By David A. Thompson, M.D. 
March 22, 2017

911 warning


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Does this describe your symptoms?


  • Runny or stuffy nose, nasal congestion

  • The nasal discharge may be clear, cloudy, yellow, or green

Other symptoms of a cold include:

  • Sneezing

  • Mild fever and muscle aches, feeling tired and sleepy, headache

  • Scratchy or sore throat

  • Postnasal drip, throat clearing, cough

  • Sometimes there is hoarseness, tearing eyes, and swollen lymph nodes in the neck

General Information

  • Colds are very common. The average adult experiences 3-4 colds each year.

  • Viruses cause colds, and no medicine or "shot" will cure an uncomplicated cold.

  • Colds are usually not serious. Most patients with colds do not need to be seen by a doctor. Rarely colds can lead to more serious illnesses such as: sinusitis, bronchitis, pneumonia, and otitis media. Elderly persons and individuals with a weakened immune system (due to chemotherapy, HIV positive, splenectomy, or the regular use of steroid medications) are at higher risk of developing these infectious complications.

Honey for Cough

  • Recent Research Study: A recent research study compared honey to either dextromethorphan (DM) or no treatment for the treatment of nocturnal coughing. The study group contained 105 children age 2 to 18 years. Honey consistently scored the best for reducing cough frequency and cough severity. It also scored best for improving sleep. Dextromethorphan (DM) did not score significantly better than "no treatment" (showing its lack of efficacy).

  • How Might Honey Work? One explanation for how honey works is that sweet substances naturally cause reflex salivation and increased airway secretions. These secretions may lubricate the airway and remove the trigger (or tickle) that causes a dry, nonproductive cough.

  • Adult Dosage: 2 teaspoon (10 ml) at bedtime.

If not, see these topics


When to Call Your Doctor

call 911

Call 911 Now (you may need an ambulance) If

  • Severe difficulty breathing (e.g., struggling for each breath, unable to speak)

  • Very weak (can't stand)

call now

Call Your Doctor Now (night or day) If

  • You feel weak or very sick

  • Difficulty breathing, and is not from a blocked or stuffy nose

  • Fever of 103° F (39.4° C) or higher

  • Fever of 100.5° F (38.1° C) or higher and you:

    • Are over 60 years of age OR

    • Have diabetes mellitus or a weakened immune system (e.g., HIV positive, cancer chemotherapy, chronic steroid treatment, splenectomy) OR

    • Are bedridden (e.g., nursing home patient, stroke, chronic illness, recovering from surgery)

call within 24 hours

Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If

  • You think you need to be seen

  • Fever present for more than 3 days

  • Fever returns after gone for over 24 hours, and your symptoms are worse or not improved

  • Sinus pain (not just pressure or fullness) and fever

  • Sore throat present more than 5 days

call within 24 hours

Call Your Doctor During Weekday Office Hours If

  • You have other questions or concerns

  • Sinus pain (not just pressure or fullness) despite using nasal washes for 24 hours

  • Sinus congestion (pressure, fullness) present for more than 10 days

  • Runny nose (nasal discharge) present for more than 10 days

home care

Self Care at Home If

  • Mild cold and you don't think you need to be seen



General Instructions for Treating a Cold

  1. Reassurance:

    • Colds are very common and may make you feel uncomfortable.

    • Colds are caused by viruses, and no medicine or "shot" will cure an uncomplicated cold.

    • Colds are usually not serious. An uncomplicated cold can be treat at home

  2. For a Runny Nose With Profuse Discharge: Blow the Nose.

    • Nasal mucus and discharge helps to wash viruses and bacteria out of the nose and sinuses.

    • Blowing the nose is all that is needed.

    • If the skin around your nostrils gets irritated, apply a tiny amount of petroleum ointment to the nasal openings once or twice a day.

  3. For a Stuffy Nose - Use Nasal Washes:  

    • Introduction: Saline (salt water) nasal irrigation is an effective and simple home remedy for treating cold symptoms and other conditions involving the nasal and sinus passages. Nasal irrigation consists of pouring, spraying, or squirting salt water into the nose and then letting it run back out.

    • How it Helps: The salt water rinses out excess mucus, washes out any irritants (dust, allergens) that might be present, and moisturizes the nasal cavity.

    • Methods: There are several ways to perform nasal irrigation. You can use a saline nasal spray bottle (available over-the-counter), a rubber ear syringe, a medical syringe without the needle, or a Neti Pot.

    Step-By-Step Instructions: 

    • Step 1: Lean over a sink.

    • Step 2: Gently squirt or spray warm salt water into one of your nostrils.

    • Step 3: Some of the water may run into the back of your throat. Spit this out. If you swallow the salt water it will not hurt you.

    • Step 4: Blow your nose to clean out the water and mucus.

    • Step 5: Repeat steps 1-4 for the other nostril. You can do this a couple times a day if it seems to help you.

