Common Cold

The all-too-common cold More than 200 different viruses are responsible for what we call the common cold. But regardless of the speciful culprit, the course is the same: You get sick. You get tired muscles, a stuffy nose, a sore throat, and headaches. Throughout the year, you may catch between two to four colds -- for kids it's more like eight to 12.
Synonyms
  • Upper respiratory infection
  • Acute nasopharyngitis
Detailed Description
  • Less serious than the flu, colds plague people year round, though they are most common during late fall, winter, and early spring. Typically, colds start to exhibit symptoms one to three days after infection. A cold begins with a sore throat and discomfort in the nose. As the cold progresses you'll start sneezing, coughing, developing a runny nose, and feeling generally ill. Sometimes a slight fever may develop when symptoms start surfacing. Initially, secretions from the nose are clear and watery; as the cold progresses they tend to become thick, opaque, and yellow-green in color.
  • Most cold viruses -- all 200-plus of them -- are quite contagious via the air -- when someone coughs or sneezes -- and direct contact with fingers or tissues that have been exposed to the virus. It is very important to try to limit this type of contact when suffering from a cold.
  • Most adults battle a cold two to four times a year. This number can increase for those working in a school or healthcare environment as well as those with small children. Children may experience up to eight to 12 colds per year.
  • The best way to treat colds is with rest, fluids, and chicken soup. Yes, the chicken-soup connection has finally been studied, and chicken soup (the spicier the better, so toss in a few hot peppers) does indeed help treat the symptoms of the common cold. So curl up with a warm blanket and a hot bowl of soup, followed by a nice long nap. You'll be back on your way to being healthy in no time. Antibiotics have no place in the treatment of viral infections.
  • If symptoms persist beyond two weeks or get worse, it may be necessary to consult your doctor as you may be dealing with a bacterial rather than a viral infection. Some colds can lead to a bacterial infection of the ears, sinuses, windpipe, and airways. These infections may require antibiotic treatment. Individuals with persistent bronchitis or asthma may find breathing more difficult when dealing with a cold, and thus may need earlier attention from their doctor.
  • It is still unknown why some people get colds and others don't. People experiencing fatigue or emotional distress are more likely to contract a cold, as are those with poor hygiene. It is believed that the best way to prevent a cold is to get adequate rest and remember to wash your hands frequently.
Characteristics of the Common Cold Most colds start with a sore throat and discomfort in the nose. As the cold progresses you'll start sneezing, coughing, develop a runny nose, and feeling generally ill. Sometimes a slight fever may develop when symptoms start surfacing. Initially, secretions from the nose are clear and watery; as the cold progresses they tend to become thick and opaque.
How Common Is the Common Cold The name says it all. Colds occur most frequently during the winter season. All ages are affected, with children being most susceptible. Both sexes are equally likely to catch a cold. What You Can Expect Colds usually run their course in four to 10 days, though most people experience the cough for a bit longer as the body and cough reflex area recovers from the viral irritation to the tissues. Sometimes complications can arise such as bacterial infections of the ears, throat, sinuses, or lungs that require medical attention and antibiotics. Other signs that you should see a doctor:
  • Difficult or painful breathing
  • Persistent fever and chills
  • Earache
  • Severe headache
  • Enlarged and tender lymph nodes in the neck
Cold medications and cough suppressants can make you more comfortable during the course of a normal cold, but they cannot "cure" a cold. There is no cure for the common cold. Established Causes The common cold is caused by any of more than 200 viruses spread by person-to-person contact or via the air. The most common include rhinoviruses and adenoviruses. In 40% of cases, however, no agent is identified. Identification of the virus type would not change treatment, as it is your immune system that fights off all viruses. Drugs That Can Cause or Aggravate the Common Cold There are no drugs that can cause the common cold. However, drugs that suppress the immune system can make a person more susceptible to infectious conditions, including the common cold.
Risk Factors Contrary to popular belief, cold weather does not cause the common cold. It may, however, increase the frequency and level of risk of infection (colds appear more often during the winter). Other risks you should be aware of:
  • Being present in public places over an extended period of time. Children attending daycare and/or school most often contract colds this way.
  • Another household member with a cold (extremely contagious).
  • Crowded and/or unsanitary living conditions. This type of environment is conducive to harvesting cold viruses, and contaminated items facilitate the spread of the virus.
