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De. Albert Frankel

Family Physician

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Featured Article: "Common cold"



Introduction

A common cold is an infection of your upper respiratory tract. It's relatively harmless — but it usually doesn't feel that way. If it's not a runny nose, sore throat and cough, it's watery eyes, sneezing and congestion. Or maybe all of the above. In fact, because any one of more than 200 viruses can cause a common cold, symptoms tend to vary greatly.

Unfortunately, if you're like most adults, you're likely to have a common cold two to four times a year. Children, especially preschoolers, may have a common cold as many as eight to 10 times annually.

The good news is that you or your child should be feeling better in about a week or so. If symptoms of a common cold aren't improving in that time, see your doctor to make sure you don't have a bacterial infection in your lungs, sinuses or ears.

Signs and symptoms

Symptoms of a common cold usually appear about one to three days after exposure to a cold virus. Signs and symptoms of a common cold may include:

  • Runny or stuffy nose
  • Itchy or sore throat
  • Cough
  • Congestion
  • Slight body aches or a mild headache
  • Sneezing
  • Watery eyes
  • Low fever — less than 102 F
  • Mild fatigue

The discharge from your nose may become thicker and yellow or green in color as a common cold runs its course. What makes a cold different from other viral infections is that you generally won't have a high fever. You're also unlikely to experience significant fatigue from a common cold.

Causes

Although more than 200 viruses can cause a common cold, the rhinovirus is the most common culprit, and it's highly contagious.

A cold virus enters your body through your mouth or nose, but it's likely you also had a "hand" in your own illness. The virus can spread through droplets in the air when someone who is sick coughs, sneezes or talks. But it also spreads by hand-to-hand contact with someone who has a cold or by using shared objects, such as utensils, towels, toys or telephones. Touch your eyes, nose or mouth after such contact or exposure, and you're likely to "catch" a cold.

Risk factors

Children are especially susceptible to common colds because they haven't yet developed resistance to most of the viruses that cause them. But an immature immune system isn't the only thing that makes kids vulnerable. They also tend to spend lots of time with other children and aren't always careful about washing their hands and covering their coughs and sneezes.

As you age, you develop immunity to many of the viruses that cause common colds. You'll have colds less frequently than you did as a child, though you can still come down with a cold when you're exposed to cold viruses, have an allergic reaction that affects your nasal passages or have a weakened immune system.

Both children and adults are more susceptible to colds in fall and winter, when children are in school and most people are spending a lot of time indoors. In places where there is no winter, colds are more frequent in the rainy season.

Other beliefs about how you catch a common cold — such as going outdoors with wet hair or getting chilled — are starting to be seriously studied. In a small study at the Common Cold Centre in Wales, scientists tested 180 healthy volunteers. Half submerged their bare feet in ice water for 20 minutes, and half stayed dry. Within five days, nearly one-third of the chilled participants developed sore throats and runny noses, whereas only 9 percent of their warmer counterparts did.

Some researchers theorize that cold constricts blood vessels in the nose, slowing the white cells that fight infection and disrupting the first-line defense against germs. And with reduced immunity, dormant infections are more likely to develop into full-blown colds. This theory isn't universally accepted by any means. Many researchers insist that colds are more common in winter because people spend more time indoors where germs spread easily.

When to seek medical advice

Seek medical attention if you have:

  • Fever greater than 102 F
  • High fever accompanied by achiness and fatigue
  • Fever accompanied by sweating, chills and a cough with colored phlegm
  • Symptoms that get worse instead of better or last more than about 10 days

In general, children are sicker with a common cold than adults are and often develop complications such as ear infections. Your child doesn't need to see the doctor for a routine common cold, but you'll need to seek medical attention right away if your child has any of the following signs or symptoms:

  • Fever of 103 F or higher, chills or sweating
  • Fever that lasts more than 72 hours
  • Vomiting or abdominal pain
  • Unusual sleepiness
  • Severe headache
  • Difficulty breathing
  • Persistent crying
  • Ear pain
  • Persistent cough

Complications

  • Acute ear infection (otitis media). The most frequent complication of common colds in children, ear infections occur when bacteria infiltrate the space behind the eardrum. Typical signs and symptoms include earaches and, in some cases, a green or yellow discharge from the nose or the return of a fever following a common cold. Children who are too young to verbalize their distress may simply cry or pull on the affected ear.
  • Wheezing. A cold can trigger wheezing in children with asthma.
  • Sinusitis. In adults or children, a common cold that doesn't resolve may lead to sinusitis — inflammation and infection of the sinuses.
  • Other secondary infections. These include strep throat (streptococcal pharyngitis), pneumonia, chronic bronchitis in adults and croup in children. These infections need to be treated by a doctor.

