Upper Respiratory Infections - Coryza

oPatientPlus articles are written by UK doctors and are based on research evidence, UK and European Guidelines. They are designed for health professionals to use, so you may find the language more technical than the condition leaflets.

Synonym: common cold

An acute, mild, self-limiting catarrhal syndrome. It is most often caused by infection with rhinoviruses and coronaviruses. It may also be due to infection by myxovirus, paramyxovirus (parainfluenza, respiratory syncytial virus) and adenovirus.[1]

  • This is caused by inhalation of airborne respiratory droplets from people infected with the virus.
  • It possibly also occurs by direct contact with infectious secretions. Some viruses may be spread by hand contact.
  • Transmission most commonly occurs in the home, in schools, and in daycare centres. The main reservoir of viruses is in young children.

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  • Adults have an average of between two and four colds a year. Children have up to 12 colds a year. Young children in nursery schools may average up to nine colds during the winter months.
  • Annual epidemics occur within the colder months in temperate climates and during the rainy season in the tropics.
  • There are over 200 viruses which cause colds, and many people suffering from cold symptoms are found to be infected with several viruses at the same time.[2] 
  • The most frequent symptoms are nasal discharge, nasal obstruction, sore throat, headache, and cough. Hoarseness, loss of taste and smell, mild burning of the eyes, and a feeling of pressure in the ears or sinuses, due to obstruction and/or mucosal swelling, may also occur.
  • Cough is associated with 30% of colds and tends to start on about the fourth or fifth day when nasal symptoms decrease.
  • There may be a mild increase in body temperature. Infants and young children are more likely to develop higher temperatures.
  • In infants there may be irritability, snuffles resulting in difficulty feeding, and diarrhoea. Diagnosis may be difficult and fever can be the main symptom during the early part of the illness.

Adults

  • Allergic rhinitis: nasal itching, sneezing, watery rhinorrhoea, and nasal obstruction. It is also often accompanied by itchy, watery eyes. It can be perennial, seasonal, or due to occupational exposure.
  • Non-allergic rhinitis: presents with chronic nasal symptoms.
  • Pharyngitis: acute pharyngitis is caused by a variety of organisms, including the adenoviruses and Streptococcus pyogenes. This pharyngitis is often more severe than the mild-to-moderate pharyngeal discomfort in the common cold.
  • Influenza: initially presents with systemic symptoms, including fever, rigors, headaches, myalgia, malaise, and anorexia.

Children

  • In addition to the above list, consider a foreign body in the nose. The discharge is unilateral, purulent, foul-smelling, and blood-stained.

Infants

See also the separate article Ill and Feverish Child.

  • There are no drugs of proven benefit for the prophylaxis or treatment of the common cold, although many things have been suggested. Medical management is centred around providing symptomatic relief.
  • Antibiotic treatment of upper respiratory tract infection (URTI) does not alter the clinical outcome of the illness or prevent further complications.[3][4]
  • Ensure adequate fluid intake.
  • Address any underlying concerns. Taking the time to educate people that colds are self-limiting and have no specific curative treatment may reduce anxiety and prevent unnecessary visits to the doctor in the future.
  • Sometimes, offering a delayed prescription for antibiotics can be a good option and this may reduce overall antibiotic use.[5] 
National Institute for Health and Care Excellence (NICE) guidance[6]
  • Provide reassurance that the common cold is a mild self-limiting illness and antibiotics are not needed because they will make little difference to symptoms and may have side-effects - eg, diarrhoea, vomiting and rash.
  • Offer a clinical review if the respiratory tract infection worsens or becomes prolonged.
  • Provide advice about the usual natural history of the illness and average total length of illness (10 days).

Medication should have only a minor role in the management of simple viral URTIs, and only acts to reduce the symptoms.

The Medicines and Healthcare products Regulatory Agency (MHRA) has issued advice about management of URTIs in children under 2 years old. Over-the-counter (OTC) products for very young children should be restricted as follows:[7] 

  • Paracetamol or ibuprofen:[8]
    • Paracetamol is an effective first-choice analgesic and antipyretic in most people. Aspirin (in adults) and ibuprofen (in adults and children) are licensed to treat pyrexia. Aspirin has a higher incidence of adverse effects compared with ibuprofen.
    • Paracetamol or ibuprofen should be used for discomfort in children, such as when caused by sore throat, muscle pain or high fever. They should not be used just to 'treat' a high temperature. Fever is not harmful and may in fact have some benefit for simple viral infections.
  • Simple non-pharmacological cough mixtures for the treatment of coughs (eg, paediatric simple linctus or those containing glycerol or honey and lemon). OTC cough mixtures have little or no evidence for efficacy in children. Honey and lemon is probably as good as any formulation.[9] However, honey is not recommended for babies under one year because of a theoretical risk of infant botulism.
  • Vapour rubs and inhalant decongestants which can be applied to children's clothing to provide relief of a stuffy or blocked nose - for children and infants aged over 3 months. Saline (sodium chloride 0.9%) nasal drops can be helpful, particularly in infants who are having difficulty feeding.
  • The same principles can be applied to children over 2 years old, although there is a range of other OTC cough medicines that may be given to children over 2 years old.[7] However, evidence is lacking that OTC cough remedies are effective for adults or children.[10][11]
  • Preparations containing carbocisteine and acetylcysteine may be helpful in adults and older children.[12]
  • Non-steroidal anti-inflammatory drugs (NSAIDs) may be helpful in reducing discomfort but have little effect on respiratory symptoms.[13]
  • There is currently insufficient evidence to recommend nasal corticosteroid sprays.[14]
  • Antihistamines may improve a runny nose and sneezing, but there is no significant difference in overall symptoms.[15]
  • Decongestants (norephedrine, oxymetazoline) provide short-term (3- to 10-hour) relief of congestive symptoms.[16] However, stopping decongestants often leads to rebound congestion.
  • Intranasal ipratropium may help with rhinorrhoea but not with congestion, although more research is needed to clarify the benefits.[17]

