What Is the Flu?

Flu is the common name for influenza, a virus that infects the respiratory system. Often when you're sick with a virus, your body builds up a defense system by making antibodies against it. That means you usually don't get that particular virus strain again. Unfortunately, flu viruses mutate (change) each year. So you aren't protected from getting the flu forever. Some years the change in the flu virus is slight. So if you do get the flu, it's mild because the antibodies from having the flu before give you partial protection. But every 10 years or so the flu virus goes through a major change and many people get severe cases. These large-scale outbreaks are called epidemics. If they spread worldwide, they're called pandemics. The H1N1 ("swine flu") outbreak of 2009-2010 was considered a pandemic. How Does the Flu Spread? The flu virus spreads through the air when a person who has the virus sneezes, coughs, or speaks. The flu can sometimes be passed on through objects that someone with the virus touched, sneezed, or coughed on. When a healthy person touches these contaminated items and then touches his or her mouth or nose, the virus can enter their system. People carrying the virus can be contagious 1 day before their symptoms appear and about 5 to 7 days after they first get symptoms. So it's possible to pass the flu on before you even know you're sick. Flu epidemics often start in schools and then move quickly through a community as students spread the virus to family members and people around them.

How Do I Know if I Have the Flu?

Flu symptoms like headache, sore throat, fever, chills, muscle aches, and dry cough appear anywhere from 1 to 4 days after a person has been exposed to the virus. Someone with the flu may have a high fever in the range of 104 F (40 C). People with the flu often feel achy and extra tired and they may lose their appetites. The fever and aches usually disappear within a few days, but the sore throat, cough, stuffy nose, and tiredness may continue for a week or more. In addition, the flu can sometimes cause vomiting, abdominal pain, and diarrhea. If you have only vomiting and diarrhea without the other flu symptoms, you probably have gastroenteritis. Some gastrointestinal infections are caused by non-flu viruses or bacteria. Although you may feel miserable if you get the flu, it's unlikely to be serious. It's rare that healthy teens have complications from the flu. Older adults (over age 65), young kids (under age 5), and people with chronic medical conditions are more likely to become seriously ill with the flu.

How Does the Flu Spread?

The flu virus spreads through the air when a person who has the virus sneezes, coughs, or speaks. The flu can sometimes be passed on through objects that someone with the virus touched, sneezed, or coughed on. When a healthy person touches these contaminated items and then touches his or her mouth or nose, the virus can enter their system.

People carrying the virus can be contagious 1 day before their symptoms appear and about 5 to 7 days after they first get symptoms. So it's possible to pass the flu on before you even know you're sick. Flu epidemics often start in schools and then move quickly through a community as students spread the virus to family members and people around them.

What to Do When the Flu Bugs You

If you get the flu, the best way to take care of yourself is to rest in bed and drink lots of liquids like water and other non-caffeinated drinks. Stay home from school until you feel better and your temperature has returned to normal. Most people who get the flu get better on their own after the virus runs its course. But call your doctor if you have the flu and:
y y

you're getting worse instead of better you have trouble breathing or develop other complications such as a sinus infection you have a medical condition (for example, diabetes, heart problems, asthma, or other lung problems)

Most teens can take acetaminophen or ibuprofen to help with fever and aches. Avoid aspirin or any products that contain aspirin, though. If kids and teens take aspirin while they have the flu, it puts them at risk of developing Reye syndrome. Although Reye syndrome is rare, it can be serious. Antibiotics don't work on viruses, so they won't help someone with the flu get better. Sometimes doctors can prescribe an antiviral medicine to reduce the length of time a person is ill from the flu. These

medicines are effective only against some types of flu virus and must be taken within 48 hours after flu symptoms appear. Doctors usually use this medicine for people who are very young, elderly, or those who are ill or at risk for serious complications, like patients with asthma.

Vaccine to the Rescue?