  • Direct contact with infected individuals. The common cold spreads through simple touch, such as kissing or merely shaking hands.
  • Stress, fatigue, and/or allergic disorders. These weaken the immune response and expedite infection.
Risk factors are traits or behaviors that may make you statistically more likely than others in the general population to have a certain condition. They are not necessarily "causes" of the condition. Symptoms Most symptoms of the common cold are associated with irritation of the respiratory passages. These include a combination of any of the following: Conditions That May Be Mistaken for the Common ColdThe most common condition confused with the common cold is the flu, another highly contagious viral infection. Other conditions may also resemble the common cold:
  • Mumps
  • Rubella
  • Epstein-Barr virus
  • Seasonal allergies
How the Common Cold Is Diagnosed Your own observation of symptoms is often enough. Medical history and physical exam by your doctor is also sometimes necessary, and supportive measures are taken to help the immune system do its job.
Laboratory Work The following tests may be performed to assist in a diagnosis:
  • A throat culture to differentiate a cold virus from bacterial infection by streptococcus or other germs
  • Complete blood count (CBC) if symptoms continue to persist after 10 days
Specific Tests Rapid antigen tests for various respiratory viruses are available for patients requiring hospitalization. Goals of Treatment There is no known cure for the common cold. However, the symptoms of a cold can be treated with a variety of over-the-counter cold medications -- that can help loosen mucus secretions, soothe the nose and throat, and may strengthen the immune system -- in addition to rest and plenty of fluids. Treatment Overview When dealing with a cold, the best thing you can do is rest, stay warm and comfortable, drink plenty of fluids, and let your immune system do its work. The immune system works best when our bodies are at rest -- ideally, in a sleep state. The more rest, the better. Fluids have several benefits. Viruses thrive when the membranes of the respiratory tract become dehydrated. By drinking plenty of fluids, you prevent dehydration and decrease the chance of infection. Proper fluids also aid the white blood cells as well as keeping mucus thin and loose. Viral infection is repelled by a moist respiratory tract, and drinking liquids also improves white blood cell function. Keep sugar intake at a minimum. Avoid milk, as it can thicken secretions.

To help ease your symptoms you can also try gargling with warm, salty water soothes a sore throat. Sucking on hard candy helps keep it lubricated.
Current Therapies AvailableThere are many over-the-counter medications that are known to help reduce the symptoms of a common cold. Various tablets, capsules, syrups, sprays, rubs, and liquids can help reduce fevers and treat sore throat, congestion, cough, runny nose, and sneezing.
  • Topical decongestants help break down congestion and promote drainage
  • Topical anticholinergics help control rhinorrhea (runny nose) but offer no relief from sneezing or nasal congestion
  • Oral decongestants help break down congestion and promote drainage; oral decongestants tend to work longer than topical anticholinergenics
  • Antihistamines help alleviate sneezing as well as drying out mucus; their sedative qualities have also been known to help promote rest
  • Cough suppressants subdue coughs and have the added benefit of sometimes encouraging drowsiness so that you can rest
  • Expectorants are sometimes selected when a patient wants to cough up the mucus accumulating in the lungs
Coughing may, in some cases, be the only way to clear secretions and other debris from the airways during a cold. For this reason, some say it is wise to leave a cough untreated unless it interferes with sleep or is causing great discomfort.

Vaporizers and cool-mist humidifiers can be used to increase air moisture to assist in loosening mucus and reducing chest tightness.

Acetaminophen (such as Tylenol), ibuprofen (such as Advil) and aspirin may be used to reduce fever. Do not give aspirin to anyone under 18 years of age during a viral infection due to an increased risk of Reye's syndrome, a potentially life-threatening disorder.

Before you self-medicate with over-the-counter cold and cough medications, check with your doctor. Some are contraindicated if you have heart disease, hypertension, or diabetes, or in older men with prostate problems.
Drug TherapyDrugs Most Commonly Prescribed Various tablets, capsules, syrups, sprays, rubs, and liquids can help in treating sore throat, congestion, cough, runny nose, sneezing, and fever.
  • Nonprescription, over-the-counter drugs such as acetaminophen (Tylenol) may be used to alleviate aches. Aspirin may also be used, but not for children under 18 experiencing a viral infection.
  • Antihistamines are effective in relieving sneezing.
