Are colds getting worse?

It's only November, but already everybody seems to have 'the bug'. Whole offices are going down like ninepins, and nobody seems to be able to shake it off. We all feel more ill than we normally do with an ordinary cold. What's happening? Jeremy Laurance investigates

In the past couple of months, three people known to me have been hospitalised with pneumonia. The first was a nine-year-old girl, the second a woman in her forties (who is undergoing a bronchoscopy to check her lungs as I write) and the third and most shocking case was that of a man in his fifties who returned from holiday with a cold, thought he would not bother the doctor, suddenly worsened, was rushed to hospital and died the same night.

Pneumonia used to be known as the "old man's friend" - the final illness that carried him off gently to the grave. It is an inflammation of the lungs, normally caused by bacterial infection, which requires immediate treatment with antibiotics. It tends to affect people who are run down and is rare in the young, fit and healthy, though about one in 20 cases of flu are followed by a bout of pneumonia. There is no hard evidence to suggest that pneumonia is increasing in younger people, but some doctors believe respiratory illnesses generally may be worsening, causing more serious symptoms.

The Royal College of General Practitioners monitoring unit, which collects weekly figures on the level of respiratory illnesses nationwide, says pneumonia cases are running at just over five per 100,000, which is normal for the time of year. Flu cases are running at 33 cases per 100,000, well below the epidemic level of 400, and acute bronchitis at 178 cases per 100,000. "A lot more people have bronchitis than have flu," says Dr Douglas Fleming, director of the monitoring unit.

It is certain that these figures will rise during the winter as they do every winter. It is equally certain that they vastly underestimate the true level of infection. The RCGP monitoring unit only collects figures based on GP consultations and many people treat themselves and do not bother to visit the GP. But Dr Fleming, who is a GP in Birmingham, adds: "I have seen a number of people with more severe episodes of respiratory illness over the past few weeks. This is just my impression but they have been rather more troublesome than I normally see at this time of year."

Dr Paul Stillman, a GP based in Sussex and consultant to the Consumer Health Information Centre, set up to advise the public on colds and flu, says resistance to colds appears to be declining while mechanisms of spread are increasing. "My impression is that more people are getting colds and their colds are getting worse. They are certainly coming to see me more than they used to. Our lifestyle is probably a contributing factor. We are all so much more dependent on air-conditioning and central heating, which increase the likelihood of infection."

Air-conditioning, in which air is circulated in a closed system, taking bugs with it, spreads infectious organisms throughout a building. Draughty buildings in which windows can be opened may offer more protection. Studies of US servicemen living in draughty, old wartime huts were found to have only half as many colds as their counterparts in new quarters. Central heating which creates dry interiors, can trigger a catarrhal reaction when people step outside into damp winter air, providing the conditions in which any circulating virus may be able to take hold.

Once a cold or a bout of flu has begun the course of the illness will depend largely on the individual's resistance and general state of health. A cold, which can be caused by any one, or several, of more than 200 viruses, normally causes milder illness than flu. However, just as some who catch flu will have only a trivial illness, some who have colds will go on to develop a more serious illness.

In a recent study published in the British Medical Journal, Dr Karl Nicholson, senior lecturer in infectious diseases at Leicester University School of Medicine, suggests that colds may be causing more severe illness among the elderly than is recognised - and occasionally deaths - because they are more common than flu, which occurs in easily identifiable epidemics. A cold that begins as a mild upper respiratory illness, in the nose and throat, can descend to the chest causing more severe lower respiratory illness such as bronchitis or pneumonia. "This happens less often than with flu, but because there are more sufferers with colds, it gives a greater burden of illness," explains Dr Nicholson.

"Even in young, fit, healthy people with colds, you find subtle changes in lung function, suggesting lower airways involvement. This has consequences for patients such as asthmatics, whose condition is very often exacerbated by an upper airways infection [a cold]," he continues.

