Common cold

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Not to be confused with influenza.

Common cold
Other namesCold, acute viral nasopharyngitis, nasopharyngitis, viral rhinitis, rhinopharyngitis, acute coryza, head cold,
NSAIDs[12]
Frequency2–3 per year (adults)
6–8 per year (children)[13]

The common cold or the cold is a

health problems may develop pneumonia.[3]

Well over 200

runny nose.[6][16]

There is no

cough medicines are effective.[6][18]

The common cold is the most frequent infectious disease in humans.[19] Under normal circumstances, the average adult gets two to three colds a year, while the average child may get six to eight.[8][13] Infections occur more commonly during the winter.[3] These infections have existed throughout human history.[20]

Signs and symptoms

Woman with symptoms of the common cold

The typical symptoms of a cold include

fatigue, headache, and loss of appetite.[21] A sore throat is present in about 40% of cases, a cough in about 50%,[8] and muscle ache likewise in about 50%.[4] In adults, a fever is generally not present but it is common in infants and young children.[4] The cough is usually mild compared to that accompanying influenza.[4] While a cough and a fever indicate a higher likelihood of influenza in adults, a great deal of similarity exists between these two conditions.[22] A number of the viruses that cause the common cold may also result in asymptomatic infections.[23][24]

The color of the mucus or nasal secretion may vary from clear to yellow to green and does not indicate the class of agent causing the infection.[25]

Progression

Cold symptoms over time

A cold usually begins with fatigue, a feeling of being chilled, sneezing, and a headache, followed in a couple of days by a runny nose and cough.

post-viral cough which can linger after the infection is gone.[29] In children, the cough lasts for more than ten days in 35–40% of cases and continues for more than 25 days in 10%.[30]

Causes

Viruses

Coronaviruses are a group of viruses known for causing the common cold. They have a halo or crown-like (corona) appearance when viewed under an electron microscope.

The common cold is an infection of the upper

parainfluenza and RSV.[32] Frequently more than one virus is present.[33] In total, more than 200 viral types are associated with colds.[4] The viral cause of some common colds (20–30%) is unknown.[32]

Transmission

The common cold virus is typically transmitted via airborne droplets, direct contact with infected nasal secretions, or

fomites (contaminated objects).[8][34]Which of these routes is of primary importance has not been determined.[35] As with all respiratory pathogens once presumed to transmit via respiratory droplets, it is highly likely to be carried by the aerosols generated during routine breathing, talking, and even singing.[36] The viruses may survive for prolonged periods in the environment (over 18 hours for rhinoviruses) and can be picked up by people's hands and subsequently carried to their eyes or nose where infection occurs.[34] Transmission from animals is considered highly unlikely; an outbreak documented at a British scientific base on Adelaide Island after seventeen weeks of isolation was thought to have been caused by transmission from a contaminated object or an asymptomatic human carrier, rather than from the husky dogs which were also present at the base.[37]

Transmission is common in daycare and at school due to the proximity of many children with little immunity and frequently poor hygiene.[38] These infections are then brought home to other members of the family.[38] There is no evidence that recirculated air during commercial flight is a method of transmission.[34] People sitting close to each other appear to be at greater risk of infection.[35]

Rhinovirus-caused colds are most infectious during the first three days of symptoms; they are much less infectious afterwards.[39]

Other

lower respiratory tract infections among other diseases,[44] and it is recommended that breast feeding be continued when an infant has a cold.[45] In the developed world breast feeding may not be protective against the common cold in and of itself.[46]

Pathophysiology

upper respiratory tract
.

The symptoms of the common cold are believed to be primarily related to the

trachea, it may produce the symptoms of croup, due to the small size of their airways.[48]

Diagnosis

The distinction between viral

upper respiratory tract infections is loosely based on the location of symptoms, with the common cold affecting primarily the nose (rhinitis), throat (pharyngitis), and lungs (bronchitis).[8] There can be significant overlap, and more than one area can be affected.[8] Self-diagnosis is frequent.[4] Isolation of the viral agent involved is rarely performed,[49] and it is generally not possible to identify the virus type through symptoms.[4]

Prevention

The only useful ways to reduce the spread of cold viruses are physical and

correct hand washing technique and face masks; in the healthcare environment, gowns and disposable gloves are also used.[10] Droplet precautions cannot reliably protect against inhalation of common-cold-laden aerosols. Instead, airborne precautions such as respirators, ventilation, and HEPA/high MERV filters, are likely the only reliable protection against cold-laden aerosols.[36] Isolation or quarantine is not used as the disease is so widespread and symptoms are non-specific. There is no vaccine to protect against the common cold.[50] Vaccination has proven difficult as there are many viruses involved and they mutate rapidly.[10][51] Creation of a broadly effective vaccine is, therefore, highly improbable.[52]

Regular hand washing appears to be effective in reducing the transmission of cold viruses, especially among children.

antibacterials to normal hand washing provides greater benefit is unknown.[53] Wearing face masks when around people who are infected may be beneficial; however, there is insufficient evidence for maintaining a greater social distance.[53]

It is unclear whether zinc supplements affect the likelihood of contracting a cold.[54] Routine vitamin C supplements do not reduce the risk or severity of the common cold, though they may reduce its duration.[55]

Management

Poster from 1937 encouraging citizens to "consult your physician" for treatment of the common cold

Treatments of the common cold primarily involve

placebo effect.[57] As of 2010, no medications or herbal remedies had been conclusively demonstrated to shorten the duration of infection.[58]

Symptomatic

Various treatments for the common cold - liquid and pill cold medicine, tea, throat lozenges, and over-the-counter decongestants.