  • Cough suppressants such as codeine and dextromethorphan alleviate nonproductive coughs.
  • Avoid using nasal decongestants and drops for more than a few days to prevent possible side effects and rebound congestion. Sprays are preferred for children over six.
  • Antibiotics will not speed up treatment, but may be taken in the infrequent case of a secondary bacterial infection. Otherwise they may cause unwanted and unnecessary side effects with no benefit.
Activity and Diet Recommendations It is important to emphasize the importance of rest in dealing with a cold. The immune system functions at its peak when our bodies are at rest. Vigorous activities should be avoided, but if you feel up to it, light activities are OK. Again, avoid dehydration. It should also be noted that due to the contagious nature of the common cold, physical contact with others should be limited. Frequent hand-washing is also recommended to prevent spreading the virus.
Fluids are the key to your diet when you have a cold. Be sure to drink plenty of fluids, but avoid milk since it may thicken mucus secretions. Also avoid liquids containing high amounts of sugar in any form, including the following:
  • Glucose
  • Fructose
  • Sucrose
  • Honey
It has been shown that sugar greatly reduces the white blood cells' ability to fight and kill bacteria. Contrary to popular belief, orange juice is one of the biggest no-no's when dealing with a cold. The high levels of sugar greatly counteract any benefit from the vitamin C present in the juice.

Hot liquids help treat a cold by thinning mucus and clearing congestion. The classic remedy of chicken soup has actually been confirmed in medical studies to ease cold symptoms.
Managing Common Cold Treatment To prevent further irritation and prolonged symptoms, avoid smoking or exposure to secondhand smoke during a cold.
Monitoring the Condition Recovery generally occurs spontaneously after seven to 10 days. Contact your doctor if symptoms continue to worsen.
Possible Complications Secondary bacterial infections of other areas such as the ears, throats, sinuses, or lungs may sometimes occur. In these cases, an antibiotic is prescribed. Colds are often further complicated in individuals with a history of chronic respiratory disorders such as asthma and emphysema, as well as chronic congestive heart failure, diabetes, or cancer.
Quality of Life With proper treatment, a cold will only have a minor, short-term effect on your day-to-day life. However, if precautions such as rest and drinking plenty of fluids are not taken, you increase your chances of acquiring a secondary infection. These secondary infections may require antibiotics and increase the amount of "downtime" needed to fight a cold.
Considerations for Women Pregnancy
Codeine may pose a risk to the fetus. Consult your doctor before taking any medication while pregnant. Considerations for Children and Adolescents
  • Children are especially susceptible to the common cold. In the case of fever, acetaminophen (Tylenol) may be used. Do not give aspirin to anyone under 18 years of age during a viral infection. This could increase the risk of Reye's syndrome, which is a serious and potentially life-threatening disorder.
  • For babies too young to blow their noses, an infant nasal aspirator or bulb syringe may be used. If mucus is thick and sticky it may be loosened by using two or three drops of salt water solution (1/4 teaspoon of salt to one cup of warm water). Tissues and swabs may be used to remove discharge from the nose -- however, do not insert cotton swabs into a child's nostrils.
  • Very young children and infants may gain relief by sleeping on their backs. Upright or propped sleep may help babies with cold symptoms-- in a car seat, for instance. This position may improve nasal drainage and breathing.
Considerations for Older People
  • Any medication use should be monitored carefully, since even over-the-counter drugs are more likely to cause adverse effects in older individuals. Colds are more serious in older people due to weakened immune systems caused by age.
Herbs
  • Echinacea: This herb is a very popular cold treatment. Several studies show it may relieve symptoms and shorten colds. For example, Swedish researchers gave 60 people in the initial stages of colds either a placebo or a tincture (alcohol extract) of echinacea (20 drops every two hours for the first day, then three times a day for up to 10 days). Colds in the placebo group cleared up in about eight days. But in the echinacea group, they were gone in just four days. (Echinacea may cause temporary, harmless numbing of the tongue.) [1]
  • Yin Chiao Chieh Tu Pien (pronounced "yin chow chee dew peean"): A popular over-the-counter cold formula in China, it contains several herbs, including honeysuckle and forsythia. [5]
Supplements
  • Vitamin C: Vitamin C supplementation (500 mg four times a day, or more) is an increasingly popular component of treatment for the common cold, although debate continues about its effectiveness. However, Finnish researchers who analyzed 21 vitamin C studies found that the vitamin reduced average symptom scores by 23%. [2]
  • Zinc: sucking on zinc lozenges may also help a cold. Two noted studies have shown that zinc (taken every two waking hours) may shorten colds. [3, 4] However, in some people, it can cause stomach upset or nausea. Try zinc lozenges after eating.
