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The common cold is a widespread infectious disease affecting the upper respiratory tract, especially the nose, throat, and sinuses. Caused by over 200 virus strains like rhinoviruses and coronaviruses, symptoms include cough, sore throat, and runny nose. The immune response causes most symptoms, which typically resolve within 7–10 days. There is no vaccine due to viral variation, so prevention relies on hand washing and avoiding sick people. Treatments like zinc and NSAIDs may relieve symptoms, but antibiotics and cough medicines have no proven benefit.

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Signs and symptoms

The typical symptoms of a cold include cough, runny nose, sneezing, nasal congestion, and a sore throat, sometimes accompanied by muscle ache, fatigue, headache, and loss of appetite.31 A sore throat is present in about 40% of cases, a cough in about 50%,32 and muscle aches in about 50%.33 In adults, a fever is generally not present but it is common in infants and young children.34 The cough is usually mild compared to that accompanying influenza.35 While a cough and a fever indicate a higher likelihood of influenza in adults, a great deal of similarity exists between these two conditions.36 A number of the viruses that cause the common cold may also result in asymptomatic infections.3738

The color of the mucus or nasal secretion may vary from clear to yellow to green and does not indicate the class of agent causing the infection.39

Progression

A cold usually begins with fatigue, a feeling of being chilled, sneezing, and a headache, followed in a couple of days by a runny nose and cough.40 Symptoms may begin within sixteen hours of exposure41 and typically peak two to four days after onset.4243 They usually resolve in seven to ten days, but some can last for up to three weeks.44 The average duration of cough is eighteen days45 and in some cases people develop a post-viral cough which can linger after the infection is gone.46 In children, the cough lasts for more than ten days in 35–40% of cases and continues for more than 25 days in 10%.47

Causes

Viruses

The common cold is an infection of the upper respiratory tract which can be caused by many different viruses. The most commonly implicated is a rhinovirus (30–80%), a type of picornavirus with 99 known serotypes.48 Other commonly implicated viruses include coronaviruses, adenoviruses, enteroviruses, parainfluenza and RSV.49 Frequently more than one virus is present.50 In total, more than 200 viral types are associated with colds.51 The viral cause of some common colds (20–30%) is unknown.52

Transmission

The common cold virus is typically transmitted via airborne droplets, direct contact with infected nasal secretions, or fomites (contaminated objects).5354 Which of these routes is of primary importance has not been determined.55 As with all respiratory pathogens once presumed to transmit via respiratory droplets, it is highly likely to be carried by the aerosols generated during routine breathing, talking, and singing.56 The viruses may survive for prolonged periods in the environment (over 18 hours for rhinoviruses) and can be picked up by people's hands and subsequently carried to their eyes or noses where infection occurs.57 Transmission from animals is considered highly unlikely; an outbreak documented at a British scientific base on Adelaide Island after seventeen weeks of isolation was thought to have been caused by transmission from a contaminated object or an asymptomatic human carrier, rather than from the husky dogs which were also present at the base.58

Transmission is common in daycare and schools due to the proximity of many children with little immunity and poor hygiene.59 These infections are then brought home to other members of the family.60 There is no evidence that recirculated air during commercial flight is a method of transmission.61 People sitting close to each other appear to be at greater risk of infection.62

Other

Herd immunity, generated from previous exposure to cold viruses, plays an important role in limiting viral spread, as seen with younger populations that have greater rates of respiratory infections.63 Poor immune function is a risk factor for disease.6465 Insufficient sleep and malnutrition have been associated with a greater risk of developing infection following rhinovirus exposure; this is believed to be due to their effects on immune function.6667 Breast feeding decreases the risk of acute otitis media and lower respiratory tract infections among other diseases,68 and it is recommended that breast feeding be continued when an infant has a cold.69 In the developed world breast feeding may not be protective against the common cold in and of itself.70

Pathophysiology

The symptoms of the common cold are believed to be primarily related to the immune response to the virus.71 The mechanism of this immune response is virus-specific. For example, the rhinovirus is typically acquired by direct contact; it binds to humans via ICAM-1 receptors and the CDHR3 receptor through unknown mechanisms to trigger the release of inflammatory mediators.72 These inflammatory mediators then produce the symptoms.73 It does not generally cause damage to the nasal epithelium.74 The respiratory syncytial virus (RSV), on the other hand, is contracted by direct contact and airborne droplets. It then replicates in the nose and throat before spreading to the lower respiratory tract.75 RSV does cause epithelium damage.76 Human parainfluenza virus typically results in inflammation of the nose, throat, and bronchi.77 In young children, when it affects the trachea, it may produce the symptoms of croup, due to the small size of their airways.78

