Common Cold 29/09/2022, 8:59 PM

Common Cold
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Background
The common cold, known also as viral rhinitis, rhinopharyngitis, and acute coryza is a type of a self-limiting acute upper respiratory
tract infection. It is one of the most frequent acute illnesses that people seek treatment for at a primary care center. It is a self-
limiting disease, children can have an average of up to five colds per year and adults can have an average of two to three colds per
year. 

Etiology
The common cold is viral in nature, encompassing more than 200 subtypes of viruses. The most common ones are rhinoviruses
followed by coronaviruses. Seasonal variations are common, with rhinovirus and parainfluenza virus outbreaks during fall and late
spring, and respiratory syncytial virus (RSV) and coronavirus infections common during winter and spring. 

Transmission can occur with hand contact or droplets via sneezing or coughing. 

It should be noted that the common cold is a distinct disease and should be distinguished from similar diseases that affect the
same upper respiratory tract system (Table 5.1).

Disease  How to differentiate from common cold

Influenza  High fever, headache, and myalgias mostly

Pharyngitis  Sore throat rather than rhinorrhea 

Acute bronchitis Persistent dry or wet cough prominently 

Acute bacterial rhinosinusitis Presence of facial pain associated with purulent nasal discharge

Allergic rhinitis Chronic, with history of atopy 

Pertussis Prolonged coughing, typically paroxysmal, with vomiting and sometimes apnea

Table 5.1 – Differential diagnosis for the common cold

Risk factors
History of chronic diseases 

Immunodeficiency disorders 

Cigarette smoking 

Daycare children

Malnourishment 

Assessment
Diagnosis of the common cold is mainly clinical with a history of having: 

Nasal congestion and rhinorrhea (the most reported symptoms)

Dry cough

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Malaise

Headache

Low grade fever in children

Conjunctivitis

Dry throat described as “scratchy”

Physical examination may reveal: 

Conjunctival injection

Nasal mucosal swelling

Nasal congestion

Pharyngeal erythema

Adenopathy is typically absent or minimal

In the absence of secondary bronchospasm, the lung examination is typically clear

Investigations
Since the diagnosis is made clinically, there is no need for investigations. Chest radiograph is only indicated if a lower respiratory
tract infection is suspected such as pneumonia or other parenchymal disease. 

Red flags in the pediatric population that may prompt further evaluation 

Worsening symptoms such as a fever higher than 101°F (38.3°C)

Shortness of breath

Very bad headache or facial pain

Poor feeding

Confusion

Excessive crying 

Expected course of illness

The common cold lasts from 3 days with an average of 10 days in healthy people and may have a duration of two weeks in 25% of
adults. Smoking can prolong the duration of the disease and the cough can last even longer for up to 3 weeks after other
symptoms resolve. 

Management
Since the disease is self-limiting, treatment is supportive in reducing the severity and duration of symptoms. We can classify the
available remedies into those proven effective, those with uncertain benefit, and infective treatments (Table 2). 

Adult management
Proven
effective Evidence

Analgesics NSAIDs and paracetamol have been shown to reduce headache, ear pain, muscle pain, joint pain, and sneezing,
give short term relief of rhinorrhea and nasal obstruction but do not improve cough, cold duration, or total
symptom score. 

Decongestants Topical oxymetazoline or phenylephrine, which is included in many over-the-counter intranasal decongestants,
reduces the duration and severity of nasal congestion after multiple doses.  Patients should be warned about

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the risk of rhinitis medicamentosa when intranasal oxymetazoline is used for more than three days.

Antihistamines Antihistamines combined with oral decongestants and/or analgesics may provide some relief of cold
combined with symptoms.
decongestant

Ipratropium The only medication found to work on persistent cough related to URI and it improves cough within the first
10 days of treatment.

Zinc and Three studies that used zinc acetate in daily doses of over 75 mg showed significant reduction in duration of
complementary symptoms,Probiotics have good evidence in treatment. RCT showed daily use of lactobacillus for three months
treatments reduced the duration by 1.5 days.

Uncertain Evidence
benefit

Nasal irrigation Only effective in chronic rhinosinusitis, no active role in the common cold.