Many other therapies have been suggested, and although the evidence of benefit is mostly lacking, it is likely that little harm would occur in trying them:

  • Echinacea: there is limited evidence that some preparations of echinacea may improve cold symptoms compared with placebo.[18]
  • Steam inhalation: there is insufficient evidence to assess its value in people with the common cold.[19]
  • Vitamin C: there is limited evidence that vitamin C slightly reduces the duration of cold symptoms.[20]
  • Zinc: a Cochrane review found that zinc, administered within 24 hours of the onset of symptoms, reduces the duration and severity of the common cold in healthy people. Zinc supplements taken for at least five months were found to reduce the incidence of colds, school absenteeism and prescription of antibiotics in children. Zinc lozenges can produce side-effects and no firm recommendations about the dose, formulation and duration could be made.[21]
  • Chinese herbal medicines: current evidence is also insufficient to recommend these.[22]
  • Garlic: is reputed to be helpful in prevention and treatment of colds but a review found no good-quality evidence to support this.[23]
  • Cloves: have been suggested for relief of dry cough symptoms, but there is little evidence to support this use.
  • Young children may develop bronchiolitis, viral pneumonia, and croup.
  • Infants less than three months of age are particularly susceptible to developing secondary bacterial lower respiratory infections.
  • Approximately 65% of people aged over 60 years, who live in the community and develop a rhinovirus infection, can be expected to develop a lower respiratory tract illness. If there is a co-existing chronic medical condition or the person smokes then this risk is increased.
  • Acute otitis media occurs in 2% of people with a cold. The incidence positively correlates with the incidence of the common cold in children each year.
  • Bacterial infection of the paranasal sinuses occurs in 0.5% of people with a cold.
  • Asthma may worsen and present as an acute exacerbation.
  • People with chronic obstructive pulmonary disease who have a rhinovirus infection are more likely to have a longer duration of illness, a more severe illness, and to cough for longer afterwards than those without lung disease.[24]
  • The common cold is a major cause of absenteeism from work and school.
  • The median duration of a common cold is a week.
  • Approximately 25% of colds will last up to two weeks and, in smokers with a rhinovirus infection, the cough is more likely to be troublesome and prolonged.
  • Cigarette smokers are likely to have a more severe illness than non-smokers but do not have higher incidence of colds.
  • Preventing the spread of the common cold is very difficult but simple measures to prevent the spread of acute respiratory infections, such as hand washing (especially around younger children), wearing masks and wearing gloves, have been shown to be effective.[25]
  • Alcohol hand rub is not effective at reducing transmission of cold viruses but virucidal hand washes containing acids reduce transmission for up to three hours after use.[26]
  • People with colds should also avoid close contact (eg, hugging, kissing) and avoid sharing towels and flannels. Children should be discouraged from sharing toys belonging to a child with a cold. However, given the very high prevalence of cold viruses, it should be noted that they are not very easy to catch.
  • Vitamin D deficiency is thought to lower resistance to respiratory infections.[27] People who live further north in the UK are more likely to be deficient in vitamin D, particularly later in the winter.
  • Some work has been done on looking for a vaccine for the common cold, but this is difficult because the viruses are so numerous and so various.[28]

