The common cold is a viral infection of the lining of the nose, sinuses, throat, and large airways.

• Usually, colds are spread when a person's hands come in contact with nasal secretions from an infected person.
• Colds often start with a scratchy or sore throat or discomfort in the nose, followed by sneezing, a runny nose, a cough, and a general feeling of illness.
• Doctors base the diagnosis on symptoms.
• Good hygiene, including frequent hand washing, is the best way to prevent colds.
• Rest, decongestants, antihistamines, cough syrups, and nonsteroidal anti-inflammatory drugs can help relieve symptoms.

Common colds are among the most common illnesses. Many different viruses cause colds, but rhinoviruses (of which there are 100 subtypes) are implicated more often than others. Colds caused by rhinoviruses occur more commonly in the spring and fall. Different viruses cause colds during other times of the year.

Colds spread mainly when people's hands come in contact with nasal secretions from an infected person. These secretions contain cold viruses. When people then touch their mouth, nose, or eyes, the viruses gain entry to the body and cause a cold. Less often, colds are spread when people breathe air containing droplets that were coughed or sneezed out by an infected person. A cold is most contagious during the first 1 or 2 days after symptoms develop. Becoming chilled does not cause colds, nor does it increase a person's susceptibility to infection. General health and eating habits also do not seem to affect susceptibility to infection, nor does having an abnormality of the nose or throat (such as enlarged tonsils or adenoids).

Symptoms and Diagnosis

Symptoms start 1 to 3 days after infection. Usually, the first symptom is a scratchy or sore throat or discomfort in the nose. Later, people start sneezing, have a runny nose, and feel mildly ill. Fever is not common, but a mild fever may occur at the beginning of the cold. At first, secretions from the nose are watery and clear and can be annoyingly plentiful, but eventually, they become thicker, opaque, yellow-green, and less plentiful. Many people also develop a mild cough. Symptoms usually disappear in 4 to 10 days, although the cough often lasts into the second week.

Complications may prolong the disease. Rhinovirus infection often triggers asthma attacks in people with asthma. Some people develop bacterial infections of the middle ear (otitis media) or sinuses. These infections develop because congestion in the nose blocks the normal drainage of those areas, allowing bacteria to grow in collections of blocked secretions. Other people develop bacterial infections of the lower airways (secondary bronchitis or pneumonia).

Did You Know... Colds seldom cause a fever. Antibiotics are useless in treating colds.

Doctors are usually able to diagnose a cold based on the typical symptoms. A high fever, severe headache, rash, difficulty breathing, or chest pain suggests that the infection is not a simple cold. Laboratory tests are not usually needed to diagnose a cold. If complications are suspected, doctors may order blood tests and x-rays.

Prevention

Because so many different viruses cause colds and because each virus changes slightly over time, an effective vaccine has not yet been developed. The best preventive measure is practicing good hygiene. Because many cold viruses are spread through contact with the secretions of an infected person, people with cold symptoms and people in their household and office should wash their hands frequently. Sneezing and coughing should be done into tissues, which should be carefully disposed of. When possible, people with symptoms should sleep in a separate room. People who are coughing or sneezing because of a cold should not go to work or school where they might infect others. Cleaning shared objects and surfaces with a disinfectant can also help reduce the spread of common cold viruses.

Despite their popularity, echinacea and high-dose vitamin C (up to 2,000 milligrams per day) have not been shown to prevent colds.

Treatment

People with a cold should stay warm and comfortable and try to avoid spreading the infection to others. Anyone with a fever or severe symptoms should rest at home. Drinking fluids and inhaling steam or mist from a vaporizer may help to keep secretions loose and easier to expel.

Currently available antiviral drugs are not effective against colds. Antibiotics do not help people with colds, even when the nose or cough produces thick or colored mucus.

Echinacea (see Medicinal Herbs and Nutraceuticals: Echinacea), zinc preparations, and vitamin C have been suggested as treatment. Some small studies have shown them to be effective. Others have shown them to be ineffective. But no well-designed, large clinical studies have confirmed their effectiveness. Thus, most experts do not recommend them as treatment.

Several popular nonprescription (over-the-counter) remedies help relieve cold symptoms. Because they do not cure the infection, which usually resolves after a week regardless of treatments tried, doctors feel that their use is optional, depending on how bad the person feels. Several different types of drugs are used:

• Decongestants, which help open clogged nasal passages
• Antihistamines, which help dry a runny nose
• Cough syrups, which may make coughing easier by thinning secretions or which may suppress cough

These drugs are most often sold as combinations but can also be obtained individually. For relieving nasal congestion, inhaled decongestants are better than forms taken by mouth. However, using inhaled forms for more than 3 to 5 days, then stopping, may make congestion worse than it was originally. IpratropiumSome Trade Names
ATROVENT
, a nasal spray available only by prescription, helps dry a runny nose. Older antihistamines, such as chlorpheniramineSome Trade Names
CHLOR-TRIMETON
, can cause drowsiness. Newer antihistamines, available only by prescription, are less likely to cause drowsiness but are ineffective for treating the common cold.

