Common Cold: Chapter 11

Common Cold: Chapter 11

• Patient with complaints suggestive of a common cold: Obtain medical history, including CAM (complementary and alternative medicine) and medication history, to identify medication exclusions/precautions.
• Exclusions for self-treatment: Fever (≥100.4°F or 38.0°C), chest pain, shortness of breath, worsening symptoms, concurrent chronic cardiopulmonary conditions, compromised immune systems (e.g., AIDS, chronic immunosuppressant therapy), frail patients of advanced age, infants ≤3 months old, hypersensitivity to OTC medications.
• Recommend nondrug measures: Adequate hydration, rest, identify most problematic symptoms.
• Cough primary complaint?: If no, recommend nondrug measures. If yes, see Figure 11-3.
• Symptoms related to allergy alone?: If yes, consider saline nasal spray or decongestant, humidifiers, and elevating the head of the bed. If no, see next steps.
• Most problematic symptoms: Congestion and rhinorrhea, aches and pains, fever, pharyngitis. Corresponding treatments are suggested.
• Additional complaint of sleeplessness?: If yes, switch between typical decongestant use (sprays, nighttime use of AHs or alcohol-based products). If no, refer for further evaluation.
• Symptoms resolved after 7-14 days of therapy?: If yes, assess patient as needed. If no, refer for further evaluation.

Additional Information (page 2)

• Viral infection of the upper respiratory tract: Higher exposure rates increase susceptibility
• Leading cause of absenteeism: Children (6-10 per year), Adults (<60) (2-4 per year), Adults (>60) (1 per year)
• Pathophysiology: Limited to upper respiratory tract, host defense system to protect the body, nerves in the nose cause symptoms, ~200 viruses, peak viral levels in 2-4 days, nasopharynx for 16-18 days, self-inoculation after contact with objects, aerosol transmission
• Possible links to colds: Cold environments, sudden chilling or exposure to central heating. Walking outside barefoot, teething, enlarged tonsils are not associated with increased susceptibility.

Clinical Presentation (page 3)

• Symptoms: Appear 1-3 days after infection, persist 7-14 days, sore throat first, nasal symptoms (day 2-3), cough (<20% of cases) (day 4-5)
• Patient reports: Red pharynx, postnasal drainage, nasal obstruction, tender sinuses, clear, thin, watery secretions (day 1-2), thick secretions (green or yellow), low-grade fevers rare
• Non-pharmacological treatment: Maintain fluid intake, adequate rest, nutritious diet, increase humidity, saline spray drops, soothing foods and drinks (soup or tea), breathing strips

OTC Medications (pages 4, 5)

• Decongestants (treat sinus & nasal congestion): Adrenergic agonists NOT recommended in <6-year-olds, FDA approved to temporally relieve nasal congestion & cough.
• Systemic Decongestants (e.g., Sudafed): Maximum daily dosage (3.6g/day for adults). Side effects: increased BP, tachycardia, insomnia, restlessness, anxiety, tremors, hallucinations.
• Nasal Decongestants (e.g., Afrin): 2-3 sprays per nostril every 10-12 hours; DO NOT use for more than 3 days. -Local anesthetic (lozenges, sprays): Benzocaine (e.g., Cepacol), menthol, symptoms improving 7-14 days after use.
• Antihistamines: Not effective for colds alone
• Zinc: Modest antiviral effect, may help prevent colds.

Special Populations (page 5)

• Pregnancy: Avoid systemic decongestants; use Afrin.
• Lactating: Avoid Afrin, naphazoline, use Sudafed.
• Children (<12 years old): Using OTC cold products is controversial.

Cold (page 6)

• General Information: Viral infection restricted to the upper respiratory tract. Children (6-10 per year), Adults (<60) (2-4 per year), Adults (>60) (1 per year); Season: late August—early April. Self-limiting.
• Pathophysiology: Host defense system protection; nerves in the nose causing symptoms; over 200 viruses; Rhinoviruses; Peak virus levels (2-4 days) in the nasopharynx (16-18 days). Transmission: self-inoculation, aerosol. Increased susceptibility: higher exposure rates, allergy, less diverse social networks, weakened immunity. Possible links: cold environments, sudden chilling, exposure to central heating
• Symptoms: Seen 1-3 days after infection, persist 7-14 days; sore throat first, nasal symptoms (day 2–3), cough (<20% of cases) (day 4-5); red pharynx, postnasal drainage, nasal obstruction, tender sinuses, clear secretions (day 1–2) changing to thick (green or yellow). Low-grade fever is rare.
• Exclusions for self-treatment: Fever (>101.5°F or 38.6°C), chest pain, shortness of breath, worsening symptoms, coexisting chronic lung conditions, HIV/AIDS, compromised immune system.