The cold is considered a major health issue by the National Institute of Health. The symptoms are certainly not life threatening or even considered serious, however cold symptoms cause a reduction in the ability to function well. The National Center for Health Statistics estimates that there are 62 million cases of the common cold each year, resulting in 20 million school days and 22 million workdays lost each year in the U.S. In the workplace less work is accomplished because the cold symptoms reduce our performance. The loss of days at work and school along with a reduction in productivity at work costs the U.S. millions of dollars each year.
What is a Cold?
The cold is a group of symptoms caused by a specific viral infection that selectively affects the upper respiratory tract. Cold season typically begins in September and continues through the end of March. The nose, nasal sinuses and throat are affected. The upper respiratory symptoms of a cold include runny nose (rhinorrhea), cough and sore throat. Nasal congestion is the accumulation of mucus and inflammation in the upper section of the nose and the sinus’s. Headache and a low-grade fever can also be common features.
Main symptoms:
- runny nose
- congestion
- cough
- sore throat
Less common symptoms:
- headache
- low grade fever
Most colds are caused by rhinoviruses. There are over 100 different types of rhinovirus; this is why we can get several different colds in one season. The common cold is more frequent in the winter months because most of us are indoors in close proximity to each other. There is a greater chance the virus will be transferred to other people when they are inside together for long periods of time. In the summer we are more likely to be outside and spread out from each other. Some viruses will have more severe symptoms than others. Most colds last about 5-10 days and resolve without any treatment.
Risks of Catching a Common Cold
There are certain behaviors and conditions that increase the risk of contracting the cold virus. There are circumstances that we can try to avoid that would put us at risk of catching a cold.
Crowded areas with minimal ventilation – The most obvious is crowed places that are enclosed with limited ventilation. Flying in an airplane is significant risk factor, since we are captive to a seat location. Even if you are aware someone 1 or 2 seats away has a cold and is coughing, you may not be able to change seats if the flight is full. Another situation that most have little control over is our work environment. Maximization of office space has led to many working in close quarters the chances of spreading infections. Cramped commuting in buses, trains and even cars also increases transmission of infections due to the close proximity of many people.
Excessive Stress – Stress is also a risk factor that increases the chance of infection. Stress releases a class of hormones that weaken the immune system and breakdown our defense against infections. Stress is something everyone tries to avoid but is inherent in our lives. All stress cannot be prevented, but it is important to recognize prolonged stressful situations. It is this prolonged condition that is harmful to us and, during the cold season, puts us at risk of being unable to defend against the cold virus. It is important to take time away from stressful situations when possible, especially during cold season.
Contaminated Exercise Equipment – The gym is a place where we think about exercising and improving our health. However, many share the exercise machines, weights and bathing areas. Bacteria and viruses are more likely to stay behind when a person is sweating. Therefore the gym machines provide a good medium for virus and bacterial growth to occur. To help reduce your risk in this situation, carry alcohol a based wash and wipe down each machine before and after its use. This will help prevent acquiring the cold virus and bacterial infections.
Exercise in is an important part of maintaining our good health, but over training can lead to chronic fatigue and impair our immune system similar to the effects of prolonged stress. Once again, moderation is an important factor.
Behavioural Risks
Limit alcohol intake – One alcoholic drink a day, especially wine, has been shown to be a health benefit. However, excessive alcohol intake is a serious risk factor for a multitude of health related problems. It is clear that excessive alcohol intake impairs the immune system and reduces one’s ability to be pay attention to otherwise obvious behaviors that increase our risk of catching a cold. Most are less concerned about maintaining good cold avoiding behaviors after drinking too much. For example, when drinking people are more likely to engage in risky behaviors such as sharing a drink, washing hands incompletely or touching of the mouth and nose with contaminated hands. These routine hygiene behaviors may be ingrained in our daily activities, but even a slight impairment of alcohol may be enough affect our attention to the environment. In addition, alcohol has a dehydrating effect on the body. The mucosal lining is the first defense against air borne infections. When the mucosa is dried out, it limits the ability to defend against infection. It is not clear how much alcohol is considered excessive for each individual person, but common sense can only be applied in this situation.
