*Common Colds, a.k.a. Upper Respiratory Infections - Evidence-Based Care*
By: Haumana
14 November 2003

An upper respiratory infection (URI) or common cold is defined by the Institute for Clinical Systems as "a self-limited illness (i.e. the body heals itself unless there are complications) typically lasting 5 to 14 days, manifested by rhinorrhea (runny nose), cough, and fever that generally lasts less than 3 days, and does not exceed 102F". No laboratory tests or x-rays are needed to make the diagnosis, although testing is sometimes necessary to rule out more serious illnesses such as pneumonia, epiglottitis (inflammation of a part of the upper airway that can cause sudden, life-threatening airway obstruction), and streptococcal pharyngitis ("Strep. throat"), all of which can have some of the same symptoms as uncomplicated upper respiratory infections.

Although most URIs are uncomplicated, studies have shown that the some of the viruses which are known to cause colds are associated with significant lower respiratory tract infections, e.g. viral pneumonia and worsening of asthma, chronic obstructive pulmonary disease (COPD) - emphysema, and congestive heart failure (CHF).

What should you do to prevent URIs/colds? According to almost all sources, avoiding contact with persons who are ill and frequent and thorough hand washing are the two best ways to prevent colds. In fact, no other evidence-based preventive measures are available, although many anecdotal preventions abound. This doesn't mean that the anecdotal measures don't work. It means that there often isn't valid information on which to recommend them.

You know that you have a cold. How should you treat yourself? There is no specific treatment. Treatment is supportive or symptomatic - treat the symptoms to offer some relief. Inhaling warm, steam vapor has been shown to open the nasal passages. Sipping chicken soup thins nasal secretions and reduces the body's inflammatory response. While there is not much evidence for other non-medication therapies, e.g. rest, increased fluid intake, throat lozenges, saltwater gargles, etc., they are considered mostly safe and reasonable ways of improving your comfort.

Here are some drug therapies that have been shown in studies to offer some relief from the symptoms of colds/URIs:

Studies have shown that a combination of acetaminophen (Tylenol), 1000 mg, given with pseudoephedrine, 60 mg every 6-8 hours provided improvement of sinus symptoms after the second dose. Another study showed that combining vitamin C, acetaminophen, chlorpheniramine and caffeine gave relief from URI/cold symptoms. Similar combinations plus the addition of the anti-inflammatory drugs naproxen (Aleve) or ibuprofen (Advil and Motrin) improved cold symptoms.

Zincum gluconium nasal gel, started within the first 48 hours of the onset of cold symptoms at 4 times a day, has been shown to reduce the upper airway symptoms, but not the cough, by almost 2 days.

Albuterol, a prescription drug, either in a metered-dose inhaler (the "puffers" that asthmatics use) and perhaps in the oral forms, has been shown in multiple studies to decrease the length of time that patients have coughs and to decrease the severity of the cough. Multiple controlled studies have shown that codeine and over-the-counter (OTC) cough preparations offer no benefit in coughs due to colds/URIs.

In addition to codeine and OTC cough preparations, what doesn't work in uncomplicated URIs/colds?

What therapies are of questionable or doubtful use:

However, there are some biases in the studies cited in the source for this article that need mentioning, The dose of vitamin C was not over 1 gram/1000 mg a day. Other studies have suggested that frequent doses to a total of 2-3 grams per day of vitamin C were effective, when started early in the course of the cold. The study cited for the Echinacea used the whole-plant form and was not of a long enough duration. Another issue with Echinacea that is not directly related to the study, but is quite applicable to the decision to use or not use Echinacea, is that there are estimates that 40-90% of commercially available over-the-counter "Echinacea" is not actually Echinacea, but another plant.

How long is the cold going to last? Count on 7-14 days, no matter what therapy (or only 1-2 weeks, if you see a doctor). The cough may linger for another 2-4 additional weeks. That's up to 6 weeks of healing and recovery, so be patient and save some money by letting this resolve. Remember that it is a self-limiting illness. One key thing to know is that sinus congestion and yellow or green stuff coming out of your nose are expected and they do not mean that you have a sinus infection that requires an antibiotic.

When should you see a health care provider? If you have no long-term medical problems, you now have enough information that you should rarely need to seek medical attention for URIs/colds, especially if your doctor will give you some of the prescription drugs, like albuterol, to keep on hand. However, if you have any of the following symptoms, you should probably see your health care provider:

These tips should help you and your loved one's get through the cold season. Remember that the medication doses given in this article are for adults and you will need to adjust them for children, Here's wishing you good health and a long, active and happy life.

Source: American College of Physicians

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