Common cold

There is no cure for the common cold. Over-the-counter (OTC) cold preparations may be used for symptoms.

Healthcare professionals recommend seeking medical attention if a patient has a fever of 102 degrees Fahrenheit or higher, the fever is accompanied by aches, extreme fatigue, sweating, chills, and a cough with colored phlegm, or symptoms get worse instead of better or last more than 10 days. These are symptoms of a more serious viral illness such as influenza.

With a child that has a cold, medical attention is recommended if symptoms include a fever of 102 degrees Fahrenheit or higher with chills or sweating, a fever that lasts more than 72 hours, vomiting or abdominal pain, unusual sleepiness, severe headache, difficulty breathing, persistent crying, ear pain, or a persistent cough.

Pharmacological Therapy :

Pain relievers and fever reducers: For fever, sore throat, body aches, and headache, acetaminophen (Tylenol®) or ibuprofen (Advil®, Motrin®) may be used over-the-counter. Acetaminophen can cause liver damage, especially if taken chronically, or in doses that exceed four grams daily. Healthcare professionals recommend carefully following dosing guidelines when giving acetaminophen to children, as dosing can be confusing. Also, it is recommended to never give aspirin to children ages three to 12. Aspirin may play a role in causing Reye's syndrome, a rare but potentially fatal illness in children.

Nasal decongestants: Nasal decongestants are useful medications for the common cold. Nasal decongestants help dilate (open) swollen mucous membranes of the nasal passages so the individual can breathe easier. Nasal decongestants include tablets, sprays, inhalers, and nose drops. Nasal decongestants include the oral decongestant pseudoephedrine (Sudafed®), nasal sprays oxymetolazone (Afrin®) and phenylephrine (Neo-Synephrine®), and the nasal inhalers propylhexedrine (Benzedrex®) or levmetamfetamine (Vicks Vapor Inhaler®). They are safe for most patients, but they do have many side effects and conditions in which they should not be used, including in people with heart disease, high blood pressure, thyroid disease, glaucoma (increased pressure in the eyes), diabetes, seizure disorders, enlarged prostate, or by individuals using a monoamine oxidase inhibitor (MAOI, type of antidepressant). Stinging, burning, sneezing, increased nasal discharge, drying of the nostrils, and altered taste may occur. If these effects continue or become bothersome, inform a doctor. Other side effects include rapid or pounding heartbeat, dizziness, trouble sleeping, shaking of the hands, and tremors. Healthcare professionals recommend not using decongestants while pregnant or breastfeeding. If symptoms get worse, a doctor may need to evaluate the situation.

Over time, decongestant nose drops, inhalers, and sprays can actually cause rebound congestion, which means the nasal passages are not able to function normally without using these medications. Prolonged use can also cause chronic inflammation of the mucous membranes. Decongestant nasal drops and sprays are not used for more than three days, which helps to stop the potential of nasal rebound.

There is widespread national abuse of pseudoephedrine tablets as a drug to make methamphetamine (crystal meth or meth), an illegal drug. Methamphetamine is a highly addictive, synthetically produced central nervous system stimulant with effects similar to cocaine. Meth is the most prevalent synthetic drug manufactured in the United States and is easily produced in home laboratories using common store-bought chemicals. The ease of manufacturing meth and its highly addictive potential has caused the use of the drug to increase throughout the nation. Its use has reached epidemic levels in many parts of the country. National and state laws have attempted to stem this criminal activity by establishing limits on sales of pseudoephedrine. The pharmacist or pharmacy representative may ask for a name and address in many states to prove that the pseudoephedrine is purchased legitimately as a decongestant. There may also be limits on the how much psuedoephedrine can be purchased in one transaction as well as over a certain time period. Psuedoephedrine products may not be available in all states over-the-counter (OTC), and may need to be purchased from behind the pharmacy counter. Also, a new oral nasal decongestant formulation (Sudafed PE®) is available that decreases the potential for abuse. Sudafed PE® contains the nasal decongestant phenylephrine and not pseudoephedrine.

Antihistamines: Antihistamines dry up excess nasal secretions (mucus), and in this way help to temporarily stop a runny nose. But they can also cause side effects such as dry mouth, constipation, and drowsiness as well as confusion and increased risk of falls if administered to elderly patients. Non-sedating antihistamines include fexofenadine (Allegra® and cetirizine (Zyrtec®.) Antihistamines that cause sedation include diphenhydramine (Benadryl®), clemastine (Tavist®), chlorpheniramine (Chlor-Trimeton®), and brompheniramine (Dimetane®.)