Diagnosis

The distinction between viral upper respiratory tract infections is loosely based on the location of symptoms, with the common cold affecting primarily the nose (rhinitis), throat (pharyngitis), and lungs (bronchitis).79 There can be significant overlap, and more than one area can be affected.80 Self-diagnosis is frequent.81 Isolation of the viral agent involved is rarely performed,82 and it is generally not possible to identify the virus type through symptoms.83

Prevention

The only useful ways to reduce the spread of cold viruses are physical and engineering measures84 such as using correct hand washing technique, respirators, and improvement of indoor air. In the healthcare environment, gowns and disposable gloves are also used.85 Droplet precautions cannot reliably protect against inhalation of common-cold-laden aerosols. Instead, airborne precautions such as respirators, ventilation, and HEPA/high MERV filters, are the only reliable protection against cold-laden aerosols.86 Isolation or quarantine is not used as the disease is so widespread and symptoms are non-specific. There is no vaccine to protect against the common cold.87 Vaccination has proven difficult as there are so many viruses involved and because they mutate rapidly.8889 Creation of a broadly effective vaccine is, therefore, highly improbable.90

Regular hand washing appears to be effective in reducing the transmission of cold viruses, especially among children.91 Whether the addition of antivirals or antibacterials to normal hand washing provides greater benefit is unknown.92 Wearing face masks when around people who are infected may be beneficial; however, there is insufficient evidence for maintaining a greater social distance.93

It is unclear whether zinc supplements affect the likelihood of contracting a cold.94

Management

Treatments of the common cold primarily involve medications and other therapies for symptomatic relief.95 Getting plenty of rest, drinking fluids to maintain hydration, and gargling with warm salt water are reasonable conservative measures.96 Much of the benefit from symptomatic treatment is, however, attributed to the placebo effect.97 As of 2010,[update] no medications or herbal remedies had been conclusively demonstrated to shorten the duration of infection.98

Symptomatic

Treatments that may help with symptoms include pain medication and medications for fevers such as ibuprofen99 and acetaminophen (paracetamol).100 However, it is not clear whether acetaminophen helps with symptoms.101 It is not known if over-the-counter cough medications are effective for treating an acute cough.102 Cough medicines are not recommended for use in children due to a lack of evidence supporting effectiveness and the potential for harm.103104 In 2009, Canada restricted the use of over-the-counter cough and cold medication in children six years and under due to concerns regarding risks and unproven benefits.105 The misuse of dextromethorphan (an over-the-counter cough medicine) has led to its ban in a number of countries.106 Intranasal corticosteroids have not been found to be useful.107

In adults, short term use of nasal decongestants may have a small benefit.108 Antihistamines may improve symptoms in the first day or two; however, there is no longer-term benefit and they have adverse effects such as drowsiness.109 Other decongestants such as pseudoephedrine appear effective in adults.110111 Combined oral analgesics, antihistaminics, and decongestants are generally effective for older children and adults.112 Ipratropium nasal spray may reduce the symptoms of a runny nose but has little effect on stuffiness.113 Ipratropium may also help with coughs in adults.114 The safety and effectiveness of nasal decongestant use in children is unclear.115

Due to lack of studies, it is not known whether increased fluid intake improves symptoms or shortens respiratory illness.116 As of 2017, heated and humidified air, such as via RhinoTherm, is of unclear benefit.117 One study has found chest vapor rub to provide some relief of nocturnal cough, congestion, and sleep difficulty.118

Some experts advise against physical exercise if there are symptoms such as fever, widespread muscle aches or fatigue.119120 It is regarded as safe to perform moderate exercise if the symptoms are confined to the head, including runny nose, nasal congestion, sneezing, or a minor sore throat.121122 There is a popular belief that having a hot drink can help with cold symptoms, but evidence to support this is very limited.123

Antibiotics and antivirals

Antibiotics have no effect against viral infections, including the common cold.124 Due to their side effects, antibiotics cause overall harm but nevertheless are still frequently prescribed.125126 Some of the reasons that antibiotics are so commonly prescribed include people's expectations for them, physicians' desire to help, and the difficulty in excluding complications that may be amenable to antibiotics.127 There are no effective antiviral drugs for the common cold even though some preliminary research has shown benefits.128129

Zinc

Main article: Zinc and the common cold

Zinc supplements may shorten the duration of colds by up to 33% and reduce the severity of symptoms if supplementation begins within 24 hours of the onset of symptoms.130131132133134 Some zinc remedies directly applied to the inside of the nose have led to the loss of the sense of smell.135136 A 2017 review did not recommend the use of zinc for the common cold for various reasons;137 whereas a 2017 and 2018 review both recommended the use of zinc, but also advocated further research on the topic.138139

Alternative medicine

Main article: Alternative treatments used for the common cold

While there are many alternative medicines and Chinese herbal medicines supposed to treat the common cold, there is insufficient scientific evidence to support their use.140141 As of 2015, there is weak evidence to support nasal irrigation with saline.142 There is no firm evidence that Echinacea products or garlic provide any meaningful benefit in treating or preventing colds.143144