Thorough Hand Washing – Incomplete hand washing is a common cause of infection spread. Many briefly rub their hands on the soap and rinse. Studies have shown that it is necessary to lather with soap for 20 seconds and rinse with warm water. Soap does not actually kill the virus, but helps remove it when the hands are rinsed. Make sure a clean towel is used after hand washing. In the home, it may be best to use paper towels when a family member is sick. This way it will be less likely the virus is on the hand towel waiting for the next person to touch it.
Alcohol based hand gel is a good substitute when soap and water are not available, but it is not as effective. It is important use a sink to wash whenever available and keep the gel for emergencies.
Try to remember not to touch your face throughout the day. This way even if the hand is contaminated with the virus, a cold will not be acquired unless the hand makes it way to the mouth or nose.
How to Prevent Colds
The best way to defend against the cold is to understand how the average person catches it. The cold virus can be spread in three different ways; air-borne droplets from a cough or sneeze of a sick person, when a sick person touches their nose or mouth and later shakes hands with another, and finally when an infected person touches something that some else will touch later.
There are conditions and situations that increase the risk of catching the virus. The greatest risk of airborne contamination is in crowded areas, where it is easier to breath in the droplets from a cough or sneeze of a sick person. Many people work in offices or are in classrooms with others who may be sick. It is hard to avoid something that cannot be seen, however precautions can be taken. Covering your mouth when you cough prevents the virus from becoming airborne however puts the virus on your hand. The virus is then transferred to any object that is touched and will be picked up by the next person who touches it. The virus can survive for hours on a contaminated object. Try coughing into the bend of your arm to prevent virus droplets from spreading.
Touching an object that was contaminated by an infected person increases the risk of contracting the illness. The most common items to be infected with a cold virus are keyboards, door handles and telephones. Frequent hand washing with warm water and soap for 30 seconds, kills the virus about 98% of the time. Hand wash solutions with at least 60% alcohol content are an excellent way to decontaminate your hands when soap and water are not available. You can also wipe down a potentially infected keyboard or telephone with alcohol wipes before using it.
Avoid the virus spread
-Wash hands frequently
-wipe down commonly infected areas
-Cough into the bend of your arm
Alternatives to Prevent Colds
The immune system works best when you are getting enough sleep and are eating appropriately. People are most susceptible to infection when tired, run down, and not eating well. Most of us have a busy family life, overwhelming projects at work or exam week in school. It is an important preventive strategy during these times to try to get your normal amount of sleep and maintain a healthy diet.
Testimonials and advertising claims about vitamins or a new breakthrough to treat the cold are common. Vitamin C, Zinc and Echinacea are the most common treatments advertised.
Vitamin C – The benefit of taking high doses of vitamin C to prevent a cold has been debated for over 40 years. Many clinical studies have tested this theory, however most have been inconclusive. It is therefore uncertain as to whether vitamin C is effective in preventing infection.
The good news is that there is reason to believe that high doses of vitamin C reduces the severity and duration of cold symptoms. In a recent study from the University of Wisconsin, students taking 500mg of vitamin C per day experienced fewer and less severe symptoms when they had a cold. On average, the students taking the vitamin C experienced about half the amount coughing and sneezing. In addition, the duration of the cold was 40% shorter in those taking vitamin C.
Zinc – There are several over the counter zinc cold remedies. There have been many studies to evaluate their overall effectiveness in treating the cold, however the studies were small and inconclusive. An academic group, called the Cochrane Collaboration, combined all previous study data, in a meta-analysis, and found that Zinc gluconate lozenges reduced the duration and symptoms of a cold. Contraindications include the fact that Zinc may reduce the body’s ability to absorb antibiotics and some individuals experience a metallic taste.
