As we enter the season of sniffles, sneezes, coughs and fever, millions of Americans reach into their medicine cabinets for aspirin, acetaminophen or ibuprofen. These drugs bring down an elevated temperature, but is that a good idea? Should we fight fever at the first signs of an upper respiratory tract infection, especially in a time of COVID-19?
Even though most cold and flu remedies contain fever reducers, there is little evidence that they speed healing. Such products may even be counterproductive. This reader wants to know how to find a cold remedy that doesn’t fight fever.
Why Should I Fight Fever?
Q. I am disappointed that virtually all of the cold, cough and flu medicines on the market contain acetaminophen or an NSAID like ibuprofen. This means that people treating symptoms of an upper respiratory tract infection inadvertently treat the fever as well. That can be counterproductive because fever is the body’s natural response to overcome infection.
I am not a fan of combination therapy, but I find it difficult to obtain single-ingredient medications. It’s even more difficult to educate my patients on the dangers of consuming ingredients they don’t need.
A. Thank you for noting the importance of fever in combatting infection. Researchers have found that an elevated temperature helps the immune system respond to pathogens (Nature Reviews. Immunology, June, 2015).
Can Treating Symptoms Be Counterproductive?
Why do we get a fever when we get sick? Biologists have discovered that an elevated temperature helps mobilize immune system defenses. Fever also makes it harder for viruses and other microorganisms to reproduce (Journal of Virology, Feb. 1982).
Humans are not the only creatures who spike a fever when they are infected. Other mammals do too. Even cold-blooded vertebrates such as lizards will crawl to a sunny rock to raise their body temperatures–and if they are prevented, they are more likely to succumb to a serious infection (Science, Apr. 11, 1975).
Can A Fever Be Beneficial?
Research suggests that people who develop moderate fevers are more likely to survive serious infections (Australian Critical Care, online, Dec, 3, 2012). So what happens when we lower a fever with drugs?
More than a quarter century ago, scientists reported that treating a cold with aspirin increased virus shedding (Journal of the American Medical Association, March 24, 1975). That means people are more likely to suffer symptoms and spread their illness to others.
An experiment in which volunteers were infected with cold virus and treated with aspirin, acetaminophen, ibuprofen or placebo showed that the medications reduced the immune response to the infection, increased nasal symptoms and seemed to prolong virus shedding (Journal of Infectious Diseases, Dec. 1990).
In a different experiment, volunteers infected with influenza A virus were sick three to four days longer if they received aspirin or acetaminophen (Pharmacotherapy, Dec., 2000). But the vast majority of OTC cold and flu medicines contain such ingredients or NSAIDs.
Where’s the Evidence?
It probably comes as a surprise to most health care professionals to learn that there are no double-blind placebo-controlled clinical trials measuring the benefits of lowering a fever when patients have influenza (Journal of the Royal Society of Medicine, Oct. 2010). As a result, the conventional advice to rest in bed, drink plenty of fluids and take aspirin or acetaminophen for the flu is not evidence-based.
If drug companies want to promote cold and flu remedies that contain fever reducers, they should conduct placebo-controlled trials to prove their products do more good than harm.
What to Do?
So what should people do if they have sniffles and a moderate fever? A century ago, grandmothers had a different way of dealing with flu-like symptoms. They frequently rubbed the chest with a menthol and camphor ointment (think Vicks VapoRub) or a mustard plaster. Then they piled on the quilts to “sweat out the fever” and administered a good dose of hot, homemade chicken soup.
Such old-fashioned home remedies may not have had any evidence either, but current science suggests that they may have been more helpful than today’s drugstore remedies. Encouraging the body’s natural immune response rather than fighting it might have helped people recover faster.
Should You Fight Fever During COVID-19?
You can learn more about how ancient cultures have dealt with a fever at this link:
Should You Lower a Fever or Leave It Alone?
How do we separate a symptom from an underlying illness? An elevated temperature is often a response to infection. Should we lower a fever? If so, when?
To learn more about enhancing the body’s own ability to deal with infection we recommend that you listen to radio show # 1057 with Tieraona Low Dog, MD. In it, she shares how you can improve your immune response naturally. The streaming audio below her photo is free. Just click on the green arrow. You can also download an mp3 file of the one-hour interview for free.
Share your own thoughts about dealing with colds and flu in the comment section below.
