Acute viral nasopharyngitis (common cold): Difference between revisions

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__NOTOC__
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{{DiseaseDisorder infobox |
{{DiseaseDisorder infobox |
  Name = Acute nasopharyngitis
  Name = Acute viral nasopharyngitis
  | Image = Rhinovirus.PNG
  | Image = Rhinovirus.PNG
  | Caption = [[Rhinovirus]]es cause most common colds
  | Caption = [[Rhinovirus]]es cause most common colds
| ICD10 = {{ICD10|J|00|0|j|00}} |
ICD9 = {{ICD9|460}} |
DiseasesDB = 31088 |
MedlinePlus = 000678 |
eMedicineSubj = |
eMedicineTopic = |
MeshID = D003139 |
}}
}}
{{Acute viral nasopharyngitis}}
{{Acute viral nasopharyngitis(common cold)}}
 
'''For patient information click [[Common cold (patient information)|here]]'''
'''For patient information click [[Common cold (patient information)|here]]'''


{{CMG}}
{{CMG}}; {{AE}}{{AY}}
 
{{SK}} Acute coryza; common cold
==Overview==
'''Acute viral nasopharyngitis,''', is a highly contagious, [[virus (biology)|viral]] [[infectious disease]] of the upper [[respiratory system]], primarily caused by [[picornavirus]]es or [[coronavirus]]es.
 
Common symptoms are [[Pharyngitis|sore throat]], [[rhinitis|runny nose]], [[nasal congestion]], [[sneeze|sneezing]] and [[cough]]; sometimes accompanied by [[myalgia|muscle aches]], [[fatigue (medical)|fatigue]], [[malaise]], [[headache]], [[muscle weakness]], or [[Anorexia (symptom)|loss of appetite]]. [[Fever]] and extreme [[fatigue (medical)|exhaustion]] are more usual in [[influenza]]. The symptoms of a cold usually resolve after about one week, but can last up to 14 days. Symptoms may be more severe in infants and young children. Although the disease is generally mild and self-limiting, patients with common colds often seek professional medical help, use [[over-the-counter drug]]s, and may miss school or work days. The annual cumulative societal cost of the common cold in the United States is billions of dollars.
 
No [[vaccine]]s are available: the primary method to prevent infection is hand-washing to minimize person-to-person transmission of the virus. There are no [[antiviral]] drugs approved to treat or cure the infection. Most available medications are [[palliative care|palliative]] and treat symptoms only. [[Vitamin C megadosage|Megadoses of vitamin C]], preparations from [[echinacea]], and [[zinc gluconate]] have been studied as treatments for the common cold although none has been approved by the [[Food and Drug Administration]] or [[European Medicines Agency]].
 
==Pathology==
===Epidemiology===
Upper respiratory tract infections are the most common infectious diseases among adults, who have two to four respiratory infections annually.<ref name="pmid4014285">{{cite journal | author = Garibaldi RA | title = Epidemiology of community-acquired respiratory tract infections in adults. Incidence, etiology, and impact | journal = Am. J. Med. | volume = 78 | issue = 6B | pages = 32-7 | year = 1985 | pmid = 4014285}}</ref> Children may have six to ten colds a year (and up to 12 colds a year for school children).<ref name="NIAID2006"/><ref name="pmid17323712">{{cite journal | author = Simasek M, Blandino DA | title = Treatment of the common cold | journal = American family physician | volume = 75 | issue = 4 | pages = 515–20 | year = 2007 | pmid = 17323712 | doi = }}</ref> In the United States, the incidence of colds is higher in the fall and winter, with most infections occurring between September and April. The seasonality may be due to the start of the school year, or due to people spending more time indoors (thus in closer proximity with each other) increasing the chance of transmission of the virus.<ref name="NIAID2006"/>
 
===Virus===
Common colds are most often caused by infection by one of the more than 100 [[serovar|serotypes]] of [[rhinovirus]], a type of [[picornavirus]]. Other viruses causing colds are [[coronavirus]], [[human parainfluenza viruses]], [[human respiratory syncytial virus]], [[Adenoviridae|adenoviruses]], [[enterovirus]]es, or [[metapneumovirus]].<ref name="Merck">{{cite web | title = Common Cold (Upper Respiratory Infection) | work = The Merck Manual Online | publisher = [[Merck & Co.]] | date = November 2005 | url = http://www.merck.com/mmpe/sec14/ch188/ch188c.html}}</ref><ref name="CKS">{{cite web | author = CKS | year = 2007 | title = Common Cold (Topic Review) | publisher = Clinical Knowledge Summaries Service | url = http://www.cks.library.nhs.uk/common_cold/view_whole_topic_review}}</ref>
 
===Transmission===
[[Image:Aerosol from Sneeze.jpg | thumb | 275px | left | Cold viruses are spread by aerosols created when a patient sneezes]]
The common cold virus is transmitted between people by one of two ways:
*in aerosol form generated by coughing, sneezing, or
*from contact with the saliva or nasal secretions of an infected person, either directly or from contaminated surfaces.
 
Symptoms are not necessary for viral shedding or transmission, as a percentage of asymptomatic subjects exhibit viruses in nasal swabs.<ref name=gsacc>{{cite web | url=http://dh.sa.gov.au/pehs/Youve-got-what/ygw-common-cold.pdf |type = pdf | title=Common Cold | publisher=Department of Health, Government of South Australia | year=2005}}</ref> The infectious period (time during which an infected person can infect others) begins about one day before symptoms begin, and continues for the first five days of the illness.
 
