Management of the Common Cold

The etiology of the common cold as we all know is viral - rhinoviruses and coronaviruses most commonly, but parainfluenza viruses, RSV, adeonovirus and influenzae A or B can also be the culprits.

The symptoms are well known - rhinorrhea, sneezing, nasal obstruction, post nasal drip. Sore throat, hoarseness, cough. Many patients experience malaise, myalgia and sometimes low grade fever.

Complications include:

• contiguous infections - sinusitis, bronchitis, otitis
• exacerbation of COPD or asthma
• secondary pneumonia
• exacerbation of obstructive sleep apnea.
• reduced pulmonary functional capacity - often persisting for weeks.

Burden of Illness:

1. 10% of US population sees an MD for common cold each year
2. resulting in $1.5 billion in MD related expenses
3. $ 1 billion worth of prescriptions. Don't believe it? See JAMA 1997; 278: 901 -904 - 51% of patients diagnosed as having common colds were treated with antibiotics.

Treatment options are numerous because everyone has a remedy. The common cold has been studied extensively and there are a few lessons from these studies:

• Intranasal Ipratropium Bromide - reduces rhinorrhea and decreases sneezing if started within 1 day of onset of symptoms.
• Steam inhalation - not beneficial ( JAMA 1994; 27: 1109 -1111)
• Zinc gluconate lozenges. A RCT, double blind, placebo controlled study demonstrated that zinc gluconate lozenges ( 13.3 mg zinc) q 2 h while awake and for as long as cold symptoms persisted, reduced time to resolution of symptoms - 4.4 vs 7.6 days (Ann Intern Med 1996; 125: 81 -8). The mechanism of action ( I'm sure this is the last thing you want to know but since I found this paper I'll tell you anyhow) is postulated to be that Zn prevents rhinovirus from binding to cells and interrupts infection - Med Hypotheses 1996: 46: 295 -302.
• Vitamin C shows variable results in trials but some studies show duration and severity of cold may be decreased. The dose recommended is 2 gm per day while symptoms persist.
• Oral decongestants - questionable benefit.
• Corticosteroids - intranasal - no benefit.
• ASA and acetaminophen cause a variable effect on nasal symptoms, may suppress antibody response, and prolong viral shedding.
• There is no documented evidence supporting the use of "natural" remedies such as Echinacea

The Conclusions then are:

1. Zinc gluconate - may be helpful
2. Two grams of Vitamin C daily during the cold might help
3. Don't take 2 aspirin and call the doctor in the morning
4. Be vigilant for secondary bacterial sinusitis (this situation may need antibiotics )
5. Wash your hands frequently. Studies show that RSV can be transfered by handshaking, and we sneeze into our hands!!

- Tom Marrie

This page last updated November 13, 1997