Treatments that may help with symptoms include simple

over-the-counter cough and cold medication in children six years and under due to concerns regarding risks and unproven benefits.[62] The misuse of dextromethorphan (an over-the-counter cough medicine) has led to its ban in a number of countries.[64] Intranasal corticosteroids have not been found to be useful.[65]

In adults, short term use of

Ipratropium nasal spray may reduce the symptoms of a runny nose but has little effect on stuffiness.[70] Ipratropium may also help with cough in adults.[71] The safety and effectiveness of nasal decongestant use in children is unclear.[66]

Due to lack of studies, it is not known whether increased fluid intake improves symptoms or shortens respiratory illness.[72] As of 2017, heated and humidified air, such as via RhinoTherm, is of unclear benefit.[73] One study has found chest vapor rub to provide some relief of nocturnal cough, congestion, and sleep difficulty.[74]

Some advise to avoid

sneezing, or a minor sore throat.[75][76] There is a popular belief that having a hot drink can help with cold symptoms, but evidence to support this is very limited.[77]

Antibiotics and antivirals

Antibiotics have no effect against viral infections, including the common cold.[78] Due to their side effects, antibiotics cause overall harm but are still frequently prescribed.[78][79] Some of the reasons that antibiotics are so commonly prescribed include people's expectations for them, physicians' desire to help, and the difficulty in excluding complications that may be amenable to antibiotics.[80] There are no effective antiviral drugs for the common cold even though some preliminary research has shown benefits.[13][81]

Zinc

Main article: Zinc and the common cold

Zinc supplements may shorten the duration of colds by up to 33% and reduce the severity of symptoms if supplementation begins within 24 hours of the onset of symptoms.[11][54][82][83][84] Some zinc remedies directly applied to the inside of the nose have led to the loss of the sense of smell.[11][85] A 2017 review did not recommend the use of zinc for the common cold for various reasons;[18] whereas a 2017 and 2018 review both recommended the use of zinc, but also advocated further research on the topic.[82][83]

Alternative medicine

Main article: Alternative treatments used for the common cold

While there are many alternative medicines and Chinese herbal medicines supposed to treat the common cold, there is insufficient scientific evidence to support their use.[13][86] As of 2015, there is weak evidence to support nasal irrigation with saline.[87] There is no firm evidence that Echinacea products or garlic provide any meaningful benefit in treating or preventing colds.[88][89]

Vitamins C and D

Main article:
Vitamin C and the common cold
Main article: Vitamin D and respiratory tract infections

Vitamin C supplementation does not affect the incidence of the common cold, but may reduce its duration.[55] There is no conclusive evidence that vitamin D supplementation is efficacious in the prevention or treatment of respiratory tract infections.[90]

Prognosis

The common cold is generally mild and self-limiting with most symptoms generally improving in a week.

ear infection.[92] It is estimated that sinusitis occurs in 8% and ear infection in 30% of cases.[93]

Epidemiology

The common cold is the most common human disease[19] and affects people all over the globe.[38] Adults typically have two to three infections annually,[8] and children may have six to ten colds a year (and up to twelve colds a year for school children).[13] Rates of symptomatic infections increase in the elderly due to declining immunity.[40]

Weather

A common misconception is that one can "catch a cold" merely through prolonged exposure to cold weather.[94] Although it is now known that colds are viral infections, the prevalence of many such viruses are indeed seasonal, occurring more frequently during cold weather.[95] The reason for the seasonality has not been conclusively determined.[96] Possible explanations may include cold temperature-induced changes in the respiratory system,[97] decreased immune response,[98] and low humidity causing an increase in viral transmission rates, perhaps due to dry air allowing small viral droplets to disperse farther and stay in the air longer.[99]

The apparent seasonality may also be due to social factors, such as people spending more time indoors, near infected people,[97] and specifically children at school.[38][96] Although normal exposure to cold does not increase one's risk of infection, severe exposure leading to significant reduction of body temperature (hypothermia) may put one at a greater risk for the common cold; although controversial, the majority of evidence suggests that it may increase susceptibility to infection.[98]

History

A British poster from World War II describing the cost of the common cold[100]

While the cause of the common cold was identified in the 1950s, the disease appears to have been with humanity since its early history.

Ebers papyrus, the oldest existing medical text, written before the 16th century BCE.[101] The name "cold" came into use in the 16th century, due to the similarity between its symptoms and those of exposure to cold weather.[102]

In the United Kingdom, the

Medical Research Council in 1946 and it was where the rhinovirus was discovered in 1956.[103] In the 1970s, the CCU demonstrated that treatment with interferon during the incubation phase of rhinovirus infection protects somewhat against the disease,[104] but no practical treatment could be developed. The unit was closed in 1989, two years after it completed research of zinc gluconate lozenges in the prevention and treatment of rhinovirus colds, the only successful treatment in the history of the unit.[105]

Research directions

Antivirals have been tested for effectiveness in the common cold; as of 2009, none had been both found effective and licensed for use.[81] There are trials of the anti-viral drug pleconaril which shows promise against picornaviruses as well as trials of BTA-798.[106] The oral form of pleconaril had safety issues and an aerosol form is being studied.[106] The genomes of all known human rhinovirus strains have been sequenced.[107]

Societal impact

The economic impact of the common cold is not well understood in much of the world.

antibiotic resistance.[108] An estimated 22–189 million school days are missed annually due to a cold. As a result, parents missed 126 million workdays to stay home to care for their children. When added to the 150 million workdays missed by employees who have a cold, the total economic impact of cold-related work loss exceeds $20 billion per year.[56][108] This accounts for 40% of time lost from work in the United States.[109]

References

Notes

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Bibliography

External links

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