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

• Reassure that the common cold is a mild self-limiting illness.
• Give a full explanation of the likely course of the illness.
• Recommend symptomatic treatment only.
• Ensure adequate fluid intake.
• Educate the person about self-treatment in the future, addressing 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
  • 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.⁴
  • Decongestants (norephedrine, oxymetazoline, or pseudoephedrine): provide short term (3-10 hour) relief of congestive symptoms.⁵ 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.⁶
  • Steam inhalation: insufficient evidence to assess its value in people with common cold.⁷
  • Vitamin C: limited evidence that vitamin C slightly reduces the duration of cold symptoms.⁸
  • 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.⁹

• 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.¹⁰
• 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.