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Common cold

The common cold (also known as "acute nasopharyngitis") is a mild viral infectious disease of the nose and throat; the upper respiratory system. Symptoms include sneezing, sniffling, running/blocked nose (often these occur simultaneously, or in only one nostril); scratchy, sore, or phlegmy throat; coughing; headache; and tiredness. Colds typically last three to five days, with residual coughing lasting up to three weeks. As its name suggests, it is the most common of all human diseases, infecting subjects at an average rate of slightly over one infection per year per person. Infection rates greater than three infections per year per person are not uncommon in some populations. more...

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Children and their caretakers are at a higher risk, probably due to the high population density of schools and the fact that transmission to family members is highly efficient.

The common cold belongs to the upper respiratory tract infections. It is different from influenza, a more severe viral infection of the respiratory tract that shows the additional symptoms of rapidly rising fever, chills, and body and muscle aches. While the common cold itself is hardly life threatening, its complications, such as pneumonia, can very well be.

Pathology

The common cold is caused by numerous viruses (mainly rhinoviruses, coronaviruses, and also certain echoviruses, paramyxoviruses, and coxsackieviruses) infecting the upper respiratory system. Several hundred cold-causing viruses have been described, and a virus can mutate to survive, ensuring that any cure is still a long way off. The viruses are transmitted from person to person by droplets resulting from coughs or sneezes. The droplets or droplet nuclei are either inhaled directly, or transmitted from hand to hand via handshakes or objects such as door knobs, and then introduced to the nasal passages when the hand touches the nose or eyes.

The virus enters the cells of the lining of the nasopharynx (the area between the nose and throat), and rapidly multiplies. The major entry points are the nose and eyes, through the nasolacrymal duct drainage into the nasopharynx. The mouth is not a major point of entry and transmission does not usually occur with kissing or swallowing. The nasopharynx is the central area infected. The reasons that the virus concentrates in the nasopharynx rather than the throat may be the low temperature and high concentration of cells with receptors needed by the virus.

The virus enters the cell by binding to ICAM-1 receptors in these cells. The presence of ICAM-1 affects whether a cell will be infected. Its concentration also can be affected by various other factors, including allergic rhinitis and some other irritants including rhinoviruses themselves. ICAM-1 has been a major focal point in drug research into cold treatments.

"Cold" as misnomer

The term "cold" (as it relates to climatic temperature) is somewhat misleading. Climate may affect transmission by some means, such as by causing people to stay indoors and increasing the proximity to infected persons, but the cause of the infection remains viral. Some allergies, bacterial respiratory infections, and even climate changes can also cause common-cold-like symptoms that can last for days.

It is not definitely known whether cold weather or a humid climate can affect transmission by other means, such as by affecting the immune system, or ICAM-1 receptor concentration, or simply increasing the amount and frequency of nasal secretions and frequency of hand to face contact. A person can best avoid colds by avoiding those who are ill and the objects that they touch, as well as by keeping their immune system in top form by getting enough sleep, reducing stress, eating nutritious foods, and avoiding excess alcohol consumption. However, researchers at the Common Cold Centre at the University of Cardiff recently demonstrated that cold temperatures can lead to a greater susceptibility to viral infection. They showed that a group of people who sat with their feet in cold water for 20 minutes a day for a week had a 1 in 3 chance of developing cold symptoms during that week, while a control group who sat with their feet in an empty bowl had a 1 in 10 chance. It is thought this may be due to cold temperatures reducing blood circulation needed to carry white blood cells to the area of infection.

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Antihistamines for the common cold clinical question
From American Family Physician, 8/1/04

How effective are antihistamines for treatment of the common cold?

Evidence-Based Answer Antihistamines are of minimal to no benefit as mono-therapy for the common cold, and first-generation anti-histamines may increase sedation in patients with a cold. Antihistamine-decongestant combinations reduce nasal symptoms and improve the recovery rate in older children and adults, but these combinations are not effective in younger children.

Practice Pointers Although antihistamines are widely used in the treatment of the common cold, particularly as part of decongestant-antihistamine combinations, there is little evidence of benefit. De Sutter and colleagues reviewed 22 randomized, controlled trials (RCTs) of antihistamines as mono-therapy and 13 RCTs of antihistamines combined with another medication, usually a decongestant. Most studies excluded patients with allergic rhinitis.

There was some evidence of a small beneficial effect of first-generation antihistamines as monotherapy for rhinorrhea and sneezing and a small short-term benefit in terms of overall recovery (number needed to treat, 14). However, more patients taking a first-generation antihistamine experienced sedation (7.9 versus 4.4 percent; absolute risk increase, 3.5 percent; number needed to harm, 29). No studies found a benefit for second-generation, nonsedating antihistamines.

Antihistamine-decongestant combinations were not effective in younger children but did improve general recovery and nasal symptoms in older children and adults. However, the latter studies did not report the magnitude of benefit, so it was difficult to tell if the benefit was clinically and not just statistically significant. Of course, the benefit may have been largely due to the decongestant alone.

MARK H. EBELL, M.D., M.S.

De Sutter AI, et al. Antihistamines for the common cold. Cochrane Data-base Syst Rev 2003;3:CD001267.

REFERENCES

(1.) Jolliffe JA, Rees K, Taylor RS, Thompson D, Oldridge N, Ebrahim S. Exercise-based rehabilitation for coronary heart disease. Cochrane Database Syst Rev 2004;1:CD001800.

(2.) Grabois M, Garrison S, Hart K, Lehmkuhl LD. Cardiac rehabilitation. In: Grabois M. Physical medicine and rehabilitation: the complete approach. Malden, Mass.: Blackwell Science, 2000:1435-56.

The Author

Jasmine Chen Gatti, M.D., is a geriatrician setting up a home visit program at Hebrew Home of Greater Washington, Rockville, Md. Dr. Gatti completed a fellowship and worked as a consultant at the Australasian Cochrane Collaboration. Address correspondence to Jasmine Chen Gatti, M.D., Hebrew Home of Greater Washington, 6121 Montrose Rd., Rockville, MD 20852-4856. (e-mail: gatti@hebrew-home.org). Reprints are not available from the author.

COPYRIGHT 2004 American Academy of Family Physicians
COPYRIGHT 2004 Gale Group

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