Cough syrups: Nonprescription cough syrups, containing various combinations of antihistamines, decongestants, and cough suppressants, are available over-the-counter (OTC) for symptomatic relief of cough associated with a cold. Many doctors strongly discourage the use of these combination medications for any child younger than age two, in whom accidental overdoses could be fatal. Coughs associated with a cold usually last less than two to three weeks. If a cough lasts longer than three weeks, see a doctor. Cough due to colds in adults may be safely treated for as long as seven days. If the cough is productive (brings up mucus), the ingredient guaifenesin can help break up the chest congestion (water intake is also important.) If the cough is dry and hacking, a cough suppressant (dextromethorphan) can stop the cough.

Lozenges: Sore throat caused by a cold may be self-treated if the pain is minor. Experts recommend not self-treating sore throat for more than two days. If a sore throat lasts more than seven days, healthcare professionals recommend seeing a doctor. Lozenges for sore throat contain active ingredients such as the anesthetics benzocaine, menthol, dyclonine, phenol/sodium phenolate, and hexylresorcinol. Phenol/sodium phenolate and hexylresorcinol also have antibacterial properties.

Antiviral: A few studies have investigated the use of antiviral medications to treat rhinovirus, including interferon alfa-2a and interferon gamma. These drugs are expensive and have to be refrigerated and injected. The most common side effect of interferon alfa-2a or alfa-2b therapy is a flu-like reaction with fever, fatigue, irritability, chills, headaches, and muscle aches. These effects should become less severe and less frequent as therapy progresses.

Pleconaril (Picovir®) is an anti-viral drug in clinical testing that targets picornaviruses, the viruses that cause the majority of common colds such as rhinoviruses. Pleconaril has been reported to be effective in an oral form, but it causes severe adverse effects including liver and kidney failure. An intranasal form with less side effects is currently under development.

Antibiotics: Healthcare professionals do not recommend using antibiotics to treat a cold. Antibiotic resistance has been called one of the world's most pressing public health problems. It is caused by the over prescribing of antibiotics for conditions that will not respond to antibiotics, such as outer ear infections and viral infections, including colds and influenza.

Others: Ipratropium bromide (Atrovent®), a prescription nasal spray, significantly reduced nasal drainage and sneezing in studies of naturally occurring colds.^{The main side effects included nasaldryness, occasional epistaxis (nosebleeds), and headache. The duration of relieffrom nasal stuffiness is thought to be over threehours. Nedocromil (Tilade®) and sodium cromoglycate (Cromolyn®) are prescription drugs used in the nose have been reported to reduce the severity of the rhinovirus upper respiratory tractinfections (a common cold).}

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Non drug therapy can help reduce cold symptoms and is recommended by healthcare professionals for all infants younger than nine months. Patients of all ages benefit from rest and increased intake of fluids. The American Academy of Pediatrics highly recommends the use of calibrated measuring devices for the administration of all liquid medications to children and infants.

Saline Nasal Drops:Isotonic saline nasal drops are recommended for infants. Healthcare professionals recommend one to two drops in each nostril 15 to 20 minutes before feeding and bedtime and repeated ten minutes later. Adults and children may also use saline nasal drops (Ocean® nasal spray) to relieve dry and inflamed nasal passages.

Nasal Bulb Aspirator: A nasal bulb aspirator may be used to gently suction mucus and aid in clearing the nasal passages in infants and young children. Nasal bulb aspirators use gentle suction to remove excess mucus from the nasal passages. They can be purchased without a prescription at pharmacies and most retail outlets.

Elevating the Head: Elevating the head of an infant's or child's bed may facilitate the drainage of secretions. Parents and caregivers should be cautioned, however, never to place pillows around or under an infant's head due to increased risk of suffocation.

Humidification: A cool mist vaporizer will add moisture to the air, relieving symptoms such as sore throat and congestion. Hot steam humidifiers are not recommended because of the risk of scalding. Humidifiers and vaporizers must be cleaned frequently to deter growth of bacteria and other pathogens. Infants and young children also benefit from exposure to warm, steamy air, which helps to clear nasal and bronchial passages of mucus and to ease breathing, especially at night. Parents can hold the infant or child on their lap outside the shower while running a warm or hot shower to generate steam. The child should not be placed in the water.

Petroleum Jelly: Petroleum jelly may be applied on skin underneath the nose if it becomes raw from repeated wiping.

