Common Cold

Introduction

Because common cold has no specific cure and is self-limiting, it would be easy to dismiss the condition as unimportant.

  • Nonetheless, colds, along with coughs, represent the largest caseload for primary healthcare workers.



Clinical Features

Following an incubation period of between 1 and 3 days (although this can be as short as 10-12 hours), the patient develops a sore throat and sneezing, followed by profuse nasal discharge and congestion.

  • Cough and upper airway cough syndromes (UACS) commonly follow.
  • In addition, headache, mild to moderate fever (<38.9°C), and general malaise may be present.

Most colds resolve in 1 week, but up to 25% of people will have symptoms lasting 14 days or more.

NOTE: Acute otitis media is commonly seen in childen following a common cold and results from the virus spreading to the middle ear via the Eustachian tube, where an accumulation of pus in the middle ear or inflammation of the tympanic membrane (eardrum) results.



Questions to Ask the Patient

Some important information to be gathered include

Nature of symptoms
  • Runny or blocked nose?
    • Most patients will experience a runny nose (i.e. rhinorrhoea). This is initially a clear watery fluid, which later becomes a thicker and more tenacious, often coloured, mucus.
    • Nasal congestion occurs because of dilatation of blood vessels, which leads to swelling of the lining surfaces of the nose and can cause discomfort. This swelling narrows the nasal passages that are further blocked by increased mucus production.
  • Marked myalgia, chills and malaise are more prominent in flu than in the common cold. Loss of appetite is also common with flu.
Aggravating factors
  • Headache and pain that is worsened by sneezing, coughing and bending over suggest sinus complications.
  • If ear pain is present, especially in children, middle ear involvement is likely.
Age
  • Children or adult? If children, how many years old?

History of asthma, eczema, or intermittent allergic rhinitis in the family

  • If a first-degree relative suffers from atopy, intermittent allergic rhinitis is much more likely.



Medications

Because common cold is generally viral in origin, hence antibiotics should be avoided.

Antihistamines could theoretically reduce some of the symptoms of a cold, such as runny nose (rhinorrhoea) and sneezing, because of their antimuscarinic action.

  • This is more pronounced in the older drugs (e.g. chlorpheniramine and promethazine) than the non-sedating antihistamines (e.g. loratadine, cetirizine and acrivastine).
  • The older antihistamines may cause drowsiness, sedation, somnolence and fatigue. They also produce the same adverse effects as antimuscarinic/anticholinergic drugs (i.e. dry mouth, blurred vision, constipation and urinary retention).
  • Antihistamines are not so effective in reducing nasal congestion.

Sympathomimetics (e.g. pseudoephedrine) (nasal or oral) can be effective in reducing the symptoms of nasal congestion.

  • They work by constricting the dilated blood vessels in the nasal mucosa.
  • Sympathomimetics can cause stimulation of the heart and an increase in blood pressure, and may affect diabetic control because they can increase blood glucose levels.
  • For nasal sprays/drops, advise the patient not to use the product for longer than 7 days. Rebound congestion (i.e. rhinitis medicamentosa) can occur with topically applied sympathomimetics, but not with orally given ones.

Saline nasal drops, menthol inhalations or steam inhalations would be other possible options

OTC analgesics and antipyretics (e.g. paracetamol, ibuprofen, and naproxen) may reduce generalized pain, headache, and fever associated with the common cold.



Paediatric

Due to growing evidence of the potential harm that cough and cold medications can pose to young children, either due to adverse effects or from accidental inappropriate dosing,

At Malaysia, we are still practicing giving cough and cold mixtures for patients aged above 2 years old.



Alternative Therapies

The argument for zinc as a plausible treatment in reducing symptoms of the common cold can be traced back to 1984.

  • Zinc lozenges may decrease duration of cold symptoms in adults, but associated with bad taste and nausea.

Vitamin C has been widely recommended as a cure for the common cold by many sources, medical and nonmedical.

  • A 2013 Cochrane review found mixed evidence regarding the effectiveness of vitamin C in reducing symptoms and severity of the common cold.

The herbal remedy echinacea is marketed as a treatment for URTIs, including the common cold.

  • Clinical studies investigating the use of echinacea in the treatment of URTIs have produced inconsistent results due in part to different plant parts and extracts used and methodological problems.

Elderberry extracts may have some value in the treatment of influenza and duration of cold symptoms, and appear to have antioxidant potential.

  • Limited clinical trials have been conducted.



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