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Overview |
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Definition |
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The common cold is a viral upper respiratory infection. It accounts for at
least one-half of all human illnesses. In the United States, adults average
between 3 and 5.6 colds a year, while children have as many as
8.3. |
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Etiology |
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More than 200 possible serologically different viruses cause colds. They are
transmitted by respiratory droplets, hand-to-hand, or by object contact.
Exposure to cold and fatigue do not increase susceptibility, although
psychological stress may. |
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Risk Factors |
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- Day care centers and office buildings
- Large family size
- Poor hygiene
- Psychological stress—can increase rate and
severity
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Signs and Symptoms |
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- Rhinorrhea, sneezing, nasal congestion
- Sore throat, cough, or hoarseness
- Fever (uncommon in adults, usually indicates flu or bacterial
infection)
- In children, sudden onset of fever (lasting two to three days),
irritability, restlessness, and sneezing
- Headache
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Differential
Diagnosis |
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- Asthma
- Sinusitis
- Pneumonia
- Bronchitis, bronchiolitis
- Flu
- Allergic rhinitis
- Children—initial symptoms of measles or
pertussis; intranasal foreign body
- Infants—choanal atresia or congenital
syphilis
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Diagnosis |
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Physical Examination |
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The patient may be sneezing, have a runny nose, look fatigued, and complain
of sore throat, rarely of diarrhea or vomiting. |
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Laboratory Tests |
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Cultures are rarely done for diagnostic purposes but are performed for
research. |
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Pathology/Pathophysiology |
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Cultures determine the type of infection:
- Rhinoviruses—15% to 40% of colds; grows at
33 to 34°C (temperature of the nasal passages); one subtype, 100
serotypes
- Coronaviruses—10% to 20% of colds; three
subgroups
- Adenoviruses—3% to 5% of children's colds,
less than 2% of adults; six subgenera (A to F) and 47 serotypes
- Respiratory syncytial virus and parainfluenza
viruses—can cause colds but more likely to cause lower
respiratory tract infections, especially in children
- Edematous and hyperemic mucosa; hyperactive mucus glands
- Inflammatory cells include neutrophils, lymphocytes, plasma cells,
and eosinophils.
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Imaging |
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Computed tomography scans may show bilateral abnormalities in the ethmoid and
maxillary sinuses, with residual density possible in the maxillary sinus two
weeks after resolution. |
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Other Diagnostic
Procedures |
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- Self-diagnosis is generally accurate.
- Diagnosis can be made only by isolation of the virus (e.g., by nasal
wash), which is done almost exclusively for research purposes (e.g.,
rhinoviruses—grown in human embryonic lung
fibroblasts).
- Antibodies for rhinovirus receptors are currently being
researched.
- Experimental serotype vaccines are available but of little use given
the large number of possible
serotypes.
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Treatment Options |
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Treatment Strategy |
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There is no known antiviral treatment for the common cold, which is generally
benign and self-limited. Live vaccines exist for adenovirus types 4 and 7,
primarily for use in the military. Antibiotics should not be given unless there
are bacterial complications. Antihistamines are inappropriate and may increase
and/or prolong congestion. Treatment is primarily to relieve
symptoms. |
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Drug Therapies |
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- Nasal decongestants: may aid in preventing sinus and eustachian tube
obstruction (e.g., pseudoephedrine 60 mg tid); general vasoconstriction may
cause high blood pressure
- Nasal sprays: localized decongestant; rebound effect after three to
five days
- Analgesics: can be used for malaise; may delay immune response or
increase nasal symptoms; aspirin can cause Reye's syndrome in
children
- Adequate hydration: loosens secretions
- Warm fluids and steam inhalation: provide symptom relief by
increasing the rate of mucus flow
- Reduced activity: helps avoid
complications
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Complementary and Alternative
Therapies |
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Alternative therapies offer effective symptom relief. General measures for
treating infection are to get plenty of fluids and rest. |
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Nutrition |
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- Vitamin C (1,000 mg three to six times/day) enhances immune function
(may affect interferon and interleukin); some studies show that it shortens the
duration and ameliorates the symptoms of the common cold.
- Zinc (23 mg lozenges taken every two hours) may shorten the duration
of a cold, and may also protect against the development of symptoms. This high a
dose is for short-term use only.
- Vitamin A (25,000 IU/day) maintains integrity of mucous membranes and
stimulates antibody response. Use high dose short-term only.
- Beta-carotene (200,000 IU/day) stimulates the immune system and is an
antioxidant; safe in women of childbearing years.
- Avoid dairy and bananas, foods that increase mucus
production.
- Garlic and onions are antivirals that can be included in the
diet.
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Herbs |
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Herbs are generally a safe way to strengthen and tone the body's systems. As
with any therapy, it is important to ascertain a diagnosis before pursuing
treatment. Herbs may be used as dried extracts (capsules, powders, teas),
glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless
otherwise indicated, teas should be made with 1 tsp. herb per cup of hot water.
Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for
roots. Drink 2 to 4 cups/day. Tinctures may be used singly or in combination as
noted.
- Coneflower (Echinacea purpurea): immunomodulating, increases
phagocytosis; controversy exists whether to use for longer than two to six weeks
at a time and whether to use in autoimmune conditions or AIDS.
- Goldenseal (Hydrastis canadensis): antiviral, antibacterial
- Astragalus (Astragalus membranaceus): increases interferon to
shorten duration of colds
- Licorice (Glycyrrhiza glabra): antiviral, soothing to mucous
membranes
- Elderberry (Sambucus nigra): antiviral, increases bronchial
secretions
Use a mix of the above every two to four hours (1 cup tea or 30 to 60 drops
tincture). |
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Homeopathy |
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An experienced homeopath should assess individual constitutional types and
severity of disease to select the correct remedy and potency. For acute
prescribing use 3 to 5 pellets of a 12X to 30C remedy every one to four hours
until acute symptoms resolve.