    How to Make Saline (Salt Water) Nasal Wash: Add 1/2 tsp of table salt to 1 cup (8 oz; 240 ml) of warm water.

  4. Treatment for Associated Symptoms of Colds:

    • For muscle aches, headaches, or moderate fever (over 101 degrees F; over 38.9 C): Take acetaminophen every 4 hours.

    • Sore throat: Try throat lozenges, hard candy or warm chicken broth.

    • Cough: Use cough drops.

    • Hydrate: Drink adequate liquids.

  5. Humidifier: If the air in your home is dry, use a cool mist humidifier.

  6. Contagiousness:

    • The cold virus is present in your nasal secretions.

    • Cover your nose and mouth with a tissue when you sneeze or cough.

    • Wash your hands frequently with soap and water.

    • You can return to work or school after the fever is gone and you feel well enough to participate in normal activities.

  7. Expected Course:

    • Fever may last 2-3 days

    • Nasal discharge 7-14 days

    • Cough up to 2-3 weeks.

  8. Call Your Doctor If:

    • Difficulty breathing occurs

    • Fever lasts more than 3 days

    • Nasal discharge lasts more than 10 days

    • Cough lasts more than 3 weeks

    • You become worse

Over-the-Counter Medicines for a Cold

  1. Medicines for a Stuffy or Runny Nose:

    • Most cold medicines that are available over-the-counter (OTC) are not helpful.

    • Antihistamines are only helpful if you also have nasal allergies.

    • If you have a very runny nose and you really think you need a medicine, you can try using a nasal decongestant for a couple days.

  2. Nasal Decongestants for a Very Stuffy or Runny Nose:

    • If you have a very stuffy nose, nasal decongestant medicines can shrink the swollen nasal mucosa and allow for easier breathing. If you have a very runny nose, these medicines can reduce the amount of drainage. They may be taken as pills by mouth or as a nasal spray.

    • Most people do NOT need to use these medicines.

    • Pseudoephedrine (Sudafed) is available OTC in pill form. Typical adult dosage is two 30 mg tablets every 6 hours. Read package instructions.

    • Pheylephrine (Sudafed PE) is available OTC in pill form. Typical adult dosage is one 10 mg tablets every 4 hours. Read package instructions.

    • Oxymetazoline Nasal Drops (Afrin) are available OTC. Clean out the nose before using. Spray each nostril once, wait one minute for absorption, and then spray a second time. Read package instructions.

    • Phenylephrine Nasal Drops (Neo-Synephrine) are available OTC. Clean out the nose before using. Spray each nostril once, wait one minute for absorption, and then spray a second time. Read package instructions.

  3. Caution - Nasal Decongestants:

    • Do not take these medications if you have high blood pressure, heart disease, prostate enlargement, or an overactive thyroid.

    • Do not take these medications if you are pregnant.

    • Do not take these medications if you have used a MAO inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate) in the past 2 weeks. Life-threatening side effects can occur.

    • Do not use these medications for more than 3 days (Reason: rebound nasal congestion).

  4. Cough Medicines:

    • OTC Cough Syrups: The most common cough suppressant in OTC cough medications is dextromethorphan. Often the letters "DM" appear in the name.

    • OTC Cough Drops: Cough drops can help a lot, especially for mild coughs. They reduce coughing by soothing your irritated throat and removing that tickle sensation in the back of the throat. Cough drops also have the advantage of portability - you can carry them with you.

    • Home Remedy - Hard Candy: Hard candy works just as well as medicine-flavored OTC cough drops. Diabetics should use sugar-free candy.

    • Home Remedy - Honey: An old home remedy has been shown to help decrease coughing at night. The adult dosage is 2 teaspoons (10 ml) at bedtime.

  5. OTC Cough Syrup - Dextromethorphan:

    • Cough syrups containing the cough supppresant dextromethorphan (DM) may help decrease your cough. Cough syrups work best for coughs that keep you awake at night. They can also sometimes help in the late stages of a respiratory infection when the cough is dry and hacking. They can be used along with cough drops.

    • Examples: Benylin, Robitussin DM, Vicks 44 Cough Relief

    • Read the package instructions for dosage, contraindications, and other important information.

  6. Caution - Dextropmethorphan:

    • Do not try to completely suppress coughs that produce mucus and phlegm. Remember that coughing is helpful in bringing up mucus from the lungs and preventing pneumonia.

    • Research Notes: Dextromethorphan in some research studies has been shown to reduce the frequency and severity of cough in adults (18 years or older) without significant adverse effects. However, other studies suggest that dextromethorphan is no better than placebo at reducing a cough.

    • Drug Abuse Potential: It should be noted that dextromethorphan has become a drug of abuse.

    • CONTRAINDICATED: Do not take dextromethorphan if you are taking a monoamine oxidase (MAO) inhibitor now or in the past 2 weeks. Examples of MAO inhibitors include isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Eldepryl, Emsam, Zelapar), and tranylcypromine (Parnate). Do not take dextromethorphan if you are taking venlafaxine (Effexor).