So how do you avoid getting sick during flu outbreaks? Wash your hands often and thoroughly. Avoid sharing cups, utensils, or towels with others. If you do catch the flu, use tissues whenever you sneeze or cough to avoid spreading the virus. Everyone older than 6 months should get a flu vaccine. Your doctor will probably recommend that you get one. Flu vaccines are available as a shot or nasal mist. The shot contains killed flu viruses that won't cause you to get the flu, but will make your body create antibodies that fight off infection if you encounter the live flu virus. The nasal mist contains weakened live flu viruses. Because it contains live viruses, the mist is only for healthy people between 2 and 49 years old. Pregnant women also should avoid the mist. Most people don't have reactions to a flu shot, although a few may notice a fever, sore muscles, and tiredness. With the nasal mist vaccine, some people develop a runny nose, headache, and low fever. The flu vaccine is usually given a few weeks before flu season begins to allow the body time to develop antibodies beforehand. But you can still get a flu vaccine even after flu season starts. Anyone allergic to eggs should not get a flu vaccine because the viruses for the vaccine are grown in chicken eggs. If you do get the flu this season, take care of yourself and call your doctor with any questions or concerns. When you're feeling bad it can

help to remember that the flu usually lasts a week or less and you'll be back to your normal activities before too long.

Cough
Definition
A cough is a forceful release of air from the lungs that can be heard. Coughing protects the respiratory system by clearing it of irritants and secretions.

Description
While people can generally cough voluntarily, a true cough is usually a reflex triggered when an irritant stimulates one or more of the cough receptors found at different points in the respiratory system. These receptors then send a message to the cough center in the brain, which in turn tells the body to cough. A cough begins with a deep breath in, at which point the opening between the vocal cords at the upper part of the larynx (glottis) shuts, trapping the air in the lungs. As the diaphragm and other muscles involved in breathing press against the lungs, the glottis suddenly opens, producing an explosive outflow of air at speeds greater than 100 miles (160 km) per hour. In normal situations, most people cough once or twice an hour during the day to clear the airway of irritants. However, when the level of

irritants in the air is high or when the respiratory system becomes infected, coughing may become frequent and prolonged. It may interfere with exercise or sleep , and it may also cause distress if accompanied by dizziness , chest pain , or breathlessness. In the majority of cases, frequent coughing lasts one to two weeks and tapers off as the irritant or infection subsides. If a cough lasts more than three weeks it is considered a chronic cough, and physicians try to determine a cause beyond an acute infection or irritant. Coughs are generally described as either dry or productive. A dry cough does not bring up a mixture of mucus, irritants, and other substances from the lungs (sputum), while a productive cough does. In the case of a bacterial infection, the sputum brought up in a productive cough may be greenish, gray, or brown. In the case of an allergy or viral infection it may be clear or white. In the most serious conditions, the sputum may contain blood.

Demographics
Formal statistics on coughs are not maintained. Virtually all persons will experience coughs several times each year throughout their lives.

Causes and symptoms

In the majority of cases, coughs are caused by respiratory infections, including the following:
y y

colds or influenza , the most common causes of coughs bronchitis , an inflammation of the mucous membranes of the bronchial tubes croup, a viral inflammation of the larynx, windpipe, and bronchial passages that produces a bark-like cough in children

whooping cough, a bacterial infection accompanied by the highpitched cough for which it is named pneumonia , a potentially serious bacterial infection that produces discolored or bloody mucus tuberculosis , another serious bacterial infection that produces bloody sputum fungal infections, such as aspergillosis, histoplasmosis, and cryptococcosis

Environmental pollutants, such as cigarette smoke, dust, or smog, can also cause a cough. In the case of cigarette smokers, the nicotine present in the smoke paralyzes the hairs (cilia) that regularly flush mucus from the respiratory system. The mucus then builds up, forcing the body to remove it by coughing. Post-nasal drip, the irritating trickle of mucus from the nasal passages into the throat caused by allergies or sinusitis , can also result in a cough. Some chronic conditions, such as asthma , chronic bronchitis, emphysema, and cystic fibrosis , are characterized in part by a cough. A condition in which stomach acid backs up into the esophagus (gastroesophageal reflux) can cause coughing, especially when a person is lying down. A cough can also be a side-effect of medications that are administered via an inhaler. It can be a side-effect of beta-blockers and ACE inhibitors, which are drugs used for treating high blood pressure.

KEY TERMS
Antitussive A drug used to suppress coughing. Expectorant A drug that promotes the discharge of mucus from respiratory system. Gastroesophageal reflux The backflow of stomach contents into the esophagus.