The virus enters the [[cell (biology)|cells]] of the lining of the [[nasopharynx]] (the area between the nose and throat), and rapidly multiplies. The major entry point is normally the nose, but can also be the eyes (in this case drainage into the nasopharynx would occur through the [[Nasolacrimal duct]]).
 
==Symptoms==
After initial infection, the viral replication cycle begins within 8 to 12 hours.<ref name="coldorg">{{cite web | author = Gwaltney, JM, Hayden, FG | title = Understanding Colds | date = 2006 | url = http://www.commoncold.org/index.htm}}</ref> Symptoms can occur shortly thereafter, and usually begin within 2 to 5 days after infection, although occasionally in as little as 10 hours after infection.<ref name="coldorg">{{cite web | author = Patsy Hamilton | url = http://www.healthguidance.org/entry/6125/1/Facts-about-the-Common-Cold-Incubation-Period.html}}</ref> The first indication of a cold is often a [[Pharyngitis|sore or scratchy throat]]. Other common symptoms are [[rhinorrhea|runny nose]], [[Nasal congestion|congestion]], [[sneeze|sneezing]] and [[cough]]. These are sometimes accompanied by [[myalgia|muscle aches]], [[Fatigue (medical)|fatigue]], [[malaise]], [[headache]], [[Muscle weakness|weakness]], or [[anorexia|loss of appetite]].<ref name="CCCentre">{{cite web | url = http://www.cardiff.ac.uk/biosi/associates/cold/home.html | title = Common Cold Centre | date = 2006 | publisher = Cardiff University }}</ref> Colds occasionally cause [[fever]] and can sometimes lead to extreme exhaustion. (However, these symptoms are more usual in [[influenza]], and can differentiate the two infections.) The symptoms of a cold usually resolve after about one week, but can last up to 14 days, with a cough lasting longer than other symptoms. Symptoms may be more severe in infants and young children, and may include fever and [[urticaria|hives]].<ref name="Nordenberg1999">{{cite web | last = Nordenberg | first = Tamar | title = Colds and Flu: Time Only Sure Cure | publisher = [[Food and Drug Administration]] | date = May 1999 | url = http://www.fda.gov/fdac/features/896_flu.html}}</ref><ref name="NIAID2006">{{cite web | title = Common Cold | publisher = [[National Institute of Allergy and Infectious Diseases]] | url = http://www3.niaid.nih.gov/healthscience/healthtopics/colds/}}</ref><ref name="ALA2005">{{cite web | title = A Survival Guide for Preventing and Treating Influenza and the Common Cold | publisher = [[American Lung Association]] | date = August 2005 | url = http://www.lungusa.org/site/pp.asp?c=dvLUK9O0E&b=35873#done}}</ref><ref name="HivesACAAI">{{cite web | url = http://www.acaai.org/public/advice/urtic.htm | title = Hives | publisher = American College of Allergy, Asthma & Immunology}}</ref>
 
==Complications==
The common cold can lead to [[Opportunistic infection|opportunistic]] [[coinfection]]s or [[superinfection]]s such as [[acute bronchitis]], [[bronchiolitis]], [[croup]], [[pneumonia]], [[sinusitis]], [[otitis media]], or [[strep throat]]. People with chronic lung diseases such as [[asthma]] and [[COPD]] are especially vulnerable. Colds may cause acute exacerbations of [[asthma]], [[emphysema]] or [[chronic bronchitis]].<ref name="coldorg"/><ref name="Merck"/><ref name="CKS"/>
 
==The economic cost of the common cold==
In the USA alone, the common cold leads to 75 to 100 million physician visits annually at a conservative cost estimate of $7.7 billion per year. Americans spend $2.9 billion on over-the-counter drugs and another $400 million on prescription medicines for symptomatic relief.<ref name="pmid4014285"/><ref name="pmid12588210">{{cite journal | author = Fendrick AM, Monto AS, Nightengale B, Sarnes M | title = The economic burden of non-influenza-related viral respiratory tract infection in the United States | journal = Arch. Intern. Med. | volume = 163 | issue = 4 | pages = 487-94 | year = 2003 | pmid = 12588210 | url = http://archinte.ama-assn.org/cgi/content/full/163/4/487}}</ref>
 
More than one-third of patients who saw a doctor received an antibiotic prescription, which not only contributes to unnecessary costs ($1.1 billion annually on an estimated 41 million antibiotic prescriptions in the United States), but also has implications for antibiotic resistance from overuse of such drugs.<ref name="pmid12588210"/>
 
An estimated 22 to 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 suffering from a cold, the total economic impact of cold-related work loss exceeds $20 billion.<ref name="NIAID2006"/><ref name="pmid4014285"/><ref name="pmid12588210"/>
 
==Prevention==
The best way to avoid a cold is to avoid close contact with existing sufferers; to wash hands thoroughly and regularly; and to avoid touching the mouth and face. Anti-bacterial soaps have no effect on the cold virus; it is the mechanical action of hand washing that removes the virus particles.<ref>{{cite web
| publisher = Canadian Health Network
| url = http://www.canadian-health-network.ca/servlet/ContentServer?cid=1138724359598&pagename=CHN-RCS/CHNResource/CHNResourcePageTemplate&c=CHNResource | title = The importance of handwashing for your health
}}</ref>
 
In 2002, the [[Centers for Disease Control|Centers for Disease Control and Prevention]] recommended alcohol-based hand gels as an effective method for reducing infectious viruses on the hands of health care workers.<ref>{{cite journal
| last = Boyce
| first = John M.
| coauthors = Didier Pittet
| title = Guideline for Hand Hygiene in Health-Care Settings: Guideline for Hand Hygiene in Health-Care Settings Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force
| journal = [[Morbidity and Mortality Weekly Report]]
| date = 2002-10-25
| volume = 51
| issue = RR-16
| url = http://www.cdc.gov/mmwr/PDF/rr/rr5116.pdf
| format = pdf
| pmid = 12418624
}}</ref>
As with hand washing with soap and water, alcohol gels provide no residual protection from re-infection.
 
