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Prevention and Treatment of the Common Cold in Adults

Pathophysiology

The primary barrier to using pharmacologic or immunologic agents to prevent or treat the common cold is that no single specific pathogen causes it. The common cold can be caused by a number of different pathogens. The most common of these is a group of rhinoviruses; they still only account for 30% to 40% of colds seen clinically, however. Different types of influenza viruses also can cause syndromes synonymous with the common cold and are reported to be responsible for 25% to 30% of all colds. Other pathogens include coronaviruses, adenoviruses, parainfluenza viruses, and respiratory syncytial viruses.

The incidence of colds in the United States varies from season to season, beginning in late August to mid September and ending in the spring, with the lowest incidence in the summer. It is uncertain whether temperature has a direct impact on increasing the incidence of colds, due to possible effects on the immune system or the presence of better growth environments for the virus, or whether temperature has an indirect effect (eg, when schools are in session or when more people stay indoors).

Transfer of virus occurs through direct skin-to-skin contact, indirect skin contact through fomites, or via aerosolized droplets from respiratory secretions. Viruses are shed via the nasal mucus, which is usually associated with increased nasal mucosal drainage. Selfcare of nasal drainage (with or without facial tissue) allows the virus to be transferred to hands. The viruses are then transferred to others directly or through an intermediary object, such as a door handle, telephone, or desktop. When the virus is picked up by the hand of a noninfected person, natural human movements around the face can transmit the virus to an area of mucosal tissue, which allows the virus to infect the new host.

The viruses that cause the common cold typically invade the nasal mucosa and begin replicating and shedding new virus. The peak quantity of shed virus usually correlates to peak periods of symptoms. Presence of  the virus itself can cause some level of tissue damage, but it also results in an immunologic reaction and increases nasal fluid production (runny nose) and nasal edema (stuffy nose). Irritation to the nasal passages results in sneezing, which is a common symptom of having a cold. Sneezing also may release viruses into the air, where they can be transmitted in air droplets to other potential hosts. Although most colds are not caused by bacteria, the tissue damage and altered nasal environment may lead to an increased risk of secondary bacterial infections in the sinuses, throat, and remaining respiratory system.

Case 1


Margaret is a 35-year-old mother of 3, with children aged 14, 10, and 6. Every year, she deals with her entire family getting sick from colds, but this year, she wants to prevent it. In early November, her youngest child develops sniffles and sneezing. She comes to you to ask what she can do to prevent her entire family from getting the cold. What options can you offer her from the pharmacy, and what other recommendations can you provide?

Answer


From the pharmacy: Vitamin C, zinc, and echinacea products may have some benefit, and at normal doses are probably not harmful. Since transmission usually occurs by hand-to-mouth contact, regular use of an alcohol hand wash by all household members may be helpful when regular hand washing is not feasible.
From outside the pharmacy: Sequestering the sick child from the other family members as much as possible is probably the best way to prevent the cold from spreading to other family members; practice regular hand washing.

Cold symptoms can begin anywhere from 12 to 72 hours after exposure to a causative pathogen. The most common symptoms include runny nose, stuffy nose, sneezing, sore throat, and cough. Fever is rare in adults with a cold. Symptoms typically peak in 2 to 3 days and resolve within 1 week. Nasal discharge is usually clear to white, and excessive amounts of discharge may result in irritation of the external nares due to frequent cleaning with tissue. Concurrent respiratory conditions, including smoking, may worsen symptoms, such as difficulty breathing and coughing, and patients should be observed closely for the development of secondary infections and/or complications.

Nonpharmacologic Prevention

Nonpharmacologic prevention of the common cold is easier said than done on a regular basis. Given the ways colds are acquired, nonpharmacologic prevention entails basic infection control measures. This includes regular hand washing by individuals with a cold and those wishing to prevent infection, as well as isolation of people with the cold (eg, having people with the cold stay at home and avoid household members who are not already ill). Cleaning hands with a virucidal solution was found to be effective at preventing transmission within households.

Currently, many alcohol-based handsanitizing products are available over the counter. Although these products do kill potential pathogens, including viruses and bacteria, no data exist to support either using these products instead of regular hand washing or using them to prevent illnesses that are not known to be present. Thus, whereas these products may provide a quick means of sanitizing hands when hand washing may be delayed, the data do not indicate their superiority to regular hand washing in the home setting.

Prevention and Treatment

Dietary Supplements
Dietary supplements, which broadly include vitamins, minerals, and botanicals, are becoming increasingly popular for the prevention and treatment of the common cold. The main dietary supplements commonly used today for the prevention and/or treatment of the common cold include vitamin C, echinacea, and zinc. These products are widely available throughout most pharmacies, but the FDA has not evaluated the use of these or other dietary supplements for their stated label claims. As such, manufacturers of dietary supplements must place the following statement on the label: “This statement has not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.”