Echinacea is a popular herbal supplement and is believed to have immune boosting properties. There have been many studies evaluating its effectiveness in treating cold symptoms. The results of the studies have been mixed because there are 9 different species of the plant being used in over 800 supplements. This has complicated understanding of the herb as a treatment for colds. The University of Connecticut combined the results of 14 different studies in what is referred to as a meta-analysis. The authors concluded that there was a 58% reduction in a person’s chance of catching a cold if Echinacea is taken every day. At the first sign of a cold it is recommended that a dose of 3 grams a day should be started.
Although the use of Echinacea appears to have benefits in treating adults with cold symptoms, it is not recommended in children because due to the uncertainty of the herbs effect on their developing immune system.
Alternative medications to reduce severity and duration of cold symptoms.
-Vitamin C 500mg per day
- Zinc gluconate lozenges 2-3 times per day
- Echinacea 3 grams per day
Cold Treatments
Currently there are no anti-viral medications that kill the cold virus in the body. Antibiotics treat bacterial infections and have no effect on the cold virus or symptoms. There are several treatments and medications that alleviate symptoms of a cold and can result in less discomfort during the illness.
Warm Steam – Breathing in warm steam can treat congestion effectively. Plug the drain in the sink, turn on the hot water, lean over the sink and put a towel over your head. This will form a tent and allow the steam to be directed to your nose and mouth. Breath deeply through your nose and this will loosen the mucus in your nose and sinus significantly. This can be done 3-4 times a day and provide a clear head for several hours.
Medication – Available over the counter cold medications treat the symptoms of a runny nose and congestion. These medications are primarily antihistamines. This class of medications reduces the inflammatory reaction that increases mucus production. The medications often work well; however can have prominent side effects, including drowsiness and dizziness. Often the side effects caused by the medications can be more problematic then the cold symptoms. Nonetheless for some people the medications are helpful. One way to experience the benefit of the medication without the daytime drowsiness is to take an antihistamine before bed. It is easier to fall asleep with a clear nose and the drowsiness caused by the medication may assist in falling asleep as well.
Salt Water – An effective treatment for a sore throat is to gargle with salt water. Fill a glass with warm water from the tap, add two teaspoons of table salt and gargle for 2 minutes. The tissue in the throat is swollen and inflamed from the viral infection. The salt water causes fluid to be pulled out of the swollen cells thereby reducing the swelling and the pain in the throat. A topical spray can be used if the pain persists.
Pain Killers – Analgesics (pain killers) treat the headache, sinus pressure and sore throat that accompany many colds. Acetaminophen and ibuprofen products can significantly reduce the discomfort and can allow people to be more functional throughout the day. Aspirin should be avoided in children because it has been associated with Rye’s syndrome.
Treating Mucas – The cough associated with a cold may be caused by one of two factors. The first is mucus accumulation in the throat and lower airway. The body will try to clear the airway of the mucus by trying to cough it out. This forceful act will eventually bring out the mucus from the throat in lower airway. This is a important mechanism the body has developed to protect our breathing. However, the coughing can be disruptive to our daily functioning. Coughing excessively can further spread the virus. In this case treating the mucus congestion in the lower airway can be broken down using a class of medications referred to as expectorants (dissolves mucas). The most common expectorant, guaifenesin, is found in several over-the-counter cold medications. The mucus in the lower airways causing the coughing is absorbed into the body, therefore reducing the need to cough.
The second cause of coughing during a cold is throat irritation that triggers the brain to produce a cough. Increasing fluid intake and humidity will usually help the throat irritation. A humidifier can be placed near the bedside so the cough is less active during the nighttime hours. If the cough is persistent dispite these efforts, a class of medications referred to as cough suppressants can be used. Dextromethorphan is the most common medication used in a variety of over-the-counter medications. It acts in the brain’s “cough center” to inhibit the cough.
