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


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.