Cold

Symptoms

Possible symptoms of a cold include:

• Sore throat
• Sneezing, cold sniffles, runny nose, later nasal congestion.
• Feeling sick, fatigue
• Cough, Acute bronchitis
• Hoarseness
• Headache
• Fever is rare in adults, but is often observed in children

Causes

The common cold is caused in most cases by rhinoviruses, but numerous other viruses such as parainfluenza viruses, coronaviruses, RSV, adenoviruses and enteroviruses are also possible pathogens. Mixed infections are also possible. The characteristics vary depending on the pathogen and it is not possible to conclude the causative virus only on the basis of the symptoms. Influenza caused by influenza viruses is considered a separate disease and is not usually counted as a cold. Although cold does not cause a cold, it can potentially lead to increased susceptibility to the viruses or cause subclinical infections to break out. A cold lasts an average of 7-10 days, in some cases up to 3 weeks. The cough, in particular, can last a long time.

Transmission

Direct or indirect contact with secretions from an infected person, such as shaking hands or contact with objects. Contact with a virus-contaminated aerosol that is transmitted directly from person to person or indirectly through the air. The infectious aerosols can remain airborne for a long time. The incubation period is short and symptoms may appear as early as 12 hours after transmission. The viruses enter the nasopharynx and multiply in the epithelial cells. The sinuses and Eustachian tube are also commonly affected, which can lead to sinusitis, tubal catarrh, and otitis media. Some viruses can also affect the lower respiratory tract (bronchitis). However, they do not cause symptoms primarily by destroying tissue, but rather by the patient’s own immune system, which causes, for example, the vasodilatation that leads to the common cold.

Risk factors

• More common in children
• More common in the cold season
• Contact with infected people
• Psychological stress (immunosuppression)
• Heredity

Complications

• Tubal catarrh
• Middle ear infection, especially in children.
• Pneumonia
• Bronchitis and sinusitis
• Exacerbation of asthma
• Disruption of personal activities, absence from school and work.
• Influence on the psyche, mood and responsiveness.

Differential diagnosis

Influenza caused by influenza viruses is distinguished from the common cold on the basis of symptoms and course. It is characterized by, among other things, a sudden onset with fever, headache, and aching limbs. The course is usually more severe and forces bed rest (see also under flu). Mild streptococcal angina may be difficult to distinguish from an early cold with sore throat based on symptoms alone. However, rhinitis – the leading symptom of a cold – rarely occurs with streptococcal angina. Other infectious diseases can also cause similar symptoms. Allergic conditions such as hay fever can be mistaken for the common cold, but are usually easy to distinguish. As of 2020, the common cold had to be differentiated from covid-19, which proved difficult, especially from the fall onward. Valid differentiation is possible only with laboratory testing.

Prevention

• Hygiene measures can reduce the risk of transmission: Regular hand washing, wearing a hygienic mask, keeping your distance, not kissing or shaking hands as a greeting.
• Immunostimulants such as echinacea, vitamin C and zinc can have a preventive effect.
• Vaccines are not yet on the market. Buccalin contains inactivated germs of H. influenzae, S. pneumoniae, S. haemolyticus, S. aureus and is approved as an oral immunostimulant for bacterial colds.

Drug treatment

A wide range of conventional and alternative medicines are used to treat colds. They can relieve discomfort, but usually do not shorten the duration of the disease. Specific antiviral agents are not yet commercially available. The following list provides an overview of commonly used medicines.Painkillers:

• Paracetamol, acetylsalicylic acid or ibuprofen help against fever, sore throat, limb pain and headache. The contraindications and possible adverse effects must be observed.

Decongestant nasal sprays:

• Or nasal drops with active ingredients such as xylometazoline and oxymetazoline are used against rhinitis and constrict the dilated blood vessels in the nasal mucosa. They should not be used for more than 5-7 days, as they can cause dependence (rhinitis medicamentosa).

Oral sympathomimetics:

• Such as phenylephrine, ephedrine or pseudoephedrine are taken orally for rhinitis, tubal catarrh and sinusitis. They are not suitable for all patients and have possible adverse effects. The contraindications and interactions must be considered.

Sea water:

• Is used in the form of sprays and rinses to moisten and cleanse the nasal mucosa in rhinitis and sinusitis.

Inhalations:

• Inhalation of hot water is considered soothing by many patients. Herbs, essential oils or cold balms can be added to the water.

Nasal ointments:

• Take care of dry nasal mucous membranes. Some contain essential oils, which leads to a relieving feeling in the nose.

Cold baths:

• Contain essential oils and are used against coughs and colds.

Cold balms:

• Cold balms consist of a greasy base such as petrolatum, in which essential oils and balms are dissolved. They are rubbed on the chest against coughs and colds or inhaled with water.

Antitussives:

• Such as codeine or dextromethorphan are taken for irritable cough.

Antihistamines:

• 1st generation antihistamines such as doxylamine, pheniramine or chlorphenamine are likely to be effective against rhinorrhea and against sneezing. Antihistamines make you sleepy and are therefore often used at night for sleep disorders. This anesthetic may also have an effect against cough. Especially in children, sick and elderly people, they should be used only with caution or not at all.

Anticholinergics:

• Such as ipratropium bromide administered nasally are effective against watery rhinitis and sneezing.

Expectorants:

• Such as acetylcysteine, bromhexine or herbal drugs such as thyme and ivy are expectorants and expectorants for the treatment of cough and other ailments with heavy mucus production.

Local anesthetics:

• Such as lidocaine, oxybuprocaine or ambroxol are used in the form of lozenges, sprays and gargles to numb the pain of mouth and throat pain. Some disinfectants such as benzydamine are also local anesthetics.

Vitamins and trace elements:

• Such as vitamin C and zinc are used both preventively and therapeutically.

Herbal medicines:

• Numerous herbal medicines are traditionally used to treat colds. Echinacea is said to stimulate the immune system, pelargonium to reduce the discomfort of bronchitis. Sage is used locally for sore throat as a lozenge, tea, spray or solution.

Combined flu remedies:

• With antihistamines, analgesics, cough and cold remedies such as Pretuval, Neo-Citran or Vick Medi Nait are popular and well-known among patients. Experts usually advise against their use because of the increased risk of adverse effects and the fact that some of the active ingredients are underdosed. Particularly in children, the elderly and when taking other medications, caution is advised.

Antiviralia:

• Specific antiviral agents are in development, such as ruprintrivir (rhinovirus 3C protease inhibitor) or pleconaril (binds to the viral capsid), but are not yet on the market.

Antibiotics:

• Because the common cold is viral in nature, antibiotics are not indicated except for bacterial superinfections (eg, otitis media). Nevertheless, they are still frequently prescribed.