Vitamins C and D

Main article: Vitamin C and the common cold

Main article: Vitamin D and respiratory tract infections

Vitamin C supplementation does not affect the incidence of the common cold, but may reduce its duration if taken on a regular basis.145 There is no conclusive evidence that vitamin D supplementation is efficacious in the prevention or treatment of respiratory tract infections.146

Prognosis

The common cold is generally mild and self-limiting with most symptoms generally improving in a week.147 In children, half of cases resolve in 10 days and 90% in 15 days.148 Severe complications, if they occur, are usually in the very old, the very young, or those who are immunosuppressed.149 Secondary bacterial infections may occur resulting in sinusitis, pharyngitis, or an ear infection.150 It is estimated that sinusitis occurs in 8% and ear infection in 30% of cases.151

Epidemiology

The common cold is the most common human disease152 and affects people all over the globe.153 Adults typically have two to three infections annually,154 and children may have six to ten colds a year (and up to twelve colds a year for school children).155 Rates of symptomatic infections increase in the elderly due to declining immunity.156

Weather

A common misconception is that one can "catch a cold" merely through prolonged exposure to cold weather.157 Although it is now known that colds are viral infections, the prevalence of many such viruses are indeed seasonal, occurring more frequently during cold weather.158 The reason for the seasonality has not been conclusively determined.159 Possible explanations may include cold temperature-induced changes in the respiratory system,160 decreased immune response,161 and low humidity causing an increase in viral transmission rates, perhaps due to dry air allowing small viral droplets to disperse farther and stay in the air longer.162

The apparent seasonality may also be due to social factors, such as people spending more time indoors near infected people,163 and especially children at school.164165 Although normal exposure to cold does not increase one's risk of infection, severe exposure leading to significant reduction of body temperature (hypothermia) may put one at a greater risk for the common cold: although controversial, the majority of evidence suggests that it may increase susceptibility to infection.166

History

While the cause of the common cold was identified in the 1950s, the disease appears to have been with humanity since its early history.167 Its symptoms and treatment are described in the Egyptian Ebers papyrus, the oldest existing medical text, written before the 16th century BCE.168 The name "cold" came into use in the 16th century, due to the similarity between its symptoms and those of exposure to cold weather.169

In the United Kingdom, the Common Cold Unit (CCU) was set up by the Medical Research Council in 1946 and it was where the rhinovirus was discovered in 1956.170 In the 1970s, the CCU demonstrated that treatment with interferon during the incubation phase of rhinovirus infection protects somewhat against the disease,171 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 prevention and treatment of rhinovirus colds, the only successful treatment in the history of the unit.172

Research directions

Antivirals have been tested for effectiveness in the common cold; as of 2009, none had been both found effective and licensed for use.173 There are trials of the anti-viral drug pleconaril which shows promise against picornaviruses as well as trials of BTA-798.174 The oral form of pleconaril had safety issues and an aerosol form is being studied.175 The genomes of all known human rhinovirus strains have been sequenced.176

Societal impact

The economic impact of the common cold is not well understood in much of the world.177 In the United States, the common cold leads to 75–100 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 symptom relief.178 More than one-third of people who saw a doctor received an antibiotic prescription, which has implications for antibiotic resistance.179 An estimated 22–189 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 who have a cold, the total economic impact of cold-related work loss exceeds $20 billion per year.180181 This accounts for 40% of time lost from work in the United States.182

Notes

Bibliography

  • Eccles R, Weber O, eds. (2009). Common Cold (Illustrated ed.). Springer Science & Business Media. ISBN 978-3-7643-9912-2.
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References

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  26. Eccles p. 1 ↩

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  128. Simasek M, Blandino DA (February 2007). "Treatment of the common cold". American Family Physician. 75 (4): 515–20. PMID 17323712. Archived from the original on 26 September 2007. http://www.aafp.org/afp/20070215/515.html ↩