Treatment

There's no cure for the common cold. Antibiotics are of no use against cold viruses, and over-the-counter (OTC) cold preparations won't cure a common cold or make it go away any sooner, and most have side effects. Here's a look at the pros and cons of some common cold remedies.

  • Pain relievers. For fever, sore throat and headache, many people turn to acetaminophen (Tylenol, others) or other mild pain relievers. Keep in mind that acetaminophen can cause liver damage, especially if taken frequently or in larger-than-recommended doses. Be especially careful when giving acetaminophen to children; the dosing guidelines can be confusing. For instance, the infant drop formulation is three times as concentrated as the syrup commonly used in older children. Never give aspirin to children; it may have a role in causing Reye's syndrome, a rare, but potentially fatal illness.
  • Decongestant nasal sprays. Adults shouldn't use decongestant drops and sprays for more than a few days because prolonged use can cause chronic inflammation of your mucous membranes. And children shouldn't use them at all. There's little evidence that they work in young children, and they may cause side effects.
  • Cough syrups. In winter, nonprescription cough syrups practically fly off the drugstore shelves. But the American College of Chest Physicians strongly discourages the use of these medications because they're not effective at treating the underlying cause of cough due to colds. Some contain ingredients that may alleviate coughing, but the amounts are too small to do much good and may actually be harmful for children. In fact, the college has strongly recommended against using OTC cough syrups or cold medicines for any child younger than 14. Coughs associated with a cold usually last less than two to three weeks; if a cough lingers longer than that, see your doctor.

Prevention

Because so many different viruses can cause a common cold, no effective vaccine has been developed. But you can take some common-sense precautions to slow the spread of cold viruses:

  • Wash your hands. Clean your hands thoroughly and often, and teach your children the importance of hand washing. Carry a bottle of alcohol-based hand rub containing at least 60 percent alcohol for times when soap and water aren't available. These gels kill most germs, and are safe for older children to use themselves.
  • Scrub your stuff. Keep kitchen and bathroom countertops clean, especially when someone in your family has a common cold. Wash children's toys after play.
  • Use tissues. Always sneeze and cough into tissues. Discard used tissues right away, and then wash your hands carefully. Teach children to sneeze or cough into the bend of their elbow when they don't have a tissue. That way they cover their mouth without using their hands.
  • Be a little selfish. Don't share drinking glasses or utensils with other family members. Use your own glass or disposable cups when you or someone else is sick.
  • Steer clear of colds. Avoid close, prolonged contact with anyone who has a cold.
  • Choose your childcare center wisely. Look for a childcare setting with sound hygiene practices and clear policies about keeping sick children at home.
  • Consider the alternatives. Whether therapies such as vitamin C, zinc and echinacea relieve cold symptoms remains controversial. But the latest research seems to show that moderate doses of vitamin C can shorten the duration of a cold and that zinc nasal sprays or lozenges taken at the beginning of a cold may help reduce symptoms.

Self-care

You may not be able to cure your common cold, but you can make yourself as comfortable as possible. These tips may help:

  • Drink lots of fluids. Water, juice, tea and warm soup are all good choices. Avoid alcohol, caffeine and cigarette smoke, which can cause dehydration and aggravate your symptoms.
  • Try chicken soup. Generations of parents have spooned chicken soup into their sick children. Now scientists have put chicken soup to the test, discovering that it does seem to help relieve cold and flu symptoms in two ways. First, it acts as an anti-inflammatory by inhibiting the movement of neutrophils — immune system cells that participate in the body's inflammatory response. Second, it temporarily speeds up the movement of mucus through the nose, helping relieve congestion and limiting the amount of time viruses are in contact with the nasal lining. Researchers at the University of Nebraska compared homemade chicken soup with canned versions and found that many, though not all, canned chicken soups worked just as well as soups made from scratch.
  • Get some rest. Consider staying home from work if you have a fever or a bad cough, or are drowsy from medications. This will give you a chance to rest as well as reduce the chances that you'll infect others. Wear a mask when you have a cold if you live or work with someone with a chronic disease or compromised immune system.
  • Adjust your room's temperature and humidity. Keep your room warm, but not overheated. If the air is dry, a cool-mist humidifier or vaporizer can moisten the air and help ease congestion and coughing. Be sure to keep the humidifier clean to prevent the growth of bacteria and molds.
  • Soothe your throat. Gargling with warm salt water several times a day or drinking warm lemon water with honey may help soothe a sore throat and relieve a cough.
  • Use nasal drops. To help relieve nasal congestion, try saline nasal drops. You can purchase these drops over-the-counter, and they're effective, safe and nonirritating, even for children. To use in babies, instill several drops into one nostril, then immediately bulb suction that nostril. Repeat the process in the opposite nostril. Doing this before feeding your baby will improve your child's ability to nurse or take a bottle.
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