The common cold is caused by a large variety of viruses, which mutate quite frequently during reproduction, resulting in constantly changing virus strains. Thus, successful [[immunization]] is highly improbable.
 
==Exposure to cold weather==
Although common colds are seasonal, with more occurring during winter, there is no evidence that short-term exposure to cold weather or direct chilling increases susceptibility to infection.<ref name="NIAID2006"/><ref name="pmid13559211">{{cite journal | author = Dowling HF, Jackson GG, Spiesman IG, Inouye T | title = Transmission of the common cold to volunteers under controlled conditions. III. The effect of chilling of the subjects upon susceptibility | journal = American journal of hygiene | volume = 68 | issue = 1 | pages = 59-65 | year = 1958 | pmid = 13559211}}</ref><ref name="pmid12357708">{{cite journal | author = Eccles R | title = Acute cooling of the body surface and the common cold | journal = Rhinology | volume = 40 | issue = 3 | pages = 109-14 | year = 2002 | pmid = 12357708}}</ref><ref>{{cite journal | author = Douglas, R.G.Jr, K.M. Lindgren, and R.B. Couch | title = Exposure to cold environment and rhinovirus common cold. Failure to demonstrate effect | journal = New Engl. J. Med | volume = 279 | year = 1968}}</ref>
 
With respect to the causation of cold-like ''symptoms'', researchers at the Common Cold Centre at the Cardiff University<ref name="CCCentre"/> conducted a study to "test the hypothesis that acute cooling of the feet causes the onset of common cold symptoms."<ref name="pmid16286463">{{cite journal | author = Johnson C, Eccles R | title = Acute cooling of the feet and the onset of common cold symptoms | journal = Family Practice | volume = 22 | issue = 6 | pages = 608-13 | year = 2005 | pmid = 16286463 | doi = 10.1093/fampra/cmi072 | url = http://fampra.oxfordjournals.org/cgi/content/full/22/6/608}}</ref> The study measured the subjects' self-reported cold symptoms, and belief they had a cold, but not whether an actual respiratory infection developed. It concludes that the onset of common cold ''symptoms'' can be caused by acute chilling of the feet, but that "further studies are needed to determine the relationship of symptom generation to any respiratory infection."
 
==Treatment==
 
As there is no medically proven and accepted medication directly targeting the causative agent, there is no cure for the common cold. Treatment is limited to symptomatic supportive options, maximizing the comfort of the patient, and limiting complications and harmful sequelae. The most reliable treatment is a combination of fluids and plenty of rest.
 
The common cold is self-limiting, and the host's [[immune system]] effectively deals with the infection. Within a few days, the body's [[humoral]] immune response begins producing specific [[antibodies]] that can prevent the virus from infecting cells. Additionally, as part of the cell-mediated immune response, [[leukocytes]] destroy the virus through [[phagocytosis]] and destroy infected cells to prevent further viral replication. In healthy, immunocompetent individuals, the common cold resolves in seven days on average.<ref name="coldorg"/>
 
===Palliative care===
The [[National Institute of Allergy and Infectious Diseases]] suggests getting plenty of rest, drinking fluids to maintain hydration, [[gargling]] with warm salt water, using cough drops, throat sprays, or [[over-the-counter drug|over-the-counter]] pain or cold medicines.<ref name="NIAID2006"/> Saline nasal drops may help alleviate congestion.<ref name=PDRCC>{{cite web
| title = Common Cold
| work = PDRHealth
| publisher = Thomson Healthcare
| url = http://www.pdrhealth.com/disease/disease-mono.aspx?contentFileName=BHG01ID25.xml&contentName=Common+Cold&contentId=30
}}</ref>
 
The [[American Lung Association]] recommends avoiding coffee, tea or cola drinks that contain [[caffeine]] and avoiding [[alcoholic beverage]]s. Both caffeine and alcohol cause [[dehydration]].<ref name="ALA2005"/>
 
===Antibiotics===
[[Antibiotics]] do not have any beneficial effect against the common cold. Their use in cases of common cold infection is ineffective and may contribute to [[antibiotic resistance]] of [[bacteria]] present in the patient's body.
 
===Antivirals===
There are no approved [[antiviral drug]]s for the common cold.
 