Further reading & references

  1. Common cold; NICE CKS, November 2011
  2. Tanner H, Boxall E, Osman H; Respiratory viral infections during the 2009-2010 winter season in Central England, UK: incidence and patterns of multiple virus co-infections. Eur J Clin Microbiol Infect Dis. 2012 Nov;31(11):3001-6. doi: 10.1007/s10096-012-1653-3. Epub 2012 Jun 8.
  3. Arroll B, Kenealy T; Are antibiotics effective for acute purulent rhinitis? Systematic review and meta-analysis of placebo controlled randomised trials. BMJ. 2006 Aug 5;333(7562):279. Epub 2006 Jul 21.
  4. Kenealy T, Arroll B; Antibiotics for the common cold and acute purulent rhinitis. Cochrane Database Syst Rev. 2013 Jun 4;6:CD000247. doi: 10.1002/14651858.CD000247.pub3.
  5. Arroll B, Kenealy T, Kerse N; Do delayed prescriptions reduce antibiotic use in respiratory tract infections? A systematic review. Br J Gen Pract. 2003 Nov;53(496):871-7.
  6. Respiratory tract infections; NICE Clinical Guideline (July 2008)
  7. Children's over-the-counter cough and cold medicines: New advice; Medicines and Healthcare products Regulatory Agency (MHRA), 2009
  8. Perrott DA, Piira T, Goodenough B, et al; Efficacy and safety of acetaminophen vs ibuprofen for treating children's pain or fever: a meta-analysis. Arch Pediatr Adolesc Med. 2004 Jun;158(6):521-6.
  9. Oduwole O, Meremikwu MM, Oyo-Ita A, et al; Honey for acute cough in children. Cochrane Database Syst Rev. 2012 Mar 14;3:CD007094. doi: 10.1002/14651858.CD007094.pub3.
  10. Smith SM, Schroeder K, Fahey T; Over-the-counter (OTC) medications for acute cough in children and adults in ambulatory settings. Cochrane Database Syst Rev. 2012 Aug 15;8:CD001831. doi: 10.1002/14651858.CD001831.pub4.
  11. Smith SM, Henman M, Schroeder K, et al; Over-the-counter cough medicines in children: neither safe or efficacious? Br J Gen Pract. 2008 Nov;58(556):757-8. doi: 10.3399/bjgp08X342642.
  12. Chalumeau M, Duijvestijn YC; Acetylcysteine and carbocysteine for acute upper and lower respiratory tract infections in paediatric patients without chronic broncho-pulmonary disease. Cochrane Database Syst Rev. 2013 May 31;5:CD003124. doi: 10.1002/14651858.CD003124.pub4.
  13. Kim SY, Chang YJ, Cho HM, et al; Non-steroidal anti-inflammatory drugs for the common cold. Cochrane Database Syst Rev. 2013 Jun 4;6:CD006362. doi: 10.1002/14651858.CD006362.pub3.
  14. Hayward G, Thompson MJ, Perera R, et al; Corticosteroids for the common cold. Cochrane Database Syst Rev. 2012 Aug 15;8:CD008116. doi: 10.1002/14651858.CD008116.pub2.
  15. Sutter AI, Lemiengre M, Campbell H, et al; Antihistamines for the common cold. Cochrane Database Syst Rev. 2003;(3):CD001267.
  16. Taverner D, Latte J; Nasal decongestants for the common cold. Cochrane Database Syst Rev. 2007 Jan 24;(1):CD001953.
  17. AlBalawi ZH, Othman SS, Alfaleh K; Intranasal ipratropium bromide for the common cold. Cochrane Database Syst Rev. 2013 Jun 19;6:CD008231. doi: 10.1002/14651858.CD008231.pub3.
  18. Linde K, Barrett B, Wolkart K, et al; Echinacea for preventing and treating the common cold. Cochrane Database Syst Rev. 2006 Jan 25;(1):CD000530.
  19. Singh M, Singh M; Heated, humidified air for the common cold. Cochrane Database Syst Rev. 2013 Jun 4;6:CD001728. doi: 10.1002/14651858.CD001728.pub5.
  20. Hemila H, Chalker E; Vitamin C for preventing and treating the common cold. Cochrane Database Syst Rev. 2013 Jan 31;1:CD000980. doi: 10.1002/14651858.CD000980.pub4.
  21. Singh M, Das RR; Zinc for the common cold. Cochrane Database Syst Rev. 2013 Jun 18;6:CD001364. doi: 10.1002/14651858.CD001364.pub4.
  22. Wu T, Zhang J, Qiu Y, et al; Chinese medicinal herbs for the common cold. Cochrane Database Syst Rev. 2007 Jan 24;(1):CD004782.
  23. Lissiman E, Bhasale AL, Cohen M; Garlic for the common cold. Cochrane Database Syst Rev. 2012 Mar 14;3:CD006206. doi: 10.1002/14651858.CD006206.pub3.
  24. Kurai D, Saraya T, Ishii H, et al; Virus-induced exacerbations in asthma and COPD. Front Microbiol. 2013 Oct 1;4:293.
  25. Jefferson T, Del Mar CB, Dooley L, et al; Physical interventions to interrupt or reduce the spread of respiratory viruses. Cochrane Database Syst Rev. 2011 Jul 6;(7):CD006207.
  26. Turner RB, Hendley JO; Virucidal hand treatments for prevention of rhinovirus infection. J Antimicrob Chemother. 2005 Nov;56(5):805-7. Epub 2005 Sep 13.
  27. Bartley J; Vitamin D, innate immunity and upper respiratory tract infection. J Laryngol Otol. 2010 May;124(5):465-9. doi: 10.1017/S0022215109992684. Epub 2010 Jan 13.
  28. Simancas-Racines D, Guerra CV, Hidalgo R; Vaccines for the common cold. Cochrane Database Syst Rev. 2013 Jun 12;6:CD002190. doi: 10.1002/14651858.CD002190.pub4.

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. EMIS has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.

Original Author:
Dr Colin Tidy
Current Version:
Peer Reviewer:
Prof Cathy Jackson
Last Checked:
13/01/2014
Document ID:
2900 (v24)
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