Common Cold Disease

BASICS

DESCRIPTION

Inflammation of the nasal passages due to any number of respiratory viruses. Usually not serious; vast majority are self-treated.

System(s) affected: Pulmonary
Genetics: American Indians and Eskimos at higher risk than other ethnic groups and have more frequent complications such as otitis media; individuals with certain alpha-1-antitrypsin genotypes may be unusually susceptible to the common cold.
Incidence/Prevalence in USA: Preschool children 6-10 colds/yr; kindergarten 12/yr; schoolchildren 7/yr; adolescents/adults 2-4/yr. National Ambulatory Survey: 31 episodes/100 persons/year (counting only colds that lead to medical attention or at least one day of restricted activity).
Predominant age: Children > adults
Predominant sex: Male = Female

SIGNS AND SYMPTOMS

Nasal stuffiness and/or obstruction (80-100%)
Sneezing (50-70%)
Scratchy throat (50%)
Cough (40%)
Hoarseness (30%)
Malaise (20-25%)
Headache (25%)
Fever > 100°F/37.7°C (0-1%)

CAUSES

Usually due to one of 200 virus strains from six virus families; many strains present within the same geographic region or family
- Rhinovirus (> 200 serotypes)
- Influenza A, B, C viruses
- Parainfluenza viruses
- Respiratory syncytial viruses
- Coronaviruses
- Adenoviruses
- Certain ECHO viruses
In 40% cases, no agent can be identified

RISK FACTORS

Exposure to infected individuals
Touching one's nose or conjunctiva with contaminated fingers

DIAGNOSIS

LABORATORY

- CBC if symptoms persist for more than 10 days or with fever > 100°F (37.8°C)
- Nasal smear for eosinophilia may be useful in select individuals

Drugs that may alter lab results: N/A
Disorders that may alter lab results: N/A

PATHOLOGICAL FINDINGS

Rhinovirus infects the ciliated epithelium lining the nose. Edema and hyperemia of nasal mucous membranes results.
Exudation of serous and mucinous fluid containing immunoglobulins
Histology: edema of subepithelial connective tissue, and a scanty cellular infiltrate containing neutrophils, plasma cells, lymphocytes, and eosinophils
Rhinovirus causes a "non-destructive" inflammation of the mucous membranes, in contrast to influenza and parainfluenza which denude epithelium to the basement membrane

SPECIAL TESTS

In some centers, rapid antigen tests for various respiratory viruses are available for patients requiring hospitalization or for research purposes

IMAGING

Not indicated unless there is concern for bacterial superinfection of the sinuses, supraglottic region, trachea, or lungs

DIAGNOSTIC PROCEDURES

In rare cases, may want to attempt to culture virus from nasal washings or identify by ELISA or RIA methods

TREATMENT

APPROPRIATE HEALTH CARE

Outpatient self-care

GENERAL MEASURES

Rest, fluids, and symptomatic measures
Reassure that usual course is 6-10 days
Humidify inspired air
Discontinue tobacco and alcohol products (if not already done)
In infants, clear nasal passages with a bulb syringe, position mattress at 45°, use saline nasal drops

SURGICAL MEASURES

N/A

ACTIVITY

Up as tolerated with increased rest in the first few days

DIET

Encourage fluids

PATIENT EDUCATION

Reassure that colds are ubiquitous and a normal part of human existence
Spread is primarily via hand-to-hand transmission of virus contaminated nasal secretions; persons with colds touch their nose and eyes and then touch others
Small-particle aerosols released in talking, coughing, and sneezing do not travel very far and contain only a low concentration of rhinovirus
Rhinovirus survives for hours on the hands and hard surfaces, but does not survive long on porous surfaces such as tissues
Individual susceptibility to colds, depends in large part, on pre-existing antibody levels
Serum immunity lasts for years, but most individuals gain little protection against future colds due, in part, to the large number of viral serotypes and the antigenic drift that occurs over time in some viral types (rhinovirus, influenza)
Educate about the expected course and symptomatic measures
Advise patients to contact you if they develop dyspnea, productive cough, temperature > 102°F (38.9°C), or shaking chills

FOLLOW UP

PREVENTION/AVOIDANCE

Frequent hand washing and avoiding touching the face may help prevent colds

POSSIBLE COMPLICATIONS

Lower respiratory tract infection
Bronchial hyperreactivity
May lead to decompensation in patients with asthma and chronic lung disease
Otitis media (2% of colds)
Acute sinusitis (0.5% of colds)
Pneumonia
Rhinitis medicamentosa

EXPECTED COURSE AND PROGNOSIS

Complete recovery expected within 3-10 days

MISCELLANEOUS

ASSOCIATED CONDITIONS

Pharyngitis
Sinusitis
Bronchitis
Bronchiolitis
Pneumonia
Croup
Asthma

AGE-RELATED FACTORS

Pediatric:

Medications are likely to produce adverse effects or toxicity in young children
Incidence of colds is highest

Geriatric: Medications commonly produce adverse effects in the elderly
Others: N/A

PREGNANCY

Decongestants: no clear association between drug use and congenital defects
Antihistamines: no clear association between drug use and congenital defects
Codeine: indiscriminate use during pregnancy may pose a risk to the fetus

OTHER NOTES

N/A

ABBREVIATIONS

ELISA = enzyme linked immunosorbent assay
RIA = radioimmunoassay
URI = upper respiratory infection

Clinical Investigations

ROLE OF HOMOEOPATHY

Holistic healing that treats the person, not just the disease. Experience gentle, lasting wellness with expert constitutional care.