Winter Cold and Flu Virus Update- December 9, 2014

Winter Cold and Flu Virus Update- A word on Fever and Cough

December 9, 2014

The Cleveland community is being hit hard with a blast of viruses that is causing very high fevers, prolonged coughs, and much suffering.

Part of this onslaught is clearly the annual winter arrival of influenza virus, which typically appears every December, so it is showing up as expected.   But the high fevers and coughs are not just from the influenza virus, which tends to cause only about 1/3 of all such illnesses.

Fever

Whatever the virus causing our children's fevers and coughs right now, these viruses are giving everyone lots of very high fevers.  So here is a reminder on the key points to keep in mind with regard to fever:

• Fever, although very unpleasant, is completely harmless in the setting of these viral fevers and coughs.   Fever is unfortunately an experience that every single person will have, many times in their life.   The normal range of fever is 100.8-105.8.  Temperatures in this range are common and safe.  
• The temperature over which fever becomes abnormal or of any concern is 106.0.   It is important to note that going to 106.0 and beyond is an extremely rare event.  As universal as fevers in the range of 100.8-105.8 are, fevers beyond that range are never seen in most people.  Fever often seems to be something out of control, but in fact, the body is very careful in setting the higher temperature.  The fact it stays at 105.8 and lower shows that fever is actually a very controlled and safe event. 
• The main problem with fever is the discomfort it causes, and it is clear that the higher the fever, the more discomfort.  So it's a good idea to use ibuprofen to reduce fever to make your child more comfortable.  
• The main question fever raises, from our point of view, is what is causing it, not how high it is.  Fevers always indicate that some inflammation is present.  In the vast majority of situations, the inflammation is due to a viral infection that will come and go without causing any harm, despite all the discomforts.  
• How do you know if your child's fever is from a simple viral infection that will be harmless,or a more serious cause?  Three key items that tell us something more serious than a simple viral infection is happening are important to look for.  If you don't have any of these three problems, you are likely dealing with a simple viral infection that should be harmless:
• A stiff neck in older children
• Severe pain
• Trouble breathing
• Ibuprofen and acetaminophen.   These are the key medications available to reduce fever.  They don't always work.  It is very important not to give too much of these medications when they don't fully eliminate the fever.  As noted, fever is harmless, but overdose with either of these medications can be harmful. Here are some key points on use of fever medications:
• We recommend using ibuprofen as some studies raise concern that acetaminophen use is associated with greater risk of developing asthma. 
• Ibuprofen is a helpful drug and should be used properly.  The safe interval for children is using it every 6-8 hours.  Occassionally, during the peak of a round of fever, it is safe to give ibuprofen every 4 hours, but there should never be more than 5 doses in a 24 hour period.
• If you give your child ibuprofen every 6-8 hours, there is no further reduction in fever, and therefore no benefit, to adding acetaminophen between doses 

Cough

No symptom of viral respiratory illnesses causes as much suffering as cough.  Fever is very uncomfortable and causes tremendous distress, but cough truly is a misery.

Cough is the result of inflammation of the airways.  That means the lining of the lower throat, voice box, upper lungs, and lower lungs gets red, swollen, and irritable.  When air passes over this inflamed tissue, the tissue is quite bothered and you cough.

Airway inflammation is usually due to one of three causes:  viral infection, bacterial infection, and allergies and asthma.

Bacterial infections are the least common cause of cough in children.   When a serious bacterial infection of the lungs is present, usually the person is struggling to breathe or breathing very rapidly, even when not coughing.

Most coughs in children with fever involve viruses.  Some of these children will also have some asthmatic inflammation with their colds and flus.  

How do viral coughs and asthmatic coughs differ?

Viral inflammation is like a burn of the airway lining.  The lining gets destroyed by the virus and the inflammation remains in place until the burn heals.  It is entirely the result of the damage done by the virus.

Inflammation from asthma is from our own body's immune attack.

But the main difference is that if your airway inflammation is from asthma, medications like inhaled albuterol or inhaled steroids can get rid of the inflammation and the cough.

But, if the inflammation and cough are purely from a virus, no treatments actually can make the cough better or go away, only healing the burn from the virus will help, and only the body can do that.

So if a cough lingers and there is no reason to think bacteria are present, it makes sense to try Albuterol.  If it works there is an element of asthma present and the cough can be alleviated.  If it does not work, it is more likely a viral cough and not much will make it go away any faster than healing will.

One word on over the counter cough remedies:  they do not work.   Like any intervention, about 30% of the time it will appear to help, due to the power of the placebo effect.  But, in study after study, cough syrups do not better than water in comforting or treating a cough.   The FDA is currently investigating 500 of them for fraud.

BOTTOM LINES:

1.  Fever is a normal and universal experience, and although very uncomfortable, quite harmless.  

2.  The normal range of fever is 100.8-105.8, all temperatures in this range are harmless.

3.  Ibuprofen is the preferred medication for fever, adding acetaminophen offers little if any help.

4.  Cough in the setting of fever is usually the result of a viral infection.  For prolonged coughs a trial of Albuterol will tell if there is a component of asthma.

5.  Over the counter cough syrups don't work.

6.  The key signs to watch for to tell you if your child with cough and/or fever has an illness of concern are:

• Stiff neck
• Severe pain
• Trouble breathing when not coughing

If these appear, call us right away.

If these worrisome symptoms aren't present, you are still welcome to call, but what your child will need is to be comforted as they go through the viral infection.

To your health,

Dr. Lavin

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