Strong scientific evidence :

Andrographis: Andrographis (Andrographispaniculata) has been widely used in Indian (Hindu) folk medicine and Ayurvedic forms of medicine. A combination of andrographis with Siberian ginseng or eleuthero (Eleutherococcus senticosus) called Kan Jang® may be effective in the treatment of acute upper respiratory tract infections including sinusitis (inflammation of the sinuses), a common symptom of colds. The treatment was for five days, and improved fever, muscle soreness, cough, sore throat, and headache.

Good scientific evidence :

Sage: Sage mouthwashes and gargles have been approved for use against sore throat in Germany by the German Commission E. Additional study is needed comparing sage to standard therapies.

Vitamin C: Vitamin C, or ascorbic acid, is a water-soluble vitamin, which is necessary in the body to form collagen in bones, cartilage, muscle, and blood vessels, and aids in the absorption of iron. Dietary sources of vitamin C include fruits and vegetables, particularly citrus fruits, such as oranges. Scientific studies generally suggest that vitamin C does not prevent the onset of cold symptoms. However, in a subset of studies in people living in extreme circumstances, including soldiers in sub-arctic exercises, skiers, and marathon runners, significant reductions in the risk of developing colds by approximately 50% have been reported. This area merits additional study. Large doses of vitamin C may cause gastrointestinal upset including diarrhea.

Unclear or conflicting scientific evidence :

Andrographis: Based on clinical evidence, andrographis may prevent upper respiratory tract infection during the winter months if taken on a daily basis. Additional high quality clinical study is needed to reach a conclusion on whether andrographis may be effective in prevention of upper respiratory tract infections.

Boneset: Boneset (Eupatorium perfoliatum) is native to eastern North America and was used by Native Americans to treat fevers. Boneset is used homeopathically in very dilute amounts. Homeopathic boneset was found in one study to decrease the symptoms associated with a cold. Homeopathic medicines do not have side effects due to the very small amount of substance, such as boneset, used in their preparation.

Chamomile: Chamomile (Matricaria recutita) has been used medicinally for thousands of years, and is widely used in Europe. It is a popular treatment for numerous ailments, including sleep disorders, anxiety, and digestion/intestinal conditions. In an early study, inhalation of steam with chamomile extract was reported to help common cold symptoms. Further research is needed to confirm these results. Caution is advised when taking chamomile supplements, as adverse effects including drowsiness are possible.

Echinacea: Echinacea (Echinacea angustifolia, Echinacea puruprea, Echinacea pallida) is one of the most widely used herbal supplements in the world. Echinacea seems to improve the body's natural immune system during colds and flu. However, preliminary studies have mixed results in using Echinacea for preventing the common cold in adults. Although multiple low quality studies have previously suggested that adults taking Echinacea by mouth when cold symptoms begin may reduce the length and severity of symptoms, a clinical trial in July 2005 did not demonstrate any clinical benefit. Recent meta-analyses are conflicting; one suggested that standardized extracts of Echinacea were effective in the prevention of symptoms of the common cold after clinical inoculation, compared with placebo, whereas the other reported no such benefit. Further research is needed. Also, initial research suggests that Echinacea may not be helpful in children for treatment of upper respiratory infections. Additionally, development of rash has been associated with Echinacea use, and therefore the risks may outweigh the potential benefits in this population. Caution is advised when taking Echinacea supplements, as adverse effects including drug interactions are possible. Echinacea supplements should not be used if pregnant or breastfeeding, unless otherwise directed by a doctor.

Elder: Elder (Sambucus nigra) has been reported to have antiviral and antibacterial activity in laboratory studies. There is a small amount of research on the combination herbal product Sinupret®, which is a German product that contains elder and several other herbs in patients with bronchitis. This formula contains elder flowers (Sambucus nigra) as well as gentian root, verbena, cowslip flower, and sorrel. Although benefits have been suggested, due to design problems with this research, no clear conclusion can be drawn either for Sinupret® or elder in the management of bronchitis. Sinupret® has also been reported to have beneficial effects when used with antibiotics to treat sinus infections, although the majority of this evidence is not high quality and requires confirmation with better research.

Euphorbia: One short clinical trial involving senior patients with chronic bronchitis with Euphorbia helioscopia showed a significant effect on patients. However, this is only one short trial done in a specific population of senior patients; longer and larger trials are needed to evaluate the effect of Euphorbia helioscopia in a wider range of patients.

Garlic: Garlic (Allium sativum) supplements may reduce the severity of upper respiratory tract infections, including colds. However, this has not been demonstrated in well-designed human studies. Garlic may improve the immune system's ability to fight off infection, such as a cold virus. Caution is advised when taking garlic supplements, as adverse effects including an increase in bleeding and drug interactions are possible. Garlic supplements should not be used if pregnant or breastfeeding, unless otherwise directed by a doctor.