[[ViroPharma]] and [[Schering-Plough]] are developing an antiviral drug, [[pleconaril]], that targets [[Picornaviridae|picornaviruses]], the viruses that cause the majority of common colds. [[Pleconaril]] has been shown to be effective in an [[Route of administration|oral]] form.<ref>{{cite journal
| last = Pevear
| first = Daniel C.
| coauthors = Tina M. Tull, Martin E. Seipel, James M. Groarke
| year = 1999
| month = September
| title = Activity of Pleconaril against Enteroviruses
| journal = Antimicrobial Agents and Chemotherapy
| volume = 43
| issue = 9
| pages = 2109-2115
| url = http://aac.asm.org/cgi/content/full/43/9/2109
| language =
}}</ref><ref>{{cite journal
| quotes =
| last = McConnell
| first = J.
| date = 2 October, 1999
| title = Enteroviruses succumb to new drug
| journal = The Lancet
| volume = 354
| issue = 9185
| pages = 1185
}}</ref>
[[Schering-Plough]] is developing an [[Route of administration|intra-nasal]] formulation that may have fewer adverse effects.<ref name="CTgov">{{cite web
| url = http://www.clinicaltrials.gov/ct/gui/show/NCT00394914
| title = Effects of Pleconaril Nasal Spray on Common Cold Symptoms and Asthma Exacerbations Following Rhinovirus Exposure (Study P04295AM2)
| month = March
| year = 2007
| publisher = U.S. [[National Institutes of Health]]
| work = ClinicalTrials.gov
}}</ref>
 
===Over-the-counter symptom medicines===
There are a number of effective treatments which, rather than treat the viral infection, focus on relieving the symptoms. For some people, colds are relatively minor inconveniences and they can go on with their daily activities with tolerable discomfort. This discomfort has to be weighed against the price and possible side effects of the remedies.
*[[analgesic]]s such as [[aspirin]] or [[paracetamol]] (acetaminophen), as well as localised versions targeting the throat (often delivered in [[lozenge]] form)
*nasal decongestants such as [[pseudoephedrine]] or [[oxymetazoline]] which reduce the inflammation in the nasal passages by constricting local blood vessels
*[[cough medicine|cough suppressants]] such as [[dextromethorphan]] which suppress the cough reflex.
*first-generation [[anti-histamine]]s such as [[brompheniramine]], [[chlorpheniramine]], [[diphenhydramine]] and [[clemastine]] (which reduce mucus gland secretion and thus combat blocked/runny noses but also may make the user drowsy). Second-generation anti-histamines do not have a useful effect on colds.
 
===Herbal remedies===
Herbal teas, such as [[German Chamomile|chamomile]] tea, or lemon or ginger root tisanes may soothe some symptoms and comfort the patient.
 
[[Liquorice]] and [[garlic]] preparations have been suggested as treatments for the common cold, although their effectiveness is unproven.


====Echinacea====
{{SK}} Acute coryza; Common cold; Acute infective rhinitis; Acute nasal catarrh; Acute nasopharyngitis; Acute rhinitis; Cold; Head cold; Infective nasopharyngitis; Infective rhinitis.
[[Echinacea]], commonly called coneflowers, is a plant commonly used in herbal preparations for the treatment of the common cold.


Although there have been scientific studies evaluating echinacea, its effectiveness has not been convincingly demonstrated. For example, a peer-reviewed [[clinical study]] published in the [[New England Journal of Medicine]] concluded that "…extracts of E. angustifolia root, either alone or in combination, do not have clinically significant effects on rhinovirus infection or on the clinical illness that results from it."<ref name = "NEJM">
==[[Acute viral nasopharyngitis overview|Overview]]==
{{cite journal
| last = Turner
| first = Ronald B.
| coauthors = Rudolf Bauer, Karin Woelkart, Thomas C. Hulsey, J. David Gangemi,
| date = 2005-07-28
| title = An Evaluation of Echinacea angustifolia in Experimental Rhinovirus Infections
| journal = New England Journal of Medicine
| volume = 353
| issue = 4
| pages = 341–348
| url = http://content.nejm.org/cgi/content/abstract/353/4/341
}}</ref><ref>{{cite news
| last = Kolta
| first = Gina
| title = Study Says Popular Herb Has No Effect on Colds
| work = New York Times
| url = http://query.nytimes.com/gst/fullpage.html?sec=health&res=9805E5DC103FF93BA15754C0A9639C8B63
}}</ref>
Recent randomized, double-blind, placebo-controlled studies in adults have not shown a beneficial effect of echinacea on symptom severity or duration of the cold.<ref name="pmid15197051">
{{cite journal | author = Yale SH, Liu K | title = Echinacea purpurea therapy for the treatment of the common cold: a randomized, double-blind, placebo-controlled clinical trial | journal = Arch. Intern. Med. | volume = 164 | issue = 11 | pages = 1237-41 | year = 2004 | pmid = 15197051 | doi = 10.1001/archinte.164.11.1237 }}</ref><ref name="pmid12484708">{{cite journal | author = Barrett BP, Brown RL, Locken K, Maberry R, Bobula JA, D'Alessio D | title = Treatment of the common cold with unrefined echinacea. A randomized, double-blind, placebo-controlled trial | journal = Ann. Intern. Med. | volume = 137 | issue = 12 | pages = 939-46 | year = 2002 | pmid = 12484708 | doi = }}</ref>
A structured review of 9 placebo controlled studies suggested that the effectiveness of echinacea in the treatment of colds has not been established.<ref name="pmid15736012">{{cite journal | author = Caruso TJ, Gwaltney JM | title = Treatment of the common cold with echinacea: a structured review
| journal = Clin. Infect. Dis. | volume = 40 | issue = 6 | pages = 807-10 | year = 2005 | pmid = 15736012 | doi = 10.1086/428061}}</ref>
Conversely, two recent meta-analyses of published medical articles concluded that there is some evidence that echinacea may reduce either the duration or severity of the common cold, but results are not fully consistent. However, there have been no large, randomized placebo-controlled clinical studies that definitively demonstrate either prophylaxis or therapeutic effects in adults.<ref>{{cite journal
| last = Shah
| first = Sachin A
| coauthors = S. Sander, C. White, M. Rinaldi, C. Coleman
| year = 2007
| month = July
| title = Evaluation of echinacea for the prevention and treatment of the common cold: a meta-analysis
| journal = The Lancet Infectious Diseases
| volume = 7
| issue = 7
| pages = 473-480
| pmid = 17597571
| doi = 10.1016/S1473-3099(07)70160-3
}}</ref><ref>{{cite journal
| last = Linde
| first = K
| coauthors = Barrett B, Wölkart K, Bauer R, Melchart D.
| year = 2006
| month = January
| title = Echinacea for preventing and treating the common cold
| journal = Cochrane database of systematic reviews
| ISSN = 1469-493X
| pmid = 16437427
}}</ref>
A randomized, double-blind, placebo-controlled study in 407 children of ages ranging from 2 to 11 years showed that echinacea did not reduce the duration of the cold, or reduce the severity of the symptoms.<ref name="pmid14657066">{{cite journal
| author = Taylor JA, Weber W, Standish L, Quinn H, Goesling J, McGann M, Calabrese C
| title = Efficacy and safety of echinacea in treating upper respiratory tract infections in children: a randomized controlled trial
| journal = JAMA
| volume = 290
| issue = 21
| pages = 2824-30
| year = 2003
| pmid = 14657066
| doi = 10.1001/jama.290.21.2824
}}</ref>
Most authoritative sources consider the effect of echinacea on the cold unproven.<ref name="NIAID2006"/><ref name="pmid17323712"/><ref name="Merck"/><ref name="ALA2005"/><ref name="MayoEch">{{cite web | url = http://www.mayoclinic.com/health/echinacea/NS_patient-echinacea | title = Echinacea (E. angustifolia DC, E. pallida, E. purpurea)| author = The Natural Standard Research Collaboration | publisher = Mayo Foundation for Medical Education and Research | quote = }}</ref><ref name="UMMCEch">{{cite web | url = http://www.umm.edu/altmed/articles/echinacea-000239.htm | title = Echinacea | publisher = University of Maryland Medical Center}}</ref>


