Nasal Decongestants in Monotherapy for the Common Cold

Comment: The quality of evidence is downgraded by imprecise results (few studies in each comparison) and inconsistency (heterogeneity in outcomes).

A Cochrane review [Abstract] 1 15 trials with 1838 patients. Only adults were included in 14 studies. In 6 studies a single dose and in 9 studies multiple doses were used. Pseudoephedrine was used in 9 studies, oxymetazoline in 3 studies and phenylpropanolamine, norephedrine and xylometazoline in other studies. Eleven studies used oral and 4 studies topical decongestants.In 10 studies patient had had symptoms for less than 3 days and in 3 studies less than 5 days. In the single-dose studies, the effectiveness was measured on the same day, whereas the follow-up in multi-dose studies ranged between one and 10 days.Eight studies were conducted in university settings.

• Single-dose decongestant versus placebo (10 studies): the effectiveness was tested between 15 minutes and 10 hours after dosing. Seven studies reported subjective symptom scores for nasal congestion; none reported overall patient well-being. However, pooling was not possible due to the large diversity in the measurement and reporting of symptoms of congestion.
• Multi-dose decongestant versus placebo (9 studies): only 5 studies reported on the primary outcome, subjective symptom scores for nasal congestion. Subjective measures of congestion were significantly better for the treatment group compared with placebo approximately 3 hours after the last dose (SMD 0.49, 95% CI 0.07 to 0.92; 2 studies, n=94). However, the SMD indicates a small clinical effect. There was no difference in adverse events in the treatment group (125 per 1000) vs. placebo (126 per 1000).

References

• Deckx L, De Sutter AI, Guo L et al. Nasal decongestants in monotherapy for the common cold. Cochrane Database Syst Rev 2016;10():CD009612. [PubMed]