  7. Pain and Fever Medicines:

    • For pain or fever relief, take acetaminophen or ibuprofen.

    • Treat fevers above 101° F (38.3° C).

    • The goal of fever therapy is to bring the fever down to a comfortable level. Remember that fever medicine usually lowers fever 2-3° F (1-1.5° C).

    Acetaminophen (e.g., Tylenol):

    • Take 650 mg by mouth every 4-6 hours. Each Regular Strength Tylenol pill has 325 mg of acetaminophen.

    • Another choice is to take 1,000 mg every 8 hours. Each Extra Strength Tylenol pill has 500 mg of acetaminophen.

    • The most you should take each day is 3,000 mg.

    Ibuprofen (e.g., Motrin, Advil):

    • Take 400 mg by mouth every 6 hours.

    • Another choice is to take 600 mg by mouth every 8 hours.

    • Use the lowest amount that makes your pain feel better.

    Extra Notes:

    • Acetaminophen is thought to be safer than ibuprofen in people over 65 years old. Acetaminophen is in many OTC and prescription medicines. It might be in more than one medicine that you are taking. You need to be careful and not take an overdose. An acetaminophen overdose can hurt the liver.

    • CAUTION: Do not take acetaminophen if you have liver disease.

    • CAUTION: Do not take ibuprofen if you have stomach problems, kidney disease, are pregnant, or have been told by your doctor to avoid this type of anti-inflammatory drug. Do not take ibuprofen for more than 7 days without consulting your doctor.

    • Before taking any medicine, read all the instructions on the package.

Mineral and Vitamin and Herbal Supplements

  1. Zinc:

    • Some studies have reported that zinc gluconate lozenges (i.e., Cold-Eeze) may reduce the duration and severity of cold symptoms.

    • Dosage: Taken by mouth. Follow package instructions. You should take this with food to minimize the chance of nausea.

    • Side Effects: Some people complain of nausea and a bad taste in their mouth when they take zinc.

    • Important Note about Zicam: A zinc nasal gel (i.e., Zicam) is also available over-the-counter. There have been a number of lawsuits claiming that Zicam causes loss of smell (anosmia); it is uncertain whether this truly happens, but for now you should not use this medicine.

  2. Vitamin C:

    • A number of experts, including Nobel Prize winner Linus Pauling, have promoted taking high doses of this vitamin as a treatment for the common cold.

    • Research to date shows that Vitamin C has minimal (if any) effect on the duration or degree of cold symptoms. Thus, it cannot be recommended as a treatment.

    • Vitamin C is probably harmless in standard doses (less than 2 gms daily).

  3. Echinacea: There is no proven benefit of using this herbal remedy in treating or preventing the common cold. In fact, current research suggests that it does not help.

  4. Read the package instructions thoroughly on all supplements that you take.

Neti Pot for Sinus Symptoms

  1. Neti Pot

    • The Neti Pot is a small ceramic or plastic pot with a narrow spout. It looks like a small tea pot. Two manufacturers of the Neti Pot are the Himalayan Institute in Pennsylvania and SinuCleanse in Wisconsin.

    • How it Helps: The neti pot performs nasal washing (also called nasal irrigation or "jala neti"). The salt water rinses out excess mucus, washes out any irritants (dust, allergens) that might be present, and moisturizes the nasal cavity.

    • Indications: The neti pot is widely used as a home remedy to relieve conditions such as colds, sinus infections, and hay fever (nasal allergies).

    • Adverse reactions: None. Though, not everyone likes the sensation of pouring water into their nose.

    • YouTube Instructional Video: There are instructional videos on how to use a neti pot both on manufacturers websites and also on YouTube.

  2. Neti Pot STEP-BY-STEP Instructions:

    • Step 1: Follow the directions on the salt package to make warm salt walter.

    • Step 2: Lean forward and turn your head to one side over the sink. Keep your forehead slightly higher than your chin.

    • Step 3: Gently insert the spout of the neti pot into the higher nostril. Put it far enough so that it forms a comfortable seal.

    • Step 4: Raise the Neti Pot gradually so the salt water flows in through your higher nostril and out of the lower nostril. Breathe through your mouth.

    • Step 5: When the Neti Pot is empty, blow your nose to clean out the water and mucus.

    • Step 6: Some of the water may run into the back of your throat. Spit this out. If you swallow the salt water it will not hurt you.

    • Step 7: Refill the Neti Pot and repeat on the other side. Again, exhale vigorously to clear the nasal passages.

    How to Make Saline (Salt Water) Nasal Wash:

    • You can make your own saline nasal wash.

    • Add 1/2 tsp of table salt to 1 cup (8 oz; 240 ml) of warm water.

And remember, contact your doctor if you develop any of the "Call Your Doctor" symptoms.


March 22, 2017