===Other===
==[[Acute viral nasopharyngitis historical perspective|Historical Perspective]]==
====Vitamin C====
A well known supporter of the theory that [[Vitamin C megadosage]] prevented infection was Nobel Prize winner [[Linus Pauling]],<ref>{{cite web|url=http://www.pubmedcentral.nih.gov/pagerender.fcgi?artid=389499&pageindex=1#page|title=Pauling L, The Significance of the Evidence about Ascorbic Acid and the Common Cold, Proc Natl Acad Sci U S A. 1971 November; 68(11): 2678–2681.}}</ref> who wrote the bestseller ''Vitamin C and the Common Cold''.<ref name="isbn0-7167-0159-6">{{cite book | author = Pauling, Linus | title = Vitamin C and the common cold | publisher = W. H. Freeman | location = San Francisco | year = 1970 | pages = | isbn = 0-7167-0159-6 | oclc = | doi = }}</ref> A [[meta-analysis]] published in 2005 found that "the lack of effect of prophylactic vitamin C supplementation on the incidence of common cold in normal populations throws doubt on the utility of this wide practice".<ref name="pmid15971944">{{cite journal | author = Douglas RM, Hemilä H | title = Vitamin C for preventing and treating the common cold | journal = PLoS Med. | volume = 2 | issue = 6 | year = 2005 | pmid = 15971944 | doi = 10.1371/journal.pmed.0020168}}</ref>


A follow-up meta-analysis supported these conclusions: <blockquote>[[Prophylaxis|Prophylactic use]] "...of vitamin C has no effect on common cold incidence&nbsp;... [but] reduces the duration and severity of common cold symptoms slightly, although the magnitude of the effect was so small its clinical usefulness is doubtful. Therapeutic trials of high doses of vitamin C&nbsp;... starting after the onset of symptoms, showed no consistent effect on either duration or severity of symptoms.&nbsp;... More therapeutic trials are necessary to settle the question, especially in children who have not entered these trials."<ref name="pmid17636648">{{cite journal | author = Douglas R, Hemilä H, Chalker E, Treacy B | title = Vitamin C for preventing and treating the common cold | journal = Cochrane Database of Systematic Reviews (Online) | volume = | issue = 3 | pages = CD000980 | year = 2007 | pmid = 17636648 | doi = 10.1002/14651858.CD000980.pub3 | url = http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD000980/frame.html}}</ref><ref>{{cite news | title = Vitamin C 'does not stop colds' | publisher = BBC | date = 2007-07-18 | url = http://news.bbc.co.uk/2/hi/health/6901405.stm}}</ref></blockquote>
==[[Acute viral nasopharyngitis classification|Classification]]==


Most of the studies showing little or no effect employ doses of ascorbate such as 100&nbsp;mg to 500&nbsp;mg per day, considered "small" by vitamin C advocates. Equally important, the plasma half life of high dose ascorbate above the baseline, controlled by renal resorption, is approximately 30 minutes,<ref>{{cite web|url=http://www.annals.org/cgi/content/full/140/7/533|title=Padayatty SL et al, "Vitamin C Pharmacokinetics: Implications for Oral and Intravenous Use," Ann Intern Med. 2004 Apr 6;140(7):533-7.}}</ref><ref>{{cite web|url=http://www.prweb.com/releases/2004/7/prweb139053.htm|title=Researchers Question Government Recommended Daily Allowance (RDA) for vitamin C, PR Web, July 7, 2004}}</ref> which implies that most high dose studies have been methodologically defective and would be expected to show a minimum benefit. Clinical studies of divided dose supplementation, predicted on pharmacological grounds to be effective, have only rarely been reported in the literature.
==[[Acute viral nasopharyngitis pathophysiology|Pathophysiology]]==


====Zinc preparations====
==[[Acute viral nasopharyngitis causes|Causes]]==
[[Zinc]] is an essential element, necessary for sustaining life. Recommended daily intake has been established and results of zinc deficiency and toxicity have been well characterized.


