Common Cold

(Acute Rhinitis)

Department of Pediatrics
Faculty of Medicine
Kandahar University
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June 06, 2023
 Definition
 A mild viral URTI, characterized by sneezing,
coughing, watery eyes, nasal congestion(Stuff
nose ) , sore throat, breathing difficulties, low
grade fever, etc.

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 Epidemiology
• Most common diagnosis in family medicine.
• Peaks in winter months.
• Incidence
 Children = 6–10 times/year
 Adults = 2–4 times/year

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Transmission
• Person to person contact via secretions on
skin/objects.
• Aerosol droplets.
• Etiology
 Mainly rhinoviruses (30–35% of all colds)
 Others: coronavirus, adenovirus, RSV, influenza,
parainfluenza, coxsackie virus
• Incubation
 1–5 days

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 Risk Factors
• Psychological stress
• Excessive fatigue
• Allergic nasopharyngeal disorders
• Smoking
• Sick contacts

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 Stages
• Incubation: infection – symptoms ( 12h – 3 to
5 days )
• Appearance / Progression : peaks 1-3 days
• Remission : symptoms decreasing and stops
( 3-10 days )
• Recovery : after 2 weeks ( long lasting
symptoms )

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 Clinical Features

Symptoms
• Local: nasal congestion, secretions (clear to
mucopurulent), sneezing, sore throat,
conjunctivitis, cough.
• General: malaise, headache, myalgias, mild fever.
Signs
• Erythematous nasal/oropharyngeal mucosa.
• Lymphadenopathy.
• Normal chest exam.
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 Complications
• Secondary bacterial infections
 Otitis media
 Sinusitis
 Bronchitis
 Pneumonia
• Asthma
• COPD exacerbation

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 Management
Patient education
• Symptoms peak at 1–3 days and usually subside within 1
week.
• Cough may persist for days to weeks after other
symptoms disappear.
• No antibiotics indicated because of viral etiology.
• Secondary bacterial infection can present within 3–10
days after onset of cold symptoms.
Prevention
• Frequent hand washing, avoidance of hand to mucous
membrane contact, use of surface disinfectant
• Yearly influenza vaccination 9
 Management
Symptomatic relief
• Rest, hydration, gargling warm salt water, steam, nasal
irrigation (spray/pot)
• Analgesics and antipyretics: acetaminophen, ibuprofen,
ASA (not in children because risk of Reye’s syndrome).
• Cough suppression: dextromethorphan or codeine if
necessary (children <6 year of age should not use any
cough/cold medications).
• Decongestants (e.g., Pseudoephedrine).
• Antihistamines.

Note: Patients with reactive airway disease will require

increased use of bronchodilators and inhaled corticosteroids.
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Acute Laryngotracheobronchitis
(Croup)

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 Definition
• Definition
 Inflammation of larynx, trachea, and bronchial
passageways.
• Swelling of mucosal lining associated with thick,
viscous, mucopurulent exudate which
compromises upper airway.
• Normal function of ciliated mucous membrane
impaired.

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 Etiology
• Viral
 Para-influenzae I (most common)
 Influenza (types A and B)
 RSV

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 Clinical Features
• Age: 4 months–5 years.
• Preceded by URTI symptoms.
• Generally occurs at night.
• Biphasic stridor and croupy cough (loud, sea-lion
bark).
• Appear less toxic than epiglottitis.
• Supraglottic area normal.
• Rule out foreign body and subglottic stenosis
• “Steeple-sign” on AP X-ray of neck
• If recurrent croup, think subglottic stenosis 14
“Steeple-sign” on AP X-ray of neck 15
 Treatment
• Racemic adrenaline via metered-dose inhaler
q1–2h prn (only if in respiratory distress)
• Systemic corticosteroids (e.g. dexamethasone
0.5 mg/kg, prednisolone)
• Adequate hydration
• Close observation for 3–4 hours
• Intubation if severe (use smaller endotracheal
tube than expected for age)
• Encourage oral intake
• Treat fever ( Acetamenophen/Brufen )
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 Treatment
• Avoid smoking in the home
• Keep the child's head elevated ( extra pillow)
• Stay near to child at night time

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 Treatment
• Hospitalize if poor response to steroids after 4 h
and persistent stridor at rest.
• Consider alternate diagnosis if poor response to
therapy (e.g. bacterial tracheitis).
• If recurrent episodes of croup-like symptoms,
rule out underlying subglottic stenosis and
consider bronchoscopy for definitive diagnosis.

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 Inclusion criteria
• 6 months to 6 years
• Barky cough
• Stridor
• Hoarse voice/cry

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 Exclusion criteria
• Outside age range
• Toxic appearance
• Upper airway abnormality
• Down syndrome
• Poor response to therapy
• Possible ( epiglottitis, bacterial tracheitis)

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 Severity
• Mild :
No stridor at rest ( maybe with agitation )
Occasional barky cough
No or minimal retractions
No distress
Dexa 0.6 mg/kg oral or Im ( max 10 mg )
Discharge home / Follow up

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 Severity
• Moderate :
Stridor at rest
Frequent barky cough
Mild to moderate retractions
No or minimal distress
Minimize agitation
Racemic epinephrin 2.25%,0.05 ml/kg in 3ml NS by
neubulizer
And Dexa the same in mild form
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 Severity
• Observe for 2-4 hours
If improved : Meets discharge criteria ( No
stridor and retractions,taking oral fluids,parents
able to return if needed.if yes discharge if no
transfer to ED .
Not improved or worsening: Second dose of
Epinephrin– transfer to ED

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 Severity
• Severe:
Prominent stridor, Frequent barky cough , Marked or
severe retraction, significant agitation
Minimize agitation, O2 if needed
Racemic Epinephrin : the same in moderate
Observe : vital sign and respiratory status
Consider second dose of racemic epinephrin
If no response :
Transfer to ED
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 Outpatient care
• Prednisilone 2mg /kg for 3 days
• Neubolize budesonide as effective as Dexa
• Anti tussive
• Anti histaminic
• Decongestant
• Antibiotics
• Humidified mist

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