The dangers should not be exaggerated. The vast majority of colds and cases of flu never progress beyond mild illness. A further complication is that flu, which can be confirmed by laboratory tests, is often confused with respiratory syncytial virus. The RSV virus, sometimes known as "false flu", is present every winter, spreads like flu and causes many of the same symptoms, but is an entirely different illness. Treatment for both conditions is the same, except that inhalers may be used to clear the chest in patients with respiratory syncytial virus to prevent bronchitis, and flu vaccine provides no protection against it.

One sign of flu is loss of appetite but the old adage "starve a fever," may actually make the symptoms worse. Sufferers should try to eat something nutritious to help them fight the virus. However, the tradition of feeding chicken soup to cold sufferers, which dates back to the 13th century, has no scientific foundation beyond the comforting effects of the warm drink. In 1978, a doctor in Florida tested the soup's effects and found that it did open clogged nasal passages and allowed patients to breathe more easily. But the improvements did not last long. Any steaming hot drink probably has similar effects.

Although colds and flu rarely require a visit to the doctor, figures supplied by the Consumer Health Information Centre suggest they are the subject of 96 million GP consultations and 63 million prescriptions annually. Eight out of 10 people agreed it was important to treat themselves when they got a cold or flu, but 60 per cent said they had seen a family doctor over a minor problem in the past year. Most people want nothing more than a dose of reassurance.

COLD OR FLU?

A cold cannot be cured but its symptoms can be relieved. It may last anything from four to 14 days, longer if your body was at a low ebb in the first place. The severity of a cold and the time it lasts depends on the virus strain and your body's capacity to fight off infection. Antibiotics are useless because they act only against bacteria and colds are caused by viruses. Antibiotics are only necessary if a bacterial infection develops, such as bronchitis or pneumonia.

DAY ONE

Symptoms: None.

What's happening: You can introduce a cold virus into your body by shaking hands with someone who has the virus and then touching your eyes. This is a more effective mode of transmission than being breathed over or even kissed.

What you should do: Wash your hands regularly, especially if those around you have colds. Eat foods rich in Vitamin C (oranges, lemons, red peppers) and zinc (oysters, red meat), which are thought to help maintain the body's defences against infection.

ONE OR TWO DAYS LATER

Symptoms: Runny nose, sore throat.

What's happening: The virus has taken over the cells in your nose and throat, killing them. The dead cells pile up and by about day two of your cold, your body starts to produce a watery fluid to wash them out of your nose.

What you should do: Drink plenty of fluids.

TWO TO FOUR DAYS LATER

Symptoms: Blocked nose, sneezing, sore throat.

What's happening: The invaded cells in your nose and throat send chemical signals to attract white blood cells to fight the infection. This causes inflammation, blocking your nose and causing your throat to swell.

What you should do: Inhaling steam or taking hot drinks may ease a blocked nose and a sore throat. Continue to drink plenty of fluids.

AFTER FOUR OR FIVE DAYS

Symptoms: Fatigue and raised temperature.

What's happening: A second level of your body's defence system may go into action, involving two types of white blood cell, which raises the body temperature preventing the virus from multiplying further.

What you should do: Continue drinking plenty of fluids and get plenty of rest. Over-the-counter medicines such as paracetamol can ease pain and help reduce fever.

FOUR TO 14 DAYS LATER

Symptoms: Getting better but runny nose and or cough remains.

What's happening: As your body conquers the virus, inflammation subsides but it is still clearing out the dead cells left over.

What you should do: Keep up the rest and fluids.

THE DIFFERENCE BETWEEN COLDS AND FLU

Colds:

Symptoms start gradually.

You do not have a high temperature.

Appetite is normal.

You may feel sick.

Flu:

Symptoms start rapidly.

You get a temperature in the first 24 hours.

You lose your appetite.

Your muscles ache.

Based on advice issued by the Consumer Health Information Centre, set up by the Proprietary Association of Great Britain, which represents pharmacists. The centre has a helpline, staffed by pharmacists, to give advice on treatment of colds and flu. Call 0845 6061611.