[[Zinc acetate]] and [[zinc gluconate]] have been tested as potential treatments for the common cold, in various dosage form including nasal sprays, nasal gels, and lozenges.<ref name="eby-1984">{{cite journal | author=Eby GA, Davis DR, Halcomb WW | title=Reduction in duration of common colds by zinc gluconate lozenges in a double-blind study | journal=Antimicrob Agents Chemother | year=1984 | pages=20-4 | volume=25 | issue=1 | id = PMID 6367635}}</ref><ref>{{cite journal | last = Macknin | first = ML | coauthors = | date = | year = 1999 | month = January | title = Zinc lozenges for the common cold | journal = Cleve Clin J Med | volume = 66 | issue = 1 | pages = 27-32 | pmid = 9926628}}</ref> Some studies have shown some effect of zinc preparations on the duration of the common cold, but conclusions are diverse.<ref>{{cite journal | author = Jeffrey L. Jackson, Emil Lesho and Cecily Peterson | title = Zinc and the Common Cold: A Meta-Analysis Revisited | journal = Journal of Nutrition | year = 2000 | pages = 1512-15 | volume = 130 | issue = Supplement | pmid = | url = http://jn.nutrition.org/cgi/content/full/130/5/1512S}}</ref><ref>{{cite journal | last = Hulisz | first = D | year = 2003 | title = Efficacy of zinc against common cold viruses: an overview | journal = J Am Pharm Assoc | volume = 44 | issue = 5 | pages = 594-603 | pmid = 15496046}}</ref><ref name="jackson-1997">{{cite journal | author=Jackson JL, Peterson C, Lesho E | title=A meta-analysis of zinc salts lozenges and the common cold | journal=Arch Intern Med | year=1997 | pages=2373-6 | volume=157 | issue=20 | id=PMID 9361579 | url=http://archinte.ama-assn.org/cgi/content/abstract/157/20/2373}}</ref> Approximately half of studies demonstrate efficacy. Even studies that show clinical effect have not demonstrated the mechanism of action.<ref name="MedLinePlus_Zinc">
==[[Differentiating acute viral nasopharyngitis from other diseases|Differentiating acute viral nasopharyngitis from other diseases]]==
{{cite web | url = http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-zinc.html | title = MedlinePlus Herbs and Supplements: Zinc}}</ref> The studies differ in the salt used, concentration of the salt, dosage form, and formulation, and some suffer from defects in design or methods. For example, there is evidence that the potential efficacy of zinc gluconate lozenges may be affected by other food acids ([[citric acid]], [[ascorbic acid]] and [[glycine]]) present in the lozenge.<ref name="eby-2004">{{cite journal | author=Eby GA | title=Zinc lozenges: cold cure or candy? Solution chemistry determinations | journal=Biosci Rep | year=2004 | pages=23-39 | volume=24 | issue=1 | id=PMID 15499830}}</ref> Furthermore, interpretation of the results depends on whether concentration of total zinc or ionic zinc is considered.<ref>{{cite journal | last = Eby | first = George | coauthors = Halcomb WW | year = 2006 | title = Ineffectiveness of zinc gluconate nasal spray and zinc orotate lozenges in common-cold treatment: a double-blind, placebo-controlled clinical trial | journal = Altern Ther Health Med | volume = 12 | issue = 1 | pages = 34-38 | pmid = 16454145}}</ref><ref>{{cite web | url = http://www.uspharmacist.com/oldformat.asp?url=newlook/files/alte/feat2.htm | title = Zinc and the Common Cold: What Pharmacists Need to Know | author = Darrell T. Hulisz}}</ref>


There are concerns regarding the safety of long-term use of cold preparations in an estimated 25 million persons who are [[haemochromatosis]] [[heterozygote]]s.<ref name="barton-1997">{{cite journal | author=Barton JC, Bertoli LF | title=Zinc gluconate lozenges for treating the common cold | journal=Ann Intern Med | year=1997 | pages=738-9 | volume=126 | issue=9 | id=PMID 9139564}}</ref> Use of high doses of zinc for more than two weeks may cause [[copper]] depletion, which leads to [[anemia]].<ref name = "PDRZinc">{{cite web | title = Zinc | work = PDRhealth | publisher = Thomson Healthcare | url = http://www.pdrhealth.com/drugs/altmed/altmed-mono.aspx?contentFileName=ame0182.xml&contentName=Zinc&contentId=345}}</ref> Other adverse events of high doses of zinc include [[nausea]], [[emesis|vomiting]] gastrointestinal discomfort, [[headache]], [[drowsiness]], unpleasant taste, taste distortion, abdominal cramping, and [[diarrhea]].<ref name="MedLinePlus_Zinc"/><ref name="PDRZinc"/> Some users of nasal spray applicators containing zinc have reported temporary or permanent loss of sense of [[smell]].<ref name = WashPostZinc">{{cite news | title = Paying Through the Nose: Maker of Cold Spray Settles Lawsuits for $12 Million but Denies Claim That Zinc Product Ruined Users' Sense of Smell | author = Sandra G. Boodman | publisher = The Washington Post | url = http://www.washingtonpost.com/wp-dyn/content/article/2006/01/30/AR2006013001240.html}}</ref>
==[[Acute viral nasopharyngitis epidemiology and demographics|Epidemiology and Demographics]]==


