Common Cold in Adults
A separate article on coronavirus infections is available Covid-19 and other Coronavirus Infections.
Essentials
- Acute nasal stuffiness and rhinitis, sore throat and cough are the most common symptoms.
- Viral infections should be differentiated from bacterial ones.
- Avoid unnecessary antimicrobial drugs Antibiotics for the Common Cold and Acute Purulent Rhinitis.
- Identify recurrent or chronic infections.
- If the patient smokes, advise him/her to stop smoking.
Aetiology
- In about half of the cases, the causative agent is some type of rhinovirus. of which over 100 serotypes are known.
- Other common viral aetiologies include coronavirus, RSV, influenza virus and parainfluenzavirus.
- Rarer aetiologies include, among others, adenovirus, enterovirus Enterovirus Infections, metapneumovirus and EBV Mononucleosis.
Symptoms
- Key symptoms are nasal stuffiness or runny nose and a cough.
- Other common symptoms include throat pain, headache, tiredness, muscle pain and slight rise in temperature.
- The peak of symptoms is typically around the 3rd or 4th day of the disease and symptoms alleviate within a week. Cough may persist for several weeks Prolonged Cough in a Child Prolonged Cough in Adults.
- History: earlier episodes of sinusitis or bronchitis, smoking, fever
- Pay attention to the general condition of the patient and identify complicated cases.
- Mouth and pharynx: peritonsillar swelling suggests peritonsillitis or a peritonsillar abscess Peritonsillitis and Peritonsillar Abscess
- Neck
- Enlarged lymph nodes (adenovirus, mononucleosis, streptococci)
- Tender area of the thyroid gland: subacute thyroiditis is a rather uncommon cause of anterior neck pain Subacute Thyroiditis.
- Maxillary sinuses: imaging studies of the maxillary sinuses are not recommended in short-lasting common cold which is often associated with accumulation of fluid in the sinuses.
- Ears: examined if the patient has ear symptoms
- Lungs: rales, wheezing, sputum; if the patient has respiratory difficulties, measure the peak expiratory flow.
- Laboratory tests are generally not needed. They can be used for differential diagnosis between viral and bacterial infections or if there is a reason to search for a specific pathogen.
- Basic blood count with platelet count. Lymphocytopenia is common in acute infections. Many viruses may reduce neutrophil production. Sometimes neutropenia may persist for several weeks after a viral infection that has already subsided. Bacterial infections typically cause neutrophilia and do not suppress the cell production in the bone marrow.
- The use of CRP assay to support treatment decisions reduces the prescription of antimicrobial drugs in lower respiratory tract infections and in sinusitis Crp Point-of-Care Testing in Maxillary Sinusitis and Lower Respiratory Tract Infection (Lrti).
- A rapid test for group A streptococci should be performed if the Centor score is 3 or more Sore Throat and Tonsillitis.
- In suspected mononucleosis, as the first-line test, a rapid test for detecting Epstein-Barr virus can be performed Mononucleosis.
- Influenza A and B viruses Influenza can be tested for with a PCR-based nucleic acid detection test, the sensitivity of which is 90-98%.
- A combination test is available for detecting, in addition to influenza A and B, also RSV and COVID-19 virus.
- The test result is usually available within 3-4 hours after the sample has been delivered to the laboratory.
- In outpatient care, performing a rapid test to detect influenza is not needed if more than 48 hours have passed since the symptom onset because at that stage drug therapy will not significantly reduce the duration of the disease. Patients who have very severe symptoms or are susceptible to complications as well as their close contacts are an exception to this principle.
- Symptomatic treatment
- The use of zinc does not reduce the incidence of infections, and the evidence concerning the efficacy of zinc lozenges in reducing the symptomatic period is uncertain. The use is associated with abdominal symptoms and bad taste in the mouth as adverse effects.
- When the pain in the throat is severe, a single dose of glucocorticoids (e.g. prednisolon 60 mg) rapidly alleviates the pain Corticosteroids as Standalone or Add-on Treatment for Sore Throat.
- There is no evidence on the effectiveness of cough medicines Over-the-Counter Antitussives for Acute Cough and their routine use should be avoided.
- The need of sick leave is individually evaluated according to the patient's condition and job description. If sick leave is considered necessary, 1-3 days is usually sufficient. See also local guidance on making a certificate for short-term inability to work.
- In rare cases, an adenovirus infection can trigger immunothrombosis (thrombocytopenia 10-100 × 109 /l, D dimer typically very high > 5 mg/l, even > 100 mg/l, venous and/or arterial thromboses, bleeding complications). If such a condition is suspected, consult without delay a haematology/coagulation specialist and, in case of neurological symptoms, a neurologist. See also local guidance.
References
- Zhao Y, Dong BR, Hao Q. Probiotics for preventing acute upper respiratory tract infections. Cochrane Database Syst Rev 2022;(8):CD006895. [PubMed]
- De Sutter AI, Eriksson L, van Driel ML. Oral antihistamine-decongestant-analgesic combinations for the common cold. Cochrane Database Syst Rev 2022;(1):CD004976. [PubMed]
- Perera AI, Thomas MG, Petrie KJ et al. Reducing Expectations for Antibiotics in Patients With Upper Respiratory Tract Infections: A Primary Care Randomized Controlled Trial. Ann Fam Med 2021;19(3):232-239. [PubMed]
- Jolliffe DA, Camargo CA Jr, Sluyter JD et al. Vitamin D supplementation to prevent acute respiratory infections: a systematic review and meta-analysis of aggregate data from randomised controlled trials. Lancet Diabetes Endocrinol 2021;9(5):276-292. [PubMed]
- Grande AJ, Keogh J, Silva V et al. Exercise versus no exercise for the occurrence, severity, and duration of acute respiratory infections. Cochrane Database Syst Rev 2020;4(4):CD010596. [PubMed]
- Hemilä H, Haukka J, Alho M, et al. Zinc acetate lozenges for the treatment of the common cold: a randomised controlled trial. BMJ Open 2020;10(1):e031662 [PubMed]