Glottis The opening between the vocal cords at the upper part of the larynx. Larynx Also known as the voice box, the larynx is the part of the airway that lies between the pharynx and the trachea. It is composed of cartilage that contains the apparatus for voice production the vocal cords and the muscles and ligaments that move the cords. Sputum The substance that is coughed up from the lungs and spit out through the mouth. It is usually a mixture of saliva and mucus, but may contain blood or pus in patients with lung abscess or other diseases of the lungs.

When to call the doctor

A physician or other healthcare provider should be called when a cough does not subside after three or four days. Individuals such as smokers, who have chronic coughs, should consult a doctor if the nature of their cough changes or they produce blood when they cough.

Diagnosis
To determine the cause of a cough, a physician should take an exact medical history and perform an exam. Information regarding the duration of the cough, what other symptoms may accompany it, and what environmental factors may influence it aid the doctor in his or her diagnosis. The appearance of the sputum also helps determine what type of infection, if any, may be involved. The doctor may even observe the sputum microscopically for the presence of bacteria and white blood cells. Chest x rays may help indicate the presence and extent of such infections as pneumonia or tuberculosis. If these actions are not enough to determine the cause of the cough, a bronchoscopy or laryngoscopy may be ordered. These tests use slender tubular instruments to inspect the interior of the bronchi and larynx.

Treatment
Treatment of a cough generally involves addressing the condition causing it. An acute infection such as pneumonia may require antibiotics , an asthma-induced cough may be treated with the use of bronchodilators, or an antihistamine may be administered in the case of an allergy. Physicians prefer not to suppress a productive cough, since it aids the body in clearing respiratory system of infective agents and irritants. However, cough medicines may be given if the person cannot rest because of the cough or if the cough is not productive, as is the case with most coughs associated with colds or flu. The two types of drugs used to treat coughs are antitussives and expectorants .

Antitussives
Antitussives are drugs that suppress a cough. Narcoticsprimarily codeineare used as antitussives and work by depressing the cough center in the brain. However, they can cause such side effects as drowsiness, nausea , and constipation . Dextromethorphan, the primary ingredient in many over-the-counter cough remedies, also depresses the brain's cough center but without the side effects associated with narcotics. Demulcents relieve coughing by coating irritated passageways.

Expectorants
Expectorants are drugs that thin mucus in order to make it easier to cough up. Guaifenesin and terpin hydrate are the primary ingredients in most over-the-counter expectorants. However, some studies have shown that in acute infections, simply increasing fluid intake has the same thinning effect as taking expectorants.

Coughs due to bacterial or viral upper respiratory infections may be effectively treated with botanical and homeopathic therapies. The choice of remedy will vary and be specific to the type of cough the person has. Some combination over-the-counter herbal and homeopathic cough formulas can be very effective for cough relief. Lingering coughs or coughing up blood should be treated by a trained practitioner. Many health practitioners advise increasing fluids and breathing in warm, humidified air as ways of loosening chest congestion. Others recommend hot tea flavored with honey as a temporary home remedy for coughs caused by colds or flu. Various vitamins , such as vitamin C, or minerals , such as zinc, may be helpful in preventing or treating conditions (including colds and flu) that lead to coughs. Avoiding of mucus-producing foods can be effective in healing a cough condition. These mucus-producing foods can vary, based on individual intolerance, but dairy products are a major mucus-producing food for most people.

Prognosis
Because the majority of coughs are related to the common cold or influenza, most will end in seven to 21 days. The outcome of coughs due to a more serious underlying disease depends on the pathology of that disease.

Prevention
It is important to identify and treat the underlying disease and origin of the cough. It is helpful to avoid cigarette smoke and coming in direct contact with people experiencing cold or flu symptoms. Hands should be washed frequently during episodes of upper-respiratory illnesses.

Nutritional concerns
Persons with coughs should be sure to maintain balanced and healthy diets.

Parental concerns
Parents of children under the age of five should closely monitor their children when they have a cough. Parents of children over five years of age must accept the fact that their children are likely to acquire coughs and related illnesses from schoolmates. They should remain vigilant and consider having their children seen by a physician if the cough does not resolve after five to seven days