  129. Eccles p. 218 ↩

  130. "Zinc – Fact Sheet for Health Professionals". Office of Dietary Supplements, US National Institutes of Health. 10 July 2019. Archived from the original on 25 March 2021. Retrieved 27 December 2019. Although studies examining the effect of zinc treatment on cold symptoms have had somewhat conflicting results, overall zinc appears to be beneficial under certain circumstances.... In September of 2007, Caruso and colleagues published a structured review of the effects of zinc lozenges, nasal sprays, and nasal gels on the common cold [69]. Of the 14 randomized, placebo-controlled studies included, 7 (5 using zinc lozenges, 2 using a nasal gel) showed that the zinc treatment had a beneficial effect and 7 (5 using zinc lozenges, 1 using a nasal spray, and 1 using lozenges and a nasal spray) showed no effect. More recently, a Cochrane review concluded that "zinc (lozenges or syrup) is beneficial in reducing the duration and severity of the common cold in healthy people, when taken within 24 hours of onset of symptoms" [73]. The author of another review completed in 2004 also concluded that zinc can reduce the duration and severity of cold symptoms [68]. However, more research is needed to determine the optimal dosage, zinc formulation and duration of treatment before a general recommendation for zinc in the treatment of the common cold can be made [73]. As previously noted, the safety of intranasal zinc has been called into question because of numerous reports of anosmia (loss of smell), in some cases long-lasting or permanent, from the use of zinc-containing nasal gels or sprays [17–19]. https://ods.od.nih.gov/factsheets/Zinc-HealthProfessional ↩

  131. Singh M, Das RR (June 2013). Singh M (ed.). "Zinc for the common cold". The Cochrane Database of Systematic Reviews (6): CD001364. doi:10.1002/14651858.CD001364.pub4. PMID 23775705. (Retracted, see doi:10.1002/14651858.CD001364.pub5, PMID 25924708,  Retraction Watch) /wiki/Doi_(identifier) ↩

  132. Rondanelli M, Miccono A, Lamburghini S, Avanzato I, Riva A, Allegrini P, et al. (2018). "Self-Care for Common Colds: The Pivotal Role of Vitamin D, Vitamin C, Zinc, and Echinacea in Three Main Immune Interactive Clusters (Physical Barriers, Innate and Adaptive Immunity) Involved during an Episode of Common Colds-Practical Advice on Dosages and on the Time to Take These Nutrients/Botanicals in order to Prevent or Treat Common Colds". Evidence-Based Complementary and Alternative Medicine. 2018: 5813095. doi:10.1155/2018/5813095. PMC 5949172. PMID 29853961. Considering zinc, the supplementation may shorten the duration of colds by approximately 33%. CC patients may be instructed to try zinc within 24 hours of onset of symptoms. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5949172 ↩

  133. Hemilä H, Fitzgerald JT, Petrus EJ, Prasad A (2017). "Zinc Acetate Lozenges May Improve the Recovery Rate of Common Cold Patients: An Individual Patient Data Meta-Analysis". Open Forum Infectious Diseases. 4 (2): ofx059. doi:10.1093/ofid/ofx059. PMC 5410113. PMID 28480298. The 3-fold increase in the rate of recovery from the common cold is a clinically important effect. The optimal formulation of zinc lozenges and an ideal frequency of their administration should be examined. Given the evidence of efficacy, common cold patients may be instructed to try zinc acetate lozenges within 24 hours of onset of symptoms. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5410113 ↩

  134. Hemilä H, Petrus EJ, Fitzgerald JT, Prasad A (November 2016). "Zinc acetate lozenges for treating the common cold: an individual patient data meta-analysis". British Journal of Clinical Pharmacology. 82 (5): 1393–1398. doi:10.1111/bcp.13057. PMC 5061795. PMID 27378206. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5061795 ↩

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  136. "Loss of Sense of Smell with Intranasal Cold Remedies Containing Zinc". Food and Drug Administration. 2009. Archived from the original on 4 June 2015. https://web.archive.org/web/20150604024153/https://www.fda.gov/Drugs/DrugSafety/DrugSafetyPodcasts/ucm167282.htm ↩

  137. Malesker MA, Callahan-Lyon P, Ireland B, Irwin RS (November 2017). "Pharmacologic and Nonpharmacologic Treatment for Acute Cough Associated With the Common Cold: CHEST Expert Panel Report". Chest. 152 (5): 1021–1037. doi:10.1016/j.chest.2017.08.009. PMC 6026258. PMID 28837801. A suggestion for the use of zinc lozenges in healthy adults with cough due to common cold was considered by the expert panel. However, due to weak evidence, the potential side effects of zinc, and the relatively benign and common nature of the condition being treated, the panel did not approve inclusion of this suggestion. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6026258 ↩

  138. Rondanelli M, Miccono A, Lamburghini S, Avanzato I, Riva A, Allegrini P, et al. (2018). "Self-Care for Common Colds: The Pivotal Role of Vitamin D, Vitamin C, Zinc, and Echinacea in Three Main Immune Interactive Clusters (Physical Barriers, Innate and Adaptive Immunity) Involved during an Episode of Common Colds-Practical Advice on Dosages and on the Time to Take These Nutrients/Botanicals in order to Prevent or Treat Common Colds". Evidence-Based Complementary and Alternative Medicine. 2018: 5813095. doi:10.1155/2018/5813095. PMC 5949172. PMID 29853961. Considering zinc, the supplementation may shorten the duration of colds by approximately 33%. CC patients may be instructed to try zinc within 24 hours of onset of symptoms. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5949172 ↩

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