Flu season seems to be striking with a vengeance in some areas of the country. Here are some questions I hear most often from patients about the flu:
How do you know you have the flu? And does it matter what kind of flu it is?
Many know that different varieties of flu circulate each year — influenza A, influenza B, H1N1 (swine flu), bird flu and more. For most patients, it’s not important to know exactly what the virus is — doctors treat them all the same.
Common flu symptoms include fever, dry cough, sore throat and muscle pain. However, children — especially those younger than 5 — may have stomach problems like nausea, vomiting or diarrhea, as well as earaches.
Do you test for flu?
Not usually. Some lab tests are available, but during flu season — especially when flu is widespread — we usually diagnose it based on symptoms.
The rapid test can be helpful to start you on appropriate medications, especially if you end up in an emergency room or urgent care clinic with bad flu symptoms and you’re at high risk for complications, such as a pregnant woman, severe asthmatic, immunocompromised patient or someone with another chronic illness.
[See: Pharmacist Recommended Cough, Cold and Allergy Medicines.]
What treatment do you recommend?
Flu is a virus, and unlike a bacterial infection that can be killed with antibiotics, there’s no medicine that can actually cure it. The main treatments are rest, to give your immune system a chance to work, and plenty of liquids, to help thin mucus and prevent dehydration.
For fever and muscle aches, I usually recommend ibuprofen or Tylenol every six hours. However, don’t give adult medicine to children or try to estimate dosages. Follow the exact dosing instructions on the bottle or from the health care provider, and use the measuring device that comes with the medication. Household “teaspoons” and other measuring instruments are not accurate enough for medicines.
You can also reduce fevers with a cool compress on the head or a cool bath. I make sure parents know to never give aspirin (acetylsalicylic acid) to a child, as it increases the risk for Reye’s Syndrome, a dangerous condition.
What about decongestants or cough medicine?
If a patient is very congested or has a very bad cough, I may recommend a decongestant or cough medicine — but not for young children.
The American Academy of Pediatricians says the risks of using these medications by children under 4 outweigh the benefits — and children ages 4 to 6 should only use them when prescribed by a physician. Multi-symptom cold and flu medicines are not recommended for children, either, as they are not proven effective and pose a risk of over-medication. AAP recommends using a nasal wash to ease congestion and warm liquids such as juice, honey or corn syrup to soothe a cough. Never give honey to children under 12 months of age.
Even in older teenagers and adults, I would not recommend taking these medicines for more than five days, as they can be a harm in the long run. If congestion or coughing symptoms persist or worsen, consult a doctor for safer medications.
[See: Old-School Cold Remedies That Really Work.]
What about antiviral medicines?
There are a few antiviral medicines that we use for flu — especially for patients who are very sick or at high risk of complications such as pneumonia, sinus or ear infection. These medicines won’t kill the virus, but they will slow it down, ease symptoms and possibly reduce the length of time the patient feels sick.
I don’t give them to all patients with flu, as many will get better by themselves, but I do use them for women who are pregnant or who have recently given birth, as well as people with asthma, COPD, diabetes and some chronic heart or blood conditions. I also recommend antivirals for caregivers of high-risk people, to reduce chances of spreading germs.
Do you have to start antivirals right away?
The Centers for Disease Control and Prevention recommends starting antiviral treatment within 48 hours of when symptoms begin, but they also say treatment can be beneficial for some patients up to four or five days after symptom onset.
— Tamiflu (oseltamivir) is approved for patients as young as two weeks old, and it comes in a liquid or capsules. The medicine should be taken for five days — sometimes longer.
— Relenza (zanamivir) is an inhaled medicine approved for people age 7 and up, but it should not be used by those with asthma.
— In the hospital, patients may receive another antiviral — Rapivab (peramivir) — which is given through an IV.
If a patient has not been vaccinated against the flu by January or February, do you still recommend vaccination?
If the person is healthy, yes. We do not vaccinate those who are acutely ill. If you are feeling flu symptoms, wait until you’re symptom-free before getting your flu shot. It takes up to two weeks for the vaccine to take full effect — so if flu is circulating in your community, you could pick up the virus before the vaccine takes effect. But it’s still worth doing, as flu season can drag on well into the spring, and the flu shot is the most effective way to prevent it.
[See: 8 Surprising Facts About Asthma and Seasonal Allergies.]
What other treatment options should people be aware of?
Prevention is key. A flu shot early in the season is important. After that, focus on preventing exposure. Wash your hands often, especially before eating, and teach children not to put their hands in their mouths and eyes. Stay away from people who are sick — and stay home if you’re the one who’s ill. Try to use your own pen when signing for credit card purchases, or use alcohol-based hand wipes when leaving the store.
Adequate nutrition and sleep are very important in preventing flu. You’re more likely to catch an illness if you’re not eating healthy foods or getting enough sleep every night, as your immune system is weaker.
When someone in your family is sick, isolate the person as much as possible. Assign one main caregiver who can take extra precautions, like frequent handwashing or wearing a hygienic mask. Wipe down surfaces where viruses linger, like doorknobs, stairway bannisters, microwave or refrigerator handles, remote controls, cell phones and even computer keyboards.
Purvi Parikh, MD, is an allergist and immunologist with Allergy & Asthma Network, the leading nonprofit patient education organization for people with allergies, asthma and related conditions. She practices in New York City at Allergy and Asthma Associates of Murray Hill and New York University School of Medicine. She sits on the Board of Directors for the advocacy council of the American College of Allergy, Asthma & Immunology.
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