Description
Acute infection of upper airway, generally producing nasal congestion, rhinorrhea, cough, sneezing and sore throat
Also called
- Common cold
- Upper-respiratory-tract infection (URTI)
- Acute rhinitis/nasopharyngitis
- Nonspecific URTI
Who is most affected
- Children
- Adults with increased exposure to children
Incidence/prevalence
The average U.S. adult has an estimated two to four colds per year, and the average U.S. schoolchild has six to 10 colds per year.
Causes
- Generally viral in origin
- Most commonly rhinovirus
- Other viruses may include enterovirus, influenza C.
- No infectious agent identified in 50% of patients with acute upper-respiratory symptoms
- Common cold in elderly due to same infectious agents
Pathogenesis
Pathogenesis of each respiratory virus can differ
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Likely risk factors
- Higher levels of psychological stress may increase susceptibility to upper-respiratory infection (URI)
- Exposure to young children (e.g., in day care)
- Shorter sleep duration and poorer sleep efficiency in weeks prior to rhinovirus exposure
Possible risk factors
- Exposure to persons with respiratory complaints
- Lack of social ties
- Biomass fuels
- Exposure to tobacco smoke
- Recent airplane travel
- Antibiotic treatment for acne
- Negative emotional style
Factors not associated with increased risk
- Asthma may not increase risk of infections in primary-care patients
- Exposure to dampness or mold at home
Complications
- Otitis media
- Sinusitis
- Asthma exacerbation
- Exacerbation of other pulmonary diseases
- Loss of olfactory function
History
Chief concern
- Nasal congestion, rhinorrhea, cough
- Other symptoms can include sore throat, headache, hoarseness, malaise, lethargy, and myalgias.
History of present illness
- Initial symptoms typically are sore throat, malaise, and low-grade fever
- Typical presenting symptoms of nasal congestion, rhinorrhea, and cough appear within 24 to 48 hours
- Duration of symptoms
- Usually peak at day 3 to day 4
- Resolve or significantly improve by day 7
- Usually last one to two weeks, but may be more than three weeks
- Common cold often lasts >10 days.
Physical
General physical examination
- Mild fever occasionally present in adults and is fairly common in children
- The signs and symptoms may have insufficient sensitivity and specificity to differentiate viral from bacterial URIs
Head, eyes, ears, nose, and throat examination
- Typical signs may include
- Nasal discharge
- Sinus tenderness
- Erythema of oropharynx
Making the diagnosis
- Diagnosis is usually made clinically, based on symptoms of nasal congestion, rhinorrhea, cough, or sore throat in the absence of identified cause.
Differential diagnosis
- Influenza
- Streptococcal pharyngitis
- Acute sinusitis
- Acute bronchitis
- Asthma
- Allergic rhinitis
- Pneumonia
- Infectious mononucleosis
Diagnostic testing
- Not usually indicated or needed for diagnosis
- Nose and throat swabs appear sufficiently sensitive to rule out influenza A and respiratory syncytial virus
- xTAG Respiratory Viral Panel FDA-approved to test for 12 respiratory viruses from single sample
- Nucleic acid test
- Viruses tested include : Influenza A subtypes H1 and H3; influenza B ; human metapneumovirus; respiratory syncytial virus subtypes A and B ; parainfluenza 1, 2 and 3 ; rhinovirus and adenovirus
Imaging studies
- Not usually indicated
- Radiographic sinusitis common during the common cold
Treatment
- No randomized trials that evaluate increasing fluid intake have been identified
- Receiving information/reassurance strongly associated with patient satisfaction
- Acetaminophen might reduce fever in children, but evidence is limited and inconclusive
- Nonsteroidal anti-inflammatory drugs may reduce discomfort or pain
- Treatments that may reduce symptom duration or overall symptom severity
- Pelargonium sidoides extract (Umcka ColdCare) Echinacea (evidence inconsistent)
- Zinc lozenges ≥75 mg/day may decrease duration but not severity of cold symptoms in adults (intranasal zinc not recommended due to possible loss of smell).
- Andrographis paniculata in adults (KalmCold and Kan Jang tablets)
- Iota-carrageenan (sulfated galactose polymer derived from Rhodophyceae seaweed)
- OTC combination products containing antihistamines, decongestants, and/or analgesics in older children and adults
- Isotonic saline nasal wash (seawater) six times/day during acute illness, then three times/day in children
- Heated, humidified air
- Vapor rub may improve nighttime symptoms in children
- Sipping hot water or hot chicken soup has been reported to increase nasal mucus velocity
- Treatments for cough – Recommendations from the American College of Chest Physicians
- Benefit suggested with either : Brompheniramine plus sustained-release pseudoephedrine
- Ipratropium oral inhalation (Atrovent HFA)
- Cough suppressants should not be used.
- Most OTC oral medicines for acute cough do not have good evidence of benefit; medicines that have some evidence of efficacy in adults (but not children) are
- Dextromethorphan
- Guaifenesin
- Bromhexine
- Dexbrompheniramine/pseudoephedrine
- Honey may reduce nocturnal cough and sleep disruption in children with acute cough, and might be more effective than dextromethorphan or diphenhydramine.
- Treatments for nasal symptoms
- Decongestants (nasal or oral) are moderately effective for short-term relief in adolescents and adults
- Ipratropium nasal spray may improve rhinorrhea but not nasal congestion.
- Medications that do not appear effective
- Antibiotics
- Antivirals
- Nonprescription medicines for acute cough in children
- Antihistamines alone
- Vitamin C at onset of cold symptoms
- Intranasal corticosteroids
- Homeopathy
- Intranasal sodium cromoglycate does not appear to be effective for reducing cold symptoms in children
- Hypertonic saline
- Goldenseal should not be used due to reported serious adverse effects
- There is limited evidence for the use of Chinese herbal medicines to treat common cold
- American Geriatrics Society Beers Criteria
- Avoid first-generation antihistamines in older adults
- Avoid inhaled anticholinergic agents or strongly anticholinergic drugs in men with lower-urinary-tract symptoms and/or benign prostatic hyperplasia
Prevention
- Interventions that may reduce incidence of acute respiratory infections
- Educational programs to promote hand-washing
- Hand disinfection
- Physical activity
- Vitamin C prophylaxis may slightly reduce incidence, duration, and severity of common cold
- No evidence for reduction of incidence of acute respiratory infections with
- Multivitamins
- Vitamin E—200 mg daily
- Insufficient evidence to support or refute use of vitamin D
Alan Drabkin, MD, is a clinical editor for DynaMed, a database of comprehensive updated summaries covering more than 3,200 clinical topics, and Assistant Clinical Professor of Population Medicine at Harvard Medical School.
