Upper Respiratory Infections - Coryza

Synonym: common cold

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

• Is caused by inhalation of airborne respiratory droplets from people infected with the virus.
• Possibly also occurs by direct contact with infectious secretions. Some viruses may be spread by hand contact.
• Transmission most commonly occurs in the home, school, and day-care centres. The main reservoir of viruses is in young children.

• 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.
• Adults with children at home have more colds than people without children.
• Annual epidemics occur within the colder months in temperate climates and during the rainy season in the tropics.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 4th or 5th day when nasal symptoms decrease.²
• 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 nose. The discharge is unilateral, purulent, foul-smelling, and blood-stained.
• Infants:
  • Consider the possibility of a more serious condition, e.g. meningitis, septicaemia, pneumonia.

• There are no drugs of proven benefit for the prophylaxis or treatment of the common cold. Therefore medical management is centred around providing symptomatic relief.
• Antibiotic treatment of children with URTI does not alter the clinical outcome of the illness or prevent further complications.³
• 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.

Drugs

• Recommend symptomatic treatment only.
• It is good practice to restrict the use of over the counter products for the treatment of cough and cold symptoms in children under 2 years old to the following:⁵
  • Paracetamol or ibuprofen to relieve pain and lower temperature.
  • Simple non-pharmacological cough mixtures for the treatment of coughs (e.g. paediatric simple linctus or those containing glycerol or honey and lemon).
  • Vapour rubs and inhalant decongestants which can be applied to children’s clothing to provide relief of stuffy or blocked nose for children and infants over 3 months. Saline (Sodium Chloride 0.9%) nose 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 are a range of other over the counter cough medicines that may be given to children over 2.⁵
• Paracetamol is an effective first-choice analgesic and antipyretic in most people.
• Aspirin (in adults) and ibuprofen (in children) are the only non-steroidal anti-inflammatory drugs licensed to treat pyrexia. Aspirin has a higher incidence of adverse effects than ibuprofen.
• Antihistamines: may improve runny nose and sneezing, no significant difference in overall symptoms.⁶
• Decongestants (norephedrine, oxymetazoline, or pseudoephedrine): provide short term (3-10 hour) relief of congestive symptoms.⁷ However stopping decongestants often leads to rebound congestion.
• Other therapies:
  • Echinacea: limited evidence that some preparations of echinacea may improve cold symptoms compared with placebo.⁸
  • Steam inhalation: insufficient evidence to assess its value in people with common cold.⁹
  • Vitamin C: limited evidence that vitamin C slightly reduces the duration of cold symptoms.¹⁰
  • Zinc (intranasal gel or lozenges): limited evidence that zinc gluconate or acetate lozenges may reduce duration of cold symptoms at 7 days compared with placebo.¹¹

• Young children may develop bronchiolitis, viral pneumonia, and croup.
• Infants less than 3 months of age are particularly susceptible to developing secondary bacterial lower respiratory infections.
• Approximately 65% of people 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 coexisting 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.
• 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.¹²
• 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 2 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.