Although widely available and advertised in the United States as dietary supplements or homeopathic treatments, the safety and efficacy of zinc preparations have not been evaluated or approved by the [[Food and Drug Administration]]. Authoritative sources consider the effect of zinc preparations on the cold unproven.<ref name="Merck"/><ref name="ALA2005"/>{{see also|Zinc gluconate}}
==[[Acute viral nasopharyngitis risk factors|Risk Factors]]==


====Steam inhalation====
==[[Acute viral nasopharyngitis Screening|Screening]]==
Many people believe that steam inhalation reduces symptoms of the cold.<ref name="pmid10718693">{{cite journal
| author = Braun BL, Fowles JB, Solberg L, Kind E, Healey M, Anderson R
| title = Patient beliefs about the characteristics, causes, and care of the common cold: an update
| journal = The Journal of Family Practice
| volume = 49
| issue = 2
| pages = 153-6
| year = 2000
| pmid = 10718693
| doi =
}}</ref>


However, a [[double-blind]], placebo-controlled, randomized study found no effect of steam inhalation on cold symptoms.<ref>{{cite journal
==[[Acute viral nasopharyngitis natural history, complications and prognosis|Natural History, Complications and Prognosis]]==
| last = Forstall
| first = G. J.
| coauthors = M. L. Macknin, B. R. Yen-Lieberman, S. V. Medendrop
| date = 13 April, 1994
| title = Effect of inhaling heated vapor on symptoms of the common cold
| journal = Journal of the American Medical Association (JAMA)
| volume = 271
| issue = 14
| url = http://jama.ama-assn.org/cgi/content/abstract/271/14/1109
}}</ref> A scientific review of medical literature concluded that "there is insufficient evidence to support the use of steam inhalation as a treatment."<ref>{{cite journal
| last = Singh
| first = M
| date = 19 April, 2004
| title = Heated, humidified air for the common cold
| journal = The Cochrane Database of Systematic Reviews
| issue = 2
| url = http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/rel0002/CD001728/frame.html
}}</ref> There have been reports of children being badly burned when using steam inhalation to alleviate cold symptoms leading to the recommendation to "...start discouraging patients from using this form of home remedy, as there appears to be no significant benefit from steam inhalation."<ref>{{cite journal
| quotes =
| author = MA Akhavani
| coauthors = RHJ Baker
| date = 1 July, 2005
| title = Steam inhalation treatment for children
| journal = British Journal of General Practice
| volume = 55
| url = http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1472796
}}</ref>


====Chicken soup====
==[[Acute viral nasopharyngitis diagnosis|Diagnosis]]==
In the twelfth century, Moses Maimonides wrote, "Chicken soup...is recommended as an excellent food as well as
[[Acute viral nasopharyngitis history and symptoms|History and Symptoms]] | [[Acute viral nasopharyngitis physical examination|Physical Examination]] | [[Acute viral nasopharyngitis laboratory findings|Laboratory Findings]] | [[Acute viral nasopharyngitis X ray |X ray]] | [[Acute viral nasopharyngitis CT|CT]] | [[Acute viral nasopharyngitis MRI|MRI]] | [[Acute viral nasopharyngitis ultrasound|Ultrasound]] | [[Acute viral nasopharyngitis other imaging findings|Other imaging findings]] | [[Acute viral nasopharyngitis other diagnostic studies|Other Diagnostic Studies]]
medication."<ref>{{cite journal
| last = Rosner
| first = F
| year = 1980
| month = October
| title = Therapeutic efficacy of chicken soup
| journal = Chest
| volume = 78
| issue = 4
| pages = 672-674
| pmid = 7191367
}}</ref>
Since then, there have been numerous reports that chicken soup alleviates the symptoms of the common cold in the United States. Even usually staid medical journals have published tongue-in-cheek humorous articles on the alleged medicinal properties of chicken soup.<ref>{{cite journal
| last = Rennard
| first = Barbara O.
| coauthors = Ronald F. Ertl, Gail L. Gossman, Richard A. Robbins, Stephen I. Rennard
| date =
| year = 2000
| month = October
| title = Chicken Soup Inhibits Neutrophil Chemotaxis In Vitro
| journal = Chest
| volume = 118
| issue = 4
| pages = 1150-1157
| pmid = 11035691
}}</ref><ref>{{cite journal
| last = Caroline
| first = NL.
| coauthors = H Schwartz
| year = 1975
| month = February
| title = Chicken soup rebound and relapse of pneumonia
| journal = Chest
| volume = 67
| issue = 2
| pages = 215-216
| pmid = 1090422
}}</ref><ref>{{cite journal
| last = Ohry
| first = Abraham
| coauthors = Jenni Tsafrir
| date = 1999-12-14
| title = Is chicken soup an essential drug?
| journal = Canadian Medical Association Journal
| volume = 161
| issue = 12
| pmid = 10624412
}}</ref>
However, the efficacy of chicken soup has not been studied in many rigorous clinical trials. Nevertheless, hot chicken soup is nutritious and easy to eat, aids in rehydration, and provides a temporary feeling of relief.


