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 


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. 


  • 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 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 


  • Otitis media

  • Sinusitis

  • Asthma exacerbation

  • Exacerbation of other pulmonary diseases
  • Loss of olfactory function 


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.


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 


  • 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


  • 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.