Cold medications
Congestion/runny nose: pseudoephedrine (Sudafed), diphenhydramine (Benedryl)
Fever: Acetaminophen (Tylenol), Ibuprofen (Advil)
Cough: Expectorants: guaifenesin (Humibid, Robitussin)
Cough suppressants: dextromethorphan (Robitussin DM)
Children with Colds
Cold season is from September to March when kids are together in the classroom. School age children have approximately 7-12 colds in per year, with symptoms starting more rapidly than in adults. The child may go to bed with a slight runny nose and wake up congested and miserable. In addition to the usual symptoms of runny nose, congestion and sore throat, children are more likely to have headache, fever and fatigue. It is very important to watch for secondary bacterial infections, because the smaller anatomy of the sinus and ear canals increase the chance for bacteria to grow in the mucus.
The young child’s body is not able to contain and localize infections as well as an adult, therefore children are more susceptible to secondary effects from the cold virus infection. Infants and young children with congestion and sore throat may not eat and drink because of the discomfort associated with chewing and swallowing. It is more common for children to experience vomiting and diarrhea with a cold due to postnasal mucus drip irritating the gastrointestinal tract. All of these factors can lead to poor nutritional intake and dehydration. It is therefore, important to encourage fluid intake, even a sip a minute will add up and make a difference. All of these factors contribute stress on the young body and further compromise the child’s immune system. Fever in a young child with cold symptoms is a very important sign to watch for. Fever, especially in infants, causes fluid to be lost through the skin, causes fatigue and reduced desire to eat and drink. Fever can be a sign of the infection spreading throughout the body. For these reasons an infant with cold symptoms and fever should see a doctor to evaluate for a more serious illness.
The cold in children
-starts more abruptly
-more often accompanied with vomiting and diarrhea
-at risk for dehydration and secondary bacterial infections (ear and sinus infections)
Infants can acquire a different virus with similar effects as the cold virus, called respiratory syncytial virus (RSV). Although many of the symptoms are similar, RSV infection has the potential to cause serious breathing problems. The doctor can do a viral detection test for RSV during an office visit by collecting nasal discharge on a cotton swab.
Children between the ages of 1 and 7 years with cold symptoms should be monitored for ear and sinus infections. The inflammation associated with a cold can also include the tubes draining the middle ear (Eustachian tubes) and the sinus tracts. The thick mucus may clog these drains and the fluid in the middle ear and sinuses provides a culture for bacteria to grow.
The earliest sign of an ear infection in a young child can be severe ear pain shortly after lying down. The pressure in the middle ear increases when the child lies down. A decongestant, such as diphenhydramine (Benedryl), to help dry up the fluid, and ibuprofen, to treat the pain, should help the child return to sleep. A doctor can diagnose the ear infection in the office by viewing the eardrum (tympanic membrane). Many ear infections are bacterial and would require antibiotic treatment.
Sinus infections are less dramatic and symptoms develop over several days. Sinus infections most commonly present after there has been no improvement in cold symptoms for over 5 days and child complains of facial pain, has a green or brown discharge and appears overly tired. The area over the checks is sensitive when a finger is gently pushed against the cheeks. Sinusitis can be accompanied by a fever and these symptoms should alert the parent to bring the child to the doctor. Sinus infections rarely occur in infants because the sinuses have not yet formed.
The treatment for colds in children is similar to adults. Sleep and healthy eating during this time is especially important. An extra nap may speed the recovery in children. Standing in the corner of a steamy shower and breathing through the nose will help loosen the mucus. Salt water gargling should not be attempted in young children because they will likely swallow too much saltwater, however adolescents may benefit from this practice. Throat sprays can help the pain of a sore throat. Saline drops in the nose followed by suction using a bulb syringe are very effective in removing mucus congestion in infants. See the movie below.
The guidelines for over-the-counter medications continue to change. Recently FDA guidelines state that children under 4 should not be given decongestants, antihistamines or cough medication. The recommended doses on the labels of acetaminophen and ibuprofen should be given for fever and, as needed, for pain and discomfort associated with the cold in older children.