Increased fluid Commonly recommended, but low-quality data suggest that it may not provide benefit and in rare cases can
intake cause hyponatremia. Good evidence is similarly lacking for  acetylcysteine, garlic, and Chinese medicinal
herbs.

Ineffective Evidence
treatment

Antibiotics Antibiotics have no role in the treatment of the common cold. They do not reduce the severity or duration of
symptoms, even when purulent rhinitis is present. 

Antihistamine No more effective than placebo for the treatment of cold symptoms. First-generation antihistamines, such as
monotherapy diphenhydramine, may alleviate rhinorrhea and sneezing, but their use is limited by side effects such as
sedation and drying of the eyes, nose, and mouth.

Antiviral There are no effective antiviral therapies for the prevention of viral rhinitis. Directed antiviral therapy for the
therapy common cold is complicated by the wide array of potential viral etiologies, rarity with which an etiologic
agent is identified, and paucity of agents with proven efficacy.

Antitussives They have little benefit in the treatment of cough due to the common cold. 
and
expectorants

Intranasal Three small trials found no evidence that intranasal corticosteroids relieve symptoms of the common cold.
corticosteroids

Complementary Neither steam nor vitamin D supplementation improves symptoms of the common cold. Once symptoms have
and alternative developed, vitamin C has no effect on symptom duration or severity. 
treatments

Table 5.2 – Medications for the common cold in adults

Pediatric management 
Supportive care is the key for the management of the common cold in children.

Maintaining adequate hydration may help to thin secretions and soothe the respiratory mucosa.

Ingestion of warm fluids may have a soothing effect on the respiratory mucosa, increase the flow of nasal mucus, and loosen
respiratory secretions, making them easier to remove.

Fever

The primary goal of treating the febrile child should be to improve the child’s overall comfort rather than decreasing body
temperature.

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Although combining or alternating paracetamol and ibuprofen may be more effective than either agent alone in reducing
fever, alternating between those medications exposes the child to the risk of medication confusion and overdosing.

Nasal symptoms 

Topical saline may be beneficial. The application of saline to the nasal cavity may temporarily remove bothersome nasal
secretions, improve mucociliary clearance, and lead to vasoconstriction (decongestion).

A cool mist humidifier/vaporizer may help to loosen nasal secretions, although this treatment is not well studied.

Intranasal ipratropium may decrease rhinorrhea but not congestion related to URIs in children five years and older. It should
not be used in children younger than five years.

Cough

Cough may be relieved with oral hydration, warm fluids, honey (in children older than one year), cough lozenges, or hard
candy (in children in whom they are not an aspiration risk) rather than OTC or prescription antitussives, antihistamines,
expectorants, or mucolytics.

Complementary and alternative treatments

Topical application over the chest and neck with camphor ointment, menthol, and eucalyptus oils before sleeping reduces
night cough frequency and severity in addition to easing the nasal obstruction. This provides a good night’s sleep for the child
and their caregivers. Menthol is safely used in children more than 2 years old and was perceived to improve nasal patency but
may not help with cough.

Vitamin C does not reduce symptom duration or severity once symptoms have developed. Regular intake of vitamin C does not
aid in preventing or reducing the incidence of URI. However, daily vitamin C supplementation may shorten the duration of the
common cold in children by 18% (about 1 to 2 days).

Medications not recommended and not shown to have benefit in children

Antibiotics

Antihistamines

Antitussives

Intranasal glucocorticoids

Bronchodilators

Complications of the common cold

Secondary acute bacterial rhinosinusitis

May cause eustachian tube dysfunction which may lead to acute otitis media

Certain pathogens that cause the common cold, particularly respiratory syncytial virus (RSV) and parainfluenza virus, can also
produce lower respiratory tract findings. These findings can range from bronchitis, to bronchiolitis, to pneumonia.

Prevention
Good hand hygiene, whether using alcohol sanitizer or washing hands with soap is the most effective and practical way to prevent
URIs in children and adults. 

Due to a variety of causative viruses that are continuously changing, no vaccines are available. There is no evidence that using
multivitamins or other vitamins have shown any benefit to decreasing the incidence of the common cold.

Children do not need to be excluded from child care or school because the risk of infection can be minimized with good hand
hygiene. The transmission may occur before the childis symptomatic.

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