Vitamin C
The role of vitamin C (ascorbic acid) in the prevention of the common cold is not completely understood, but it appears to act as an immune-stimulating agent by helping cells of the immune system mature. Vitamin C also may protect against cellular stress, as the concentration of vitamin C in immune cells appears to be high.19

A recent Cochrane review, which looked at published studies of vitamin C in doses ranging from 250 mg to 2 g per day, revealed that vitamin C does not affect the incidence of the common cold in the normal adult population; in a subset of this review, however, prophylactic vitamin C (when given to marathon runners, skiers, or soldiers in subarctic climates) reduced the incidence of the common cold by 50%.20 This appears to suggest that, when taken during periods of stress when the body’s immune system may be weakened, vitamin C may help to prevent the onset of the common cold. In addition, among individuals who experience a cold when taking vitamin C preventively, the duration of the cold may be reduced by 8%; the impact on the severity of the cold may only be slight, however.20

Vitamin C also has been evaluated in reducing the severity and duration of the common cold when taken as a treatment rather than preventively; however, no consistent statistically significant benefit to taking vitamin C at the onset of symptoms to help reduce the duration of the cold is apparent. Despite these overall findings, one study did find that a single 8-g dose of vitamin C, when taken at the initial onset of symptoms, reduced the duration of the cold to 2.86 days, compared with 3.52 days with placebo.21 Vitamin C treatment does not appear to reduce the severity of the common cold, despite one study that found a slight benefit to its use.

Although high-dose vitamin C (>8 g/ day) may be effective for the treatment of the common cold and is advocated by certain organizations, one of the main concerns when using vitamin C at such high doses are its gastrointestinal side effects, such as nausea and diarrhea.These side effects may impact patient adherence and thus may limit any beneficial effects. Other potential side effects of vitamin C include flushing, dizziness, headache, fatigue, heartburn, and flank pain. Individuals taking vitamin C should be counseled to take it with a full glass of water (at least 8 oz) to prevent the development of kidney stones. Individuals who have diabetes should be instructed to use a serum blood glucose monitor because vitamin C may cause false-positive or false-negative test results when measuring urinary glucose.23

Table 1
Table 1

Vitamin C supplements are available in a variety of strengths and formulations. Ester-C contains metabolites of vitamin C with calcium ascorbate, has a neutral pH, and appears to be better tolerated, compared with standard vitamin C preparations containing only ascorbic acid.25 In one observational study, Ester-C also was found to produce higher serum vitamin C levels and a higher concentration of vitamin C in white blood cells than L-ascorbic acid.26 Another formulation, Emergen-C’s drink powder, is built on 7 mineral ascorbates (potassium, calcium, magnesium, manganese, sodium, chromium, and zinc) and contains 32 active mineral complexes as well as B vitamins. The vitamin C in another product, Easy C tablets, is in the form of the mineral salt calcium ascorbate and ascorbyl palmitate. Table 1 lists examples of currently available vitamin C supplement products.

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October 22, 2008 - Posted by | Uncategorized

1 Comment »

  1. Nasal Washing Works During The Cold and Flu Season
    My patients often say “you want me to do what” when I suggest nose washing for nasal congestion from colds and other infections. I explain why nasal washing makes so much sense, why it is safe, and why it is effective in reducing both the symptoms and the use of medications. I then demonstrate the simple technique to little ones as young as 2 and to folks up to age 90, they are then ready to try it. My patients require my services less often during the winter cold and flu season if they wash daily. You may think I am trying to put myself out of business but since my job is keeping people healthy and helping them feel better, I love teaching people how to wash his or her nose, I have been doing just this for more than 20 years.
    With cold and flu season here, this is a wonderful time to share basic preventive health care. It has been clearly shown that daily nasal washing will reduce the number of infections a person experiences. Exposure to irritants such as bacteria and viruses causes swelling of the mucus membranes and an increase in mucus production as well as thicker and stickier mucus this results in abnormal environment. A buffered salt solution washes particles out, shrinks nasal membranes, increases the efficiency of the nose hairs, thins secretions and allows the tiny sinus openings to drain. Washing the body’s filter just makes sense!
    Nasal washes are also useful for those who frequently encounter pollutants: allergy sufferers, firefighters, factory workers, farmers, gardeners, painters and exercise enthusiasts. People who are fed up with using too many medications sincerely appreciate the benefits of cleaning their nose. Almost daily, the news announces a medication is recalled, the side effects are too risky and most recently, children should NOT be given cold remedies. We have known for some time that over the counter cold remedies do not shorten the course of the cold. It is clear that antibiotics, decongestants, antihistamines as well as nasal steroids are over prescribed and overused. However, the side effects, the expense, the potential drug interactions AND the development of bacterial resistance is a concerning issue for our modern society. I tell my patients when discussing any recommended treatment option, “You should look at the pros and cons of each option offered to you prior to making your decision.” How can washing with buffered salt water cause any harm?
    Nasal cleanliness is central to good health and is effective for anyone that wishes to prevent nasal woes or wishes to reduce their use of medications. It is important to have a system that makes washing easy, safe and effective. There are several methods currently available. For example, there is a squeeze bottle, a Neti pot and several squeeze bottles. The Nasopure delivery system that I personally developed to help my patients offers full control over pressure and flow and offers convenience. Pick the system that works for you because any washing is better than no washing.

    People are more likely to wash their nasal passages if it is incorporated into their daily routine – like brushing teeth, washing hands, shampooing hair, and YES: Nasal Washing!

    Comment by hana solomon, md | October 23, 2008 | Reply


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