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The Common Cold

September 22, 2013

amazingspiderman087_15Modern physicians–drawing strength from scientific advance–have expanded their array of superpowers, and family doctors are no
exception. Using high tech equipment, we exercise our broad skill sets to subdue disease, restoring health to the masses. But every comic book superhero has a nemesis. That one formidable foe that cannot be vanquished; that invulnerable villain who is impervious to attack; who taunts our technology and scoffs at our science. For family doctors the world over, that opponent must surely be: the common cold.

The common cold is caused by an army of different viruses, the commonest among them being, rhinovirus. These viruses cause nasal congestion, sneezing, runny noses, sore throats, and coughing. Each episode will typically last for three to seven days, although many people have symptoms for up to two weeks. Preschool children will succumb to roughly five to seven episodes per year, while adults can expect to endure two to three. The good news is that most symptoms will resolve, even without treatment. The bad news is that many remedies marketed to patients, simply don’t live up to expectations.

Antibiotics are ineffective against viruses and lead to unnecessary side effects. There is also insufficient evidence to promote the use of antihistamines, intranasal steroids, vitamin C, and codeine.

So, what can you do when the common cold invades your body?


There is no evidence to support the use of most over-the-counter cough remedies in children. I recommend that parents use buckwheat honey for a bothersome nighttime cough because it is safe and effective in children older than one year. Children younger than one year should avoid honey because of the risk of botulism. Applying VapoRub to the chest and neck of a child may improve cough severity and quality of sleep, but children might not tolerate the strong smell. A wheezing chest requires inhaled corticosteroids, like budesonide (Pulmicort). Acetylcysteine is sometimes used to decrease a cough in children older than two years, but can cause vomiting. Irrigating a child’s nose with saline will soothe a sore throat and thin nasal secretions, making it easier to breathe through the nose. Zinc sulphate may decrease the duration of cold symptoms when taken within the first 24 hours of onset. Alternative remedies that have demonstrated some benefit include: Zinc acetate or gluconate lozenges, and Pelargonium sidoides (South African Geranium) extract.


Runny nose and nose congestion may improve with the use of a decongestant, such as pseudoephedrine. Nasal inhalers, including ipratropium bromide and cromolyn sodium are also helpful.

Other nasal sprays such an oxymetazoline offer temporary relief of nasal congestion, but should never be used for more than two to three days, or it can worsen symptoms.

Coughing is treated by dextromethorphan, guaifenesin, and oral inhalation of ipratropium.

Sore throat and headache are best treated with a mild pain reliever such as acetaminophen (Tylenol) or a non-steroidal anti-inflammatory agent such as ibuprofen or naproxen (Motrin or Aleve).

Alternative remedies that may be effective include: Andrographis paniculata (Kalmcold) 200 mg daily for 5 days, Echinacea purpurea 20 drops three times daily for 10 days, and Pelargonium sidoides (geranium extract) 30 drops three times daily for 10 days.

Although zinc lozenges and syrup may modestly reduce the duration of a cold, intranasal zinc products have been associated with a permanent loss of smell. The benefit of zinc lozenges must be balanced against side effects, like bad taste and nausea.


Covering your mouth when sneezing or coughing, preferably by sealing it with the sleeve of your clothing (at the inner elbow), helps to limit the dispersion of viral particles into the air. Cold viruses live on hands and surfaces (such as a counter top, door handle, or phone) for several hours, so hand washing is an essential and highly effective way to prevent the spread of infection.

Vitamin C, zinc sulfate (used for at least 5 months), Chizukit (herbal preparation containing 50mg/ml of Echinacea, 50mg/ml of propolis, and 10mg/ml of vitamin C), and probiotics–such as Lactobacillus acidophilus NCFM, alone or combined with Bifidobacterium animalis– have all been used for prevention of the common cold. None have seemed to weaken the resolve of our age-old rival.

Despite all its stubbornness, the common cold remains a trivial pest. It loses battle after battle with the human immune system, but like a proverbial jack-in-the-box, springs back time and again, to disrupt our lives and mock modern medicine.


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