Goldenseal: Goldenseal (Hydrastis canadensis) has become a popular treatment for the common cold and upper respiratory tract infections, and is often added to Echinacea in commercial herbal cold remedies. Animal and laboratory research suggests that the goldenseal component berberine has effects against bacteria and inflammation. However, due to the very small amount of berberine in most goldenseal preparations, it is unclear whether goldenseal contains enough berberine to have the same effects. Caution is advised when taking goldenseal supplements, as adverse effects including drug interactions are possible. Goldenseal supplements should not be used if pregnant or breastfeeding, unless otherwise directed by a doctor.

Guided imagery: Therapeutic guided imagery may be used to help patients relax and focus on images associated with personal issues they are confronting. Experienced guided imagery practitioners may use an interactive, objective guiding style to encourage patients to find solutions to problems by exploring their existing inner resources. Biofeedback is sometimes used with imagery to enhance meditative relaxation. Interactive guided imagery groups, classes, workshops, and seminars are available, as well as books and audiotapes. Preliminary research in children suggests that stress management and relaxation with guided imagery may reduce the duration of symptoms due to upper respiratory tract infections, including colds. Additional research is needed to confirm these results.

Hydrotherapy: Hydrotherapy is broadly defined as the external application of water in any form or temperature (hot, cold, steam, liquid, ice) for healing purposes. It may include immersion in a bath or body of water (such as the ocean or a pool), use of water jets, douches, application of wet towels to the skin, or water birth. These approaches have been used for the relief of various diseases and injuries, or for general well being. There is preliminary evidence that daily showers with warm water followed by cold water, or cold water alone, may reduce the duration and frequency of common cold symptoms. Additional research is needed in this area before a clear conclusion can be drawn.

Kiwi: Kiwi (Actinidia deliciosa, Actinidia chinensis) may be beneficial in lung conditions such as upper respiratory infections (including colds). However, scientific data is lacking. One survey study suggests that kiwi, and other fruits high in vitamin C, may have a protective effect on lung conditions in children, especially wheezing. However, properly controlled studies are lacking at this time.

Mistletoe: Mistletoe (Viscum album) Iscador® (preparation of Viscum album whole extract) has been reported to improve clinical symptoms and markers of immune function in children with recurrent respiratory disease (RRD) exposed to the Chernobyl nuclear accident. There is insufficient evidence to recommend for or against mistletoe therapy for RDD in general. Caution is advised when taking mistletoe supplements, as adverse effects including drug interactions are possible. Mistletoe supplements should not be used if pregnant or breastfeeding, unless otherwise directed by a doctor. Mistletoe should not be used with seizure disorders, glaucoma (increased pressure in the eyes), diabetes, or hyperthyroidism (high thyroid hormone).

Moxibustion: Moxibustion is the application of heat to various points on the body. It is widely used traditionally in China for respiratory tract infections, including colds, in children. However, at this time evidence is insufficient.

Nasal irrigation: The three forms of nasal irrigation therapies used in clinical trials have been saline lavage, which uses a warm liquid solution of salt water; humidified warm air lavage (in hyperthermia or low body temperature); and large-particle nebulized aerosol therapy, which uses an aerosolized (droplets spread in the air) saline solution. Occasionally, antibiotics are added to the solution. Nasal saline irrigation is still the main treatment for acute rhinitis (runny nose) in infants since excessive usage of decongestant nose drops is contraindicated in early childhood. Studies support the usage of hypertonic saline for nasal irrigation. There is good evidence in support of nasal irrigation for allergic rhinitis and sinusitis. There is promising early evidence for using nasal irrigation in treating common colds, respiratory symptoms from occupational exposure, and in post-operative care following sinus or nasal surgeries.

Peppermint: Peppermint (Mentha piperita) is a flowering plant that grows throughout Europe and North America. Peppermint is widely cultivated for its fragrant oil. Peppermint oil has been used historically for numerous health conditions, including common cold symptoms, cramps, headache, indigestion, joint pain, and nausea. Menthol, a constituent of peppermint oil, is sometimes included in inhaled preparations for nasal congestion, including "rubs" that are applied to the skin and inhaled. High quality research is lacking in this area. Use of essential oils is not for internal use.

Slippery elm: Slippery elm (Ulmus fulva) is commonly used to treat sore throats, most typically taken as a lozenge. While anecdotally reported to be effective, supporting evidence is largely based on traditional evidence and the fact that components of slippery elm appear to possess soothing properties for the throat. Scientific evidence is necessary in this area before a clear conclusion can be drawn. Slipper elm throat lozenges are safe in recommended dosages.

