Common Cold Health Article

Diagnosis

Colds are readily diagnosed using a focused history and physical examination. There are no laboratory tests readily available to detect or isolate the causative virus. When patients seek medical care, the health care practitioner (physician or mid-level practitioner) may perform a throat culture or blood test to rule out a secondary bacterial infection.

Though viruses cause both colds and influenza (flu), influenza is usually a more serious viral illness. A cold develops gradually over the course of a day or two. Patients may have a runny nose, sneezing, mild sore throat, headache and body aches, but usually they do not have fever or feel completely exhausted. Influenza symptoms develop suddenly. They are similar to cold symptoms, but usually more severe. Patients with influenza generally feel sicker than those with colds because the influenza virus produces symptoms throughout the body—muscle aches, weakness, fever, and chills.

Allergies also produce rhinitis (runny nose). Symptoms of allergic rhinitis—sneezing, nasal congestion, and itchy, runny nose—are commonly caused by dust mites, animal dander, or indoor molds. Other environmental irritants such as smoke, pollen, pollutants, pesticides, and perfumes may also trigger allergic rhinitis. Allergies are usually more persistent than the common cold. An allergist can perform tests to determine if the persistent cold-like symptoms are attributable to an allergic reaction. Also, some people get a runny nose when they go outside in winter and breathe cold air. This type of runny nose, called vasomotor rhinitis, is not a symptom of a cold.

Treatment

There are no medicines that will cure the common cold. Given time, the body's immune system will make antibodies to fight the infection, and the cold will resolve without any intervention. Antibiotics are useless against a cold. There are, however, medications to provide symptom relief. Pharmaceutical companies in the United States promote an array of products designed to relieve cold symptoms. Most products contain antihistamines, decongestants, and/or pain relievers.

Antihistamines block the action of the chemical histamine that is produced when the cold virus invades the cells lining the nasal passages. Histamine increases blood flow and causes the cells to swell. Antihistamines relieve the symptoms of sneezing, runny nose, itchy eyes, and congestion. Side effects are dry mouth and drowsiness, especially with the first few doses. Patients should be advised against taking antihistamines if they intend to drive or operate dangerous equipment. The brand names of common over-the-counter antihistamines are Chlor- Trimeton, Dimetapp, Tavist, and Actifed. The generic names of two common antihistamines are chlorpheniramine and diphenhydramine.

Decongestants work to constrict the blood flow to the vessels in the nose. This can shrink the tissue, reduce congestion, and open inflamed nasal passages, making breathing easier. Decongestants can cause patients to feel jittery or prevent them from sleeping. They should not be prescribed for or used by patients with heart disease, high blood pressure, or glaucoma. The brand names of some common decongestants are Neo-Synepherine, Novafed, and Sudafed. The generic names of common decongestants are phenylephrine, phenylpropanolamine, pseudoephedrine, and in nasal sprays naphazoline, oxymetazoline, and xylometazoline.

Many over-the-counter medications are combinations of antihistamines and decongestants. They also may include an ache and pain reliever, such as acetaminophen (Datril, Tylenol, Panadol) or ibuprofen (Advil, Nuprin, Motrin, Medipren), and a cough suppressant (dextromethorphan). Common combination medications include Tylenol Cold and Flu, Triaminic, Sudafed Plus, and Tavist D. Aspirin should not be given to children with colds because of its association with a risk of Reye's syndrome.

Nasal sprays and nose drops also are promoted to relieve nasal congestion. These usually contain a decongestant, but the decongestant can act more quickly and strongly than ones found in pills or liquids because it is applied locally, directly in the nose. Congestion usually returns after a few hours.

Patients may become dependent on nasal sprays and nose drops. If used for a long time, users may suffer withdrawal symptoms when the products are discontinued. This withdrawal condition is called rhinitis medicamentosa. Nasal sprays and nose drops should not be used for more than a few days. Patients should be instructed to adhere to product-specific recommendations about duration and frequency of use.

Individuals have varied reactions to different cold medications and may find some more helpful than others. A medication may be effective initially, then lose some of its effectiveness. Children sometimes react differently from adults. Patients should be cautioned against giving over-the-counter cold remedies to infants without first consulting a health care professional.

Care should be taken not to exceed the recommended dosages, especially when combination medications or nasal sprays are used. Individuals should determine whether they wish to use any of these medications based on their need for symptom relief, since none of them shorten the duration of a cold. Patients confused about the use of over-the-counter cold remedies should be encouraged to seek counsel from a health care practitioner, such as a physician, mid-level practitioner, nurse, or pharmacist.

Along with the optional use of over-the-counter cold remedies, there are some self-care steps that patients can take to ease their discomfort. These include:

• Drinking plenty of fluids, but avoiding acidic juices, which may irritate the throat.
• Gargling with warm salt water (made by adding one teaspoon of salt to 8 oz of water) for a sore throat.
• Not smoking.
• Getting plenty of rest.
• Using a cool-mist room humidifier to ease congestion and sore throat.
• Rubbing Vaseline or other lubricant under the nose to prevent irritation from frequent nose blowing.
• For babies too young to blow their noses, the mucus should be suctioned gently with an infant nasal aspirator. It may be necessary to soften the mucus first with a few drops of salt water.

Many alternative health care practitioners believe that people contract colds because their immune systems are weak. They observe that everyone is exposed to cold viruses, but not everyone becomes ill. The difference seems to be in the ability of the immune system to fight infection. Prevention focuses on strengthening the immune system by eating a healthy diet low in sugars and high in fresh fruits and vegetables, practicing meditation to reduce stress, and getting regular moderate exercise.

There is some scientific evidence that phytochemicals, nutrients found in fruits and vegetables, may act to prevent viral infections such as colds. An herb, Echinacea purpurea, is widely used to prevent and treat colds. It is believed to act as a transient (brief) immunostimulant, however, patients with autoimmune diseases should not use it since continuous use had been linked to immunosuppression.

The use of zinc lozenges every two hours along with high doses of vitamin C is another an alternative therapy. Some alternative practitioners also suggest eliminating dairy products for the duration of the cold because they contend that dairy products encourage production of mucus.

The use of zinc lozenges to treat cold symptoms remains controversial. Some studies evaluating the effectiveness of zinc gluconate lozenges found that using zinc in the first 24 hours after cold symptoms occurred shortened the duration of symptoms. Other studies refuted these findings.