- Allium cepa for colds with profuse watery discharge that burns
and/or irritates the nostrils
- Euphrasia for colds with profuse watery discharge that is
irritating to the eyes
- Aconite for colds that come on suddenly, with fever and
anxiety
- Mercurius for profuse discharge that is irritating everywhere;
patient feels weak
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Acupuncture |
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Acupuncture for increased circulation, particularly helpful with Chinese
herbal formulas. |
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Patient Monitoring |
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Patients must learn that antibiotics cannot cure colds. High fever, sinus
tenderness, purulent sputum, dyspnea, and chest pain are indications they should
seek medical attention. |
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Other
Considerations |
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Children get colds more often than adults do. Day care centers and schools
increase exposure to and frequency of illness. |
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Prevention |
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Colds are transmitted by small aerosol particles, airborne droplets, or
secretions transferred by hand with subsequent self-inoculation. Careful hand
washing and avoiding contact with the eyes and nose is the best prevention for
nonaerosol types of infection. Interferon intranasal sprays are moderately
prophylactic (especially for rhinovirus) but may cause localized nasal
irritation or damage (e.g., oxymetazoline 0.05%, two sprays to each nostril bid
for five days). High doses of vitamin C and zinc lozenges may be no more
effective in preventing a cold than placebo, depending on the
study. |
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Complications/Sequelae |
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Secondary bacterial infections can cause complication in viral
colds.
- Otitis media: in 5% of preschoolers
- Asthma and chronic pulmonary disease
- Sinusitis: in 0.5% of colds; suspect when cold persists 7 to 10 days
past onset
- Bronchitis: more likely with coronavirus
- Pneumonia, bronchiolitis, diarrhea, and keratoconjunctivitis: more
common with adenovirus
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Prognosis |
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Colds usually last five to seven days in adults and 10 to 14 days in
children. Without complications, they are benign and
self-limiting. |
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Pregnancy |
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Goldenseal is contraindicated in pregnancy because of its ability to
stimulate oxytocin and uterine contractions. Alpha-adrenergic compounds and
epinephrine (except in cases of anaphylaxis) should be avoided. Dextromethorphan
should not be prescribed for cough. The most conservative treatment for colds in
pregnancy is rest and fluids. |
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References |
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Behrman RE, ed. Nelson Textbook of Pediatrics. 15th ed. Philadelphia,
Pa: WB Saunders Co; 1996.
Cummings S, Ullman D. Homeopathic Medicines. Los Angeles, Calif:
Jeremy P. Tarcher, Inc; 1984.
Dorn M, Knick E, Lewith G. Placebo-controlled, double-blind study of
Echinacea pallidae radix in upper respiratory tract infections.
Complementary Therapies in Medicine. 1997;5:40-42.
Eby GA. Zinc ion availability—the determinant of
efficacy in zinc lozenge treatment of common colds. J Antimicrob
Chemother. 1997;40:483-493.
Fauci AS, Braunwald E, Isselbacher KJ, et al., eds. Harrison's Principles
of Internal Medicine. 14th ed. New York, NY: McGraw-Hill; 1998.
Garland ML, Hagmeyer KO. The role of zinc lozenges in treatment of the common
cold. Ann Pharmacother. 1998;32:63-69.
Gruenwald J, Brendler T, Jaenicke C, et al., eds. PDR for Herbal
Medicines. Montvale, NJ: Medical Economics Co; 1998:817.
Hoheisel O, Sandberg M, Bertram S, Bulitta M, Schäfer M. Echinagard treatment
shortens the course of the common cold: a double-blind, placebo-controlled
clinical trial. Eur J Clin Res. 1997;9:261-269.
Melchart D, Walther E, Linde K, Brandmeier R, Lersch, C. Echinacea root
extracts for the prevention of upper respiratory tract infections. Arch Fam
Med. 1998;7:541-545.
Morrison R. Desktop Guide to Keynotes and Confirmatory Symptoms.
Albany, Calif: Hahnemann Clinic Publishing; 1993:3-6, 13-14, 158,
244-246.
Sazawal S, Black RE, Jalla S, et al. Zinc supplementation reduces the
incidence of acute lower respiratory infections in infants and preschool
children: a double-blind, controlled trial. Pediatrics. 1998;102(part
1):1-5.
Scaglione, et al. Efficacy and safety of the standardized ginseng extract
G115 for potentiating vaccination against common cold and/or influenza syndrome.
Drugs Exp Clin Res. 1996;22:65-72.
Schöneberger D. The influence of immune-stimulating effects of pressed juice
from Echinacea purpurea on the course and severity of colds.
Forum Immunol.
1992;8:2-12. |
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Copyright © 2000 Integrative Medicine
Communications This publication contains
information relating to general principles
of medical care that should not in any event be construed as specific
instructions for individual patients. The publisher does not accept any
responsibility for the accuracy of the information or the consequences arising
from the application, use, or misuse of any of the information contained herein,
including any injury and/or damage to any person or property as a matter of
product liability, negligence, or otherwise. No warranty, expressed or implied,
is made in regard to the contents of this material. No claims or endorsements
are made for any drugs or compounds currently marketed or in investigative use.
The reader is advised to check product information (including package inserts)
for changes and new information regarding dosage, precautions, warnings,
interactions, and contraindications before administering any drug, herb, or
supplement discussed herein. | |