Vitamin E: Daily supplementation with oral vitamin E does not appear to affect the incidence, duration, or severity of pneumonia (lower respiratory tract infections) in elderly nursing home residents or alter patterns of antibiotic use, although there may be a protective effect against colds (upper respiratory tract infections). Additional research is warranted. Caution is advised when taking vitamin E supplements, as adverse effects including an increase in bleeding and drug interactions are possible. Vitamin E supplements should not be used if pregnant or breastfeeding, unless otherwise directed by a doctor.

Zinc: Zinc lozenges are advertised as decreasing the symptoms, length, and severity of a cold. However, there are contradictory results regarding the efficacy of zinc formulations in treating duration and severity of common cold symptoms. Although zinc might be beneficial in the treatment of cold symptoms, more studies are needed to clarify which zinc formulations may be most effective, which rhinoviruses are affected by zinc, and if nasal sprays provide a useful alternative application route for zinc treatment. A recent study found no significant differences between zinc nasal spray and placebo. Negative results may be the cause of using doses of zinc that are too low or the presence of compounds like citric or tartaric acid, which may reduce efficacy of zinc. All nasal sprays may cause changes in taste and smell in sensitive individuals, even resulting in the temporary or permanent loss of these senses.

Fair negative scientific evidence :

Echinacea: Initial research suggests that echinacea may not be helpful in children for alleviation of cold symptoms, possibly because parents are not able to recognize the onset of common cold symptoms soon enough to begin treatment, or because the dose of echinacea for use in children is not clear. There are fundamental differences in causes of upper respiratory tract infection symptoms in children versus adults (bacterial versus viral causes; different viruses; different sites of infection; etc). Until additional research is available, echinacea cannot be considered effective in children for the treatment of upper respiratory infections. Furthermore, development of rash has been associated with echinacea use, and therefore the risks may outweigh the potential benefits for children.

Vitamin C: More than 30 clinical trials including more than 10,000 participants have examined the effects of taking daily vitamin C on cold prevention. Overall, no significant reduction in the risk of developing colds has been observed. In people who developed colds while taking vitamin C, no difference in severity of symptoms has been seen overall, although a very small significant reduction in the duration of colds has been reported (approximately 10% in adults and 15% in children). Laboratory experiments in which volunteers are infected with respiratory viruses while taking vitamin C have yielded differing results, but overall report small or no significant differences in symptom severity following infection.

Additionally, numerous studies have examined the effects of starting vitamin C for treatment of the common cold after the onset of cold symptoms. Overall, no significant benefits have been observed. Initial evidence from one study reports possible benefits with high doses of vitamin C taken at the onset of symptoms, but without additional evidence this remains indeterminate. At this time, the scientific evidence does not support this use of vitamin C.

Cleanliness: Children and adults need to understand the importance of hand washing. Healthcare professionals recommend carrying a bottle of alcohol-based hand rub containing at least 60% alcohol for times when soap and water are not available. These gels kill most germs, and are safe for older children to use themselves. Use cautiously as the overuse of antibacterial cleansers can cause damage to normal bacteria that reside on the skin.

Keeping the kitchen and bathroom countertops clean, especially when someone in the family has a common cold, is important. Children's toys should be washed before and after play when a cold is present in the house.

Avoiding spreading the virus: Sneezing and coughing into tissues keeps the viruses from spreading. Tissues are discarded right away, and then the hands are washed. Children should sneeze or cough into the bend of their elbow when they do not have a tissue. Avoiding close, prolonged contact with anyone who has a cold is recommended by healthcare professionals. Wearing a facemask, purchased at a local pharmacy, can help in the prevention of spreading or catching a cold virus.

Fluids: Water, non-sweetened juices (100% juice, not sweetened), hot teas, and warm soups (especially chicken soup) are all good choices to drink during a cold. Alcohol, caffeine, and cigarette smoke should be avoided as they may cause dehydration and aggravate the symptoms of a cold, including a runny and stuffy nose.

Sleep quality: Plenty of sleep and rest helps the body recover from a cold. Healthcare professionals recommend at least eight hours of uninterrupted sleep (not waking up).

Temperature and humidity: Keeping the room warm but not overheated where the individual with a cold lives is important. If the air is dry, a cool-mist humidifier or vaporizer can moisten the air and help ease congestion and coughing. A clean humidifier may help to prevent the growth of bacteria and molds.