Homeopathy
  • Homeopathic medicine is based on the idea that some conditions can be cured by administering small amounts of drugs or substances that, in a healthy person, would produce symptoms like that of the disease -- thereby working with, not against, the body's natural defense systems.
  • Dutch researchers gave 175 children plagued by frequent colds either a placebo or homeopathic medicines personalized for each child. The homeopathic group experienced some symptom relief. [6] Homeopaths recommend several medicines for colds, among them Allium cepa (onion).[7]
Sources
  • 1 Hoheisel. O. et al. "Echinagard Treatment Shortens The Course of the Common Cold: A Double-Blind, Placebo-Controlled Clinical Trial," European Journal of Clinical Research 9:261, 1997.
  • 2 Hemila, "Does Vitamin C Alleviate Symptoms of the Common Cold?" Scandinavian Journal of Infectious Diseases 26:1, 1994.
  • 3 Eby, G., et al. "Reduction in Duration of Common Colds by Zinc Gluconate Lozenges: A Double-Blind Study. Antimicrobial Agents and Chemotherapy 25:20, 1984.
  • 4 Godfrey, J.C. "Zinc Gluconate and the Common Cold: A Controlled Clinical Study," Journal of International Medical Research 20:234, 1992.
  • 5 Beinfield, H. and E. Korngold. Between Heaven and Earth: A Guide to Chinese Medicine. New York: Ballantine, 1991.
  • 6 DeLange de Klerk, E.S., et al. "Effect of Homeopathic Medicines on Daily Burden of Symptoms in Children with Recurrent Upper Respiratory Infections," British Medical Journal (1994) 309(6965):1329.
  • 7 Tyler, V. Herbs of Choice, New York: Pharmaceutical Products Press, pp. 90-93, 1994.
Preventing the Common Cold
  • The best prevention for the common cold is good hygiene. Because of the contagious nature of the common cold, hands should be washed frequently, used tissues should be disposed of carefully, and personal items and common surfaces should be cleaned to prevent the spreading of the virus.
  • A strong immune system may help reduce the number of times a person "catches" a cold. Proper nutrition, hygiene, rest, and stress management can help prevent the common cold. Though the theory is controversial, some say that large quantities of vitamin C can help strengthen the body and ward off colds as well.
Self-Care Measures Once you have contracted a cold, it is important to take good care of yourself, to shorten its duration. The following are ways to pamper yourself until you are feeling better:
  • Drink hot liquids. They soothe the throat and have decongestant action. One study suggests that chicken soup, a traditional cold remedy, is a better decongestant than other hot liquids.
  • Pay attention to milk's effects on you. Some people swear it thickens their respiratory mucus when they have colds, adding to their congestion. While this claim is unproven, you might want to avoid dairy items for a few days if they seem to aggravate your symptoms.
  • Try to cut down on sugar. Some research suggests that sugar (sucrose, fructose, honey) impairs the white blood cells that fight cold viruses. In one study, 100 grams of sugar (about the amount in two cans of soda) significantly reduced white blood cell activity.
  • Rest. Give yourself a chance to heal. Resting also limits your contact with other people, so there's less chance of spreading your cold.
  • Stay away from respiratory irritants. Substances like smoke, dust, and chemical fumes can irritate the lungs and worsen coughs.
Websites & Organizations Sources for This Article Books
  • Balch, James F. and Balch, Phyllis A. Prescription for Nutritional Healing. Garden City Park, NY: Avery Publishing, 1997.
  • Beinfield, H. and E. Korngold. Between Heaven and Earth: A Guide to Chinese Medicine. New York: Ballantine, 1991.
  • Bennett, J. Claude and Plum, Fred. Cecil Textbook of Medicine, eds. Philadelphia: W. B. Saunders, 1996.
  • Fauci, Anthony J. et. al. Harrison's Principles of Internal Medicine, eds. New York: McGraw-Hill, 1998.
  • Hurst, J. Willis. Medicine for the Practicing Physician eds. Stamford, CT: Appleton & Lange 1996.