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirinSome Trade Names
BAYER
, ibuprofenSome Trade Names
ADVIL MOTRIN
, and naproxenSome Trade Names
ALEVE ANAPROX NAPROSYN
, can relieve aches and pains and reduce fever, as can acetaminophenSome Trade Names
TYLENOL
. AspirinSome Trade Names
BAYER
is generally not recommended for children because in children, it increases the risk of Reye's syndrome. Cough suppressants are not routinely recommended because coughing is a good way to clear secretions and debris from the airways during a viral infection. However, a severe cough that interferes with sleep or causes great discomfort can be treated with a cough suppressant.

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Nonprescription Cold Remedies ACTION Drug Side Effects Analgesics/antipyretics Relieve aches and pains and reduce fever AcetaminophenSome Trade Names TYLENOL Minimal AspirinSome Trade Names BAYER Stomach irritation Risk of Reye's syndrome in children IbuprofenSome Trade Names ADVIL MOTRIN Stomach irritation NaproxenSome Trade Names ALEVE ANAPROX NAPROSYN Stomach irritation Antihistamines Open nasal passages and help relieve sneezing Brompheniramine Drowsiness, dry mouth, and, in older people, blurred vision, difficulty urinating, constipation, light-headedness when they stand, and confusion ChlorpheniramineSome Trade Names CHLOR-TRIMETON ClemastineSome Trade Names TAVIST-1 DiphenhydramineSome Trade Names BENADRYL Cough suppressants May help reduce cough BenzonatateSome Trade Names TESSALON Confusion and stomach upset Codeine Constipation, drowsiness, difficulty urinating, and stomach upset DextromethorphanSome Trade Names DELSYM Minimal, but at high doses, confusion, nervousness, and irritability Decongestants, nasal sprays Open clogged nasal passages NaphazolineSome Trade Names NAPHCON-A OxymetazolineSome Trade Names AFRIN DRISTAN 12-HR NASAL SPRAY OCUCLEAR PhenylephrineSome Trade Names PROMETH VC PLAIN XylometazolineSome Trade Names OTRIVIN Rebound congestion (worse congestion when the drug wears off) if the drug is used for more than a few days Decongestant, oral Dries runny nose PseudoephedrineSome Trade Names AFRINOL SUDAFED Palpitations, high blood pressure, nervousness, and insomnia Expectorant May help loosen mucus GuaifenesinSome Trade Names MUCINEX Minimal, but at high doses, headache and stomach upset Nonprescription Cold Remedies ACTION Drug Side Effects Analgesics/antipyretics Relieve aches and pains and reduce fever AcetaminophenSome Trade Names TYLENOL Minimal AspirinSome Trade Names BAYER Stomach irritation Risk of Reye's syndrome in children IbuprofenSome Trade Names ADVIL MOTRIN Stomach irritation NaproxenSome Trade Names ALEVE ANAPROX NAPROSYN Stomach irritation Antihistamines Open nasal passages and help relieve sneezing Brompheniramine Drowsiness, dry mouth, and, in older people, blurred vision, difficulty urinating, constipation, light-headedness when they stand, and confusion ChlorpheniramineSome Trade Names CHLOR-TRIMETON ClemastineSome Trade Names TAVIST-1 DiphenhydramineSome Trade Names BENADRYL Cough suppressants May help reduce cough BenzonatateSome Trade Names TESSALON Confusion and stomach upset Codeine Constipation, drowsiness, difficulty urinating, and stomach upset DextromethorphanSome Trade Names DELSYM Minimal, but at high doses, confusion, nervousness, and irritability Decongestants, nasal sprays Open clogged nasal passages NaphazolineSome Trade Names NAPHCON-A OxymetazolineSome Trade Names AFRIN DRISTAN 12-HR NASAL SPRAY OCUCLEAR PhenylephrineSome Trade Names PROMETH VC PLAIN XylometazolineSome Trade Names OTRIVIN Rebound congestion (worse congestion when the drug wears off) if the drug is used for more than a few days Decongestant, oral Dries runny nose PseudoephedrineSome Trade Names AFRINOL SUDAFED Palpitations, high blood pressure, nervousness, and insomnia Expectorant May help loosen mucus GuaifenesinSome Trade Names MUCINEX Minimal, but at high doses, headache and stomach upset

Last full review/revision November 2009 by Marguerite A. Urban, MD