==Historical research==
==[[Acute viral nasopharyngitis treatment|Treatment]]==
[[Image:Definition of a Cold by Benjamin Franklin Page 1.jpg | thumb | right | 250 px |  
[[Acute viral nasopharyngitis medical therapy|Medical Therapy]] | [[Acute viral nasopharyngitis surgery|Surgery]] | [[Acute viral nasopharyngitis primary prevention|Primary Prevention]] | [[Acute viral nasopharyngitis secondary prevention|Secondary Prevention]] | [[Acute viral nasopharyngitis cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Acute viral nasopharyngitis future or investigational therapies|Future or Investigational Therapies]]
"Definition of a Cold." Benjamin Franklin's notes for a paper he intended to write on the common cold.]]
In the 18th century, Benjamin Franklin considered the causes and prevention of the common cold. After several years of research he concluded: "People often catch cold from one another when shut up together in small close rooms, coaches, &c. and when sitting near and conversing so as to breathe in each other's transpiration." Although viruses had not yet been discovered, Franklin hypothesized that the common cold was passed between people through the air. He recommended exercise, bathing, and moderation in food and drink consumption to avoid the common cold.<ref>{{cite web | url = http://www.loc.gov/exhibits/treasures/franklin-scientist.html | title = Scientist and Inventor: Benjamin Franklin: In His Own Words... (AmericanTreasures of the Library of Congress)}}</ref> Franklin's theory on the transmission of the cold was confirmed some 150 years later.<ref name="pmid14795755">{{cite journal | author = Andrewes CH, Lovelock JE, Sommerville T  | title = An experiment on the transmission of colds | journal = Lancet | volume = 1 | issue = 1 | pages = 25–7 | year = 1951 | pmid = 14795755 | doi = }}</ref>


===Common Cold Unit===
==Case Studies==
{{main|Common Cold Unit}}
[[Acute viral nasopharyngitis case study one|Case #1]]
In the United Kingdom, the [[Common Cold Unit]] was set up by the civilian [[Medical Research Council (UK)|Medical Research Council]] in 1946 . The unit worked with volunteers who were infected with various viruses.<ref>{{cite book | title = Das Buch der verrückten Experimente (Broschiert) | author = Reto U. Schneider | year = 2004 | isbn = 344215393X | url = http://www.verrueckte-experimente.de/index_e.html}}</ref> The rhinovirus was discovered there. In the late 1950s, researchers were able to grow one of these cold viruses in a [[tissue culture]], as it would not grow in fertilized chicken eggs, the method used for many other viruses. In the 1970s, the CCU demonstrated that treatment with [[interferon]] during the incubation phase of rhinovirus infection protects somewhat against the disease, 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 prophylaxis and treatment of rhinovirus colds.<ref>{{cite journal
| journal = J Antimicrob Chemother.
| year = 1987
| month = December
| volume = 20
| issue = 6
| pages = 893-901
| title = Prophylaxis and treatment of rhinovirus colds with zinc gluconate lozenges
| last = Al-Nakib
| first = W
| coauthors = Higgins PG, Barrow I, Batstone G, Tyrrell DA.
| pmid = 3440773
}}</ref>


==See also==
==Related Chapters==
*[[Bronchiolitis]]
*[[Bronchiolitis]]
*[[Bronchitis]]
*[[Bronchitis]]
Line 354: Line 48:
*[[Viral pneumonia]]
*[[Viral pneumonia]]


==References==
==External Links==
{{reflist|2}}
*[http://www.nlm.nih.gov/medlineplus/commoncold.html Common Cold]  
 
==External links==
* {{cite news
| title = Keeping Colds at Bay. Or Maybe Not
| last = Duenwald
| first = Mary
| date = 2005-01-01
| publisher = New York Times
| url = http://www.nytimes.com/2005/02/01/health/01cons.html?ei=5070
}}
*{{cite web
| url = http://www.lung.ca/diseases-maladies/a-z/cold-rhume/index_e.php
| title = Common Cold
| publisher = Canadian Lung Association
}}
*{{cite web
| title = Using over-the-counter drugs to treat cold symptoms
| publisher = Canadian Pediatric Society
| date = March 2005
| url = http://www.cps.ca/caringforkids/whensick/otc_drugs.htm
}}
*{{cite web
| title = Colds in children
| publisher = Canadian Pediatric Society
| date = October 2005
| url = http://www.cps.ca/caringforkids/whensick/colds.htm
}}
*[http://www.fda.gov/opacom/lowlit/clds&flu.html US Food and Drug Administration, May 2000. ''What to Do for Colds and Flu'']
*[http://www.nlm.nih.gov/medlineplus/commoncold.html Common Cold] Links to health information from [[MedlinePlus]]
*[http://www.kcom.edu/faculty/chamberlain/Website/lectures/lecture/uri.htm Common Cold syllabus] from Infectious Diseases, Medical Microbiology, by Neal Chamberlain, PhD. Kirksville College of Osteopathic Medicine
 
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ahmed Younes M.B.B.CH [2]

Synonyms and keywords: Acute coryza; Common cold; Acute infective rhinitis; Acute nasal catarrh; Acute nasopharyngitis; Acute rhinitis; Cold; Head cold; Infective nasopharyngitis; Infective rhinitis.

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