  • Murray, Michael T. Encyclopedia of Natural Medicine. Prima, 1998.
  • Noble, John. Primary Care Medicine ed. St. Louis: Mosby, 1996.
  • Physicians' Desk Reference. Montvale, NJ: Medical Economics Co., 1998.
  • Rakel, Robert E. Conn's Current Therapy eds. Philadelphia: W.B. Saunders, 1998.
  • Taylor, Robert B. Family Medicine: Principles and Practice. New York: Springer-Verlag, 1998.
  • Tierney, LM, McPhee, SJ, and Papadakis, MA. Current Medical Diagnosis and Treatment eds. Stamford, CT: Appleton & Lange, 1998.
  • Tyler, V. Herbs of Choice, New York: Pharmaceutical Products Press, pp. 90-93, 1994.
Articles
  • DeLange de Klerk, ES, et al. "Effect of Homeopathic Medicines on Daily Burden of Symptoms in Children with Recurrent Upper Respiratory Infections," BMJ, 309(6965):1329, 1994.
  • Eby, G. et al. "Reduction in Duration of Common Colds by Zinc Gluconate Lozenges: A Double-Blind Study. Antimicrobial Agents and Chemotherapy, 25:20, 1984.
  • Eccles, R, Van Cauwenberge, P, Tetzloff, W, Borum, P. "A Clinical Study to Evaluate the Efficacy of the Antihistamine Doxylamine Succinate in the Relief of Runny Nose and Sneezing Associated with Upper Respiratory Tract Infection." J Pharm Pharmacol. 47(12A): 990-993. 1995.
  • Garland, ML, Hagmeyer, KO. "The Role of Zinc Lozenges in Treatment of the Common Cold." Ann Pharmacother. 32(1): 63-69. 1998.
  • Godfrey, J.C. "Zinc Gluconate and the Common Cold: A Controlled Clinical Study," Journal of International Medical Research, 20:234, 1992.
  • Gwaltney, JM Jr, Buier, RM, Rogers, JL. "The Influence of Signal Variation, Bias Noise and Effect Size on Statistical Significance in Treatment Studies of the Comon Cold." Antiviral Res. 29(2-3): 287-295. 1996.
  • Hemila, "Does Vitamin C Alleviate Symptoms of the Common Cold?" Scandinavian Journal of Infectious Diseases, 26:1, 1994.
  • Hemil"a, H. "Vitamin C Intake and Susceptibility to the Common Cold." Br J Nutr. 77(1): 59-72. 1997.
  • Hemil,a H. "Vitamin C Supplementation and Common Cold Symptoms: Problems with Inaccurate Reviews." Nutrition. 12(11-12): 804-809.
  • Hoheisel. O. et al. "Echinagard Treatment Shortens The Course of the Common Cold: A Double-Blind, Placebo-Controlled Clinical Trial," Europ. J. of Clinical Research, 9:261, 1997.
  • Jaakkola, JJ, Heinonen, OP. "Shared Office Space and the Risk of the Common Cold." Eur J Epidemiol. 11(2): 213-216. 1995.
  • Puhakka, T, M' akel" a MJ, Malmstr" om, K, Uhari, M, Savolainen, J, Terho, EO, Pulkkinen, M, Ruuskanen, O. "The Common Cold: Effects of Intranasal Fluticasone Propionate Treatment." J Allergy Clin Immunonol. 101(6 pt 1):726-731. 1998.
  • Sakethoo, K. et al. "Effects of Drinking Hot Water, Cold Water, and Chicken Soup on Nasal Mucus Velocity and Nasal Airflow Resistance," Chest, 74:408, 1978.
  • Sanchez, A. et al. "Role of Sugar in Human Neutrophilic Phagocytosis," Am. J. Clin. Nutrition, 26:1180, 1973.
  • Turner, RB. "Epidemiology, Pathogenesis, and Treatment of the Common Cold." Ann Allergy Asthma Immunol. 78(6): 531-539. 1997.
  • Winther, B. "Effects on the Nasal Mucosa of Upper Respiratory Virsuses (common cold)." Dan Med Bull. 41(2): 193-204. 1994.
  • "Zinc Lozenges Reduce the Duration of Common Cold Symptoms." Nutr Rev. 55(3): 82-85. 1997.

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