The Common Cold: Prevention and Remedies

When we say “common cold” we are usually referring to a benign, self limited viral disease. It is one of the most common viral illnesses in the United States.

This mild upper respiratory viral infection varies is severity and is usually associated with nasal congestion and discharge, sneezing, sore throat, cough, low-grade fever, headache, and malaise. The common cold is a separate and distinct entity, it is not influenza.

The vast majority of those afflicted with the common cold have an uncomplicated recovery. However, despite this fact different people have different physiologic responses to the common cold that can range from very mild symptoms to more moderate or severe symptoms.

Treatment of the common cold has been extensively studied, unfortunately many of these studies use inconsistent definitions of disease, are not uniform in how they measure outcomes, at times mix subjective and objective findings, and there is a large variable age range. This leads to inconsistencies in the study findings.

Here we will review some of the interventions that have scientific data available to support them.

Effective Therapies

Handwashing - This has been shown to prevent the spread of the cold virus (as well as others communicable diseases).

Probiotics - There is no quality evidence to support the use of probiotics for the common cold.

Analgesics - This includes Tylenol and nonsteroidal antiinflammatory drugs such as Motrin. These help with symptom relief but don't affect the duration of illness.

Antihistamine/decongestant combinations - The combination of antihistamines and decongestants has been shown to be more beneficial than either alone.

Intranasal ipratropium bromide - Runny nose and sneezing may be improved by the use of intranasal spray, however it does not improve nasal congestion.

Therapies with uncertain (or no) benefits

Dextromethorphan - Given the lack of supporting evidence, the use of dextromethorphan for acute cough due to the common cold is not recommended.

Decongestants - May offer some mild relief of nasal congestion associated with the common cold.

Saline nasal spray - Saline nasal irrigation for the common cold may have symptomatic benefits, but there is limited evidence to support using it.

Expectorants - The expectorant guaifenesin has a marginal effect compared with placebo. There is no good data for or against this therapy for the common cold.

Vitamins and Herbal products

No herbal product has been conclusively shown to significantly impact the incidence of the common cold.

Zinc

Zinc lozenges and syrup may decrease cold symptom severity and duration. However, it is not recommended because of uncertain benefits and known toxicities, including irreversible anosmia when administered intranasally.

Some have found that zinc intake is associated with a reduction in the duration and severity of cold symptoms. Zinc is available in a homeopathic preparation as intranasal zinc gluconate for the treatment and prevention for colds.

This formulation has also been found to cause hyposmia (reduced ability to smell and to detect odors) and anosmia (the loss of the ability to detect one or more smells). So much so that the US Food and Drug Administration (FDA) has issued a public health advisory advising that over-the-counter zinc-containing intranasal products should not be used.

Based on the current body of evidence, no firm conclusions could be made about specific treatment recommendations with Zinc for the common cold.

Vitamin C

This is often touted as a natural remedy for the common cold. Some have postulated that Vitamin C may reduce the duration of the common cold. This reduction is of uncertain clinical significance. Also, Vitamin C given therapeutically after symptom onset did not reduce symptom duration or severity. Regular supplementation with vitamin C does not significantly reduce the incidence of colds.

Vitamin D

Data from a United States survey population (3rd NHANES) found a potential relationship between higher serum levels of 25-hydroxyvitamin D (Vitamin D) and fewer reported respiratory infections. However, this has not been replicated in subsequent studies.

Vitamin E

To date there is nothing to support the use of Vitamin E in the prevention or treatment of the common cold.

Ineffective therapies

Antibiotic therapy - This is a viral illness and antibiotics have no role.

Antihistamines - Antihistamine use alone in patients with the common cold is of minimal benefit and frequently results in troublesome side effects.

Antiviral therapies - Directed antiviral therapy for the common cold is complicated by the wide array of viruses, the rarity with which an etiologic agent is identified, and paucity of agents with proven efficacy.

Takeaway points

For most people and most colds, symptoms are self-limited. The usual course and duration of illness is up to one and a half weeks for most people who come down with a cold. There is no evidence to support the use of antibiotics, antihistamines, antiviral therapies, or vitamins and herbal remedies in the treatment of the common cold.

Please remember that medical information provided by us must be considered an educational service only. This blog should not be relied upon as medical advice and does not replace your physician’s independent judgement. Please seek the advice of your physician or healthcare provider regarding any issues related to your health.