aspirin helps prevent dangerous blood clots from forming, but only should be taken under the supervision of a physician.
Warnings:
1) Can irritate the stomach or cause GI bleeding. Aspirin should always be taken with food, preferably after a meal due to its potential for stomach irritation and GI bleeding.
2) Children and teen-agers suffering from flu-like symptoms, chickenpox and other viral illnesses shouldn't take aspirin because of the possibility of Reye syndrome. Be sure to educate teen-agers, who may take OTC medicines without their parents' knowledge.(7)
3) The anticoagulant effect of aspirin may increase the chance of serious bleeding in some people. Therefore, aspirin should be used for its preventive anticoagulant effects only when your doctor decides, after studying your medical condition and history, that the danger of blood clots is greater than the risk of bleeding. (8)
4) Aspirin is also contraindicated in: people with allergy to aspirin or NSAIDs (Advil, Motrin, Alleve, etc), 3rd trimester pregnancy. Precautions: History of asthma or peptic ulcer, severe hepatic (liver) or renal (kidney) dysfunction, bleeding disorders, diabetes, gout, pregnancy or nursing mothers. Aspirin interacts with many medicines. (9) For more contraindications and a list of drugs that interact with aspirin, click here |
| Daytime relief |
Read the label--choose one that doesn't cause drowsiness |
| Nightime relief |
Read the label--choose one that causes drowsiness |
| Read more: |
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--Written by N Thompson, ARNP and reviewed by M Thompson MD, Internal Medicine, Last updated January 2009 |
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Bay Area Medical Information (BAMI.us)