Prevention strategies are even more important in children for several reasons. Young children are more susceptible to serious infections that may accompany the common cold, and infections spread much more rapidly among children.
Children are less likely to cover their mouths when coughing or sneezing, and other children in the area may not notice when they are sneezed or coughed on. The sick child will likely touch their face and touch objects through out the room including toys, books, pencils and door handles that will soon be handled by other children. Frequent and thorough hand washing, is especially important when a child is sick in order to prevent spread of the virus to siblings, parents and grandparents. Thorough hand washing involves warm water of soap for 20-30 seconds. A good practice for teaching children how the appropriate period of time is to have them sing the “Happy Birthday” song twice.
When to take your child to the doctor:
-any fever in an infant (less than 1 year old)
-prolonged decreased eating and drinking
-ear pain
-facial pain with colored nasal discharge
-no improvement in cold symptoms after 5-7 days
-cold symptoms with fever
Do you Need a Doctor For Colds?
A doctor visit is not necessary for the adult with classic symptoms of a cold, unless the symptoms are severe or if there are additional problems. For example, a cold can increase the risk of developing a strep throat, therefore if the throat pain is severe, the doctor may need to perform a throat culture. Additional reasons for an adult to see a doctor are a cold lasting for more than 10 days with no improvement in symptoms or the symptoms getting worse after 7 days. Cold symptoms can exacerbate asthma and increase the chance of developing sinusitis and ear infections.
Asthma is a result of inflammation in the lower respiratory tract of the lungs that causes narrowing of the airways. Asthma can be exacerbated by a variety of triggers. The most common are allergies, infection and inhaled irritants. Children and adults with cold symptoms and subsequent problems breathing should seek medical attention as soon as possible.
Signs of sinusitis include facial pain, a green or brown nasal discharge and a fever.
As seen in the illustration above, the sinuses are in direct proximity to the nasal region. The sinuses are air filled spaces within the bones of the skull. Most sinuses are located in the facial region. The sinuses are not fully formed until 7-8 years of age.
The blue areas in the above illustration are called the maxillary sinuses, green area designates the frontal sinuses, red area is called the sphenoid sinus and purple areas are the ethmoid sinuses. Facial pain is the result of some or all of the sinuses becoming filled with mucus and inflammation, usually as a result of infection.
The common cold is a self-limited illness that is acquired by breathing in or introducing the virus to the respiratory tract. The subsequent infection causes inflammation and mucus production for 3-7 days. Vitamin C and zinc can help reduce the severity and the duration of the symptoms. Steam and salt water gargling can decrease congestion and sore throat pain. Analgesics and antihistamines can also relieve these symptoms. The most important factor is to try to prevent spreading the cold by frequent hand washing, wiping down commonly used areas, and coughing into the bend of your arm.
More Cold Facts
It is hypothesized that the cold virus genetically mutated from an infection in birds to the human approximately 200 years ago.
The virus itself does not directly cause the symptoms of the cold. It is the body’s immune response that causes inflammation and increased mucus production. Mucus normally forms a protective layer over the upper respiratory area that helps protect against infection. The cough and sneeze is the body’s attempt to rid itself of the virus.
References
www.niaid.nih.gov/topics/commonCold/Pages/overview.aspx
www.merckmanuals.com/professional/sec14/ch188/ch188c.html?qt=cold&alt=sh
en.wikipedia.org/wiki/Zinc_gluconate
www.news.uconn.edu/2007/June/rel07056.html
Singh, M. Cochrane Database of Systematic Reviews, 2011
www.webmd.com/lung/tc/respiratory-syncytial-virus-rsv-infection-exams-and-tests
www.webmd.com/cold-and-flu/cold-guide/children_colds
www.merckmanuals.com/professional/sec05/ch052/ch052a.html
en.wikipedia.org/wiki/Sinus
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