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THE COMMON COLDTHE COMMON COLD(UPPER RESPIRATORY INFECTION)(UPPER RESPIRATORY INFECTION)

H. ADELI. MDH. ADELI. MD

DEFINITIONDEFINITION

�� An acute, selfAn acute, self--limited illness caused by a limited illness caused by a virus virus

�� Rhinorrhea and nasal obstruction are Rhinorrhea and nasal obstruction are invariably present invariably present

�� sore or scratchy throat and/or cough may be sore or scratchy throat and/or cough may be present present

ETIOLOGYETIOLOGY

EPIDEMIOLOGY & TRANSMISSIONEPIDEMIOLOGY & TRANSMISSION

�� The most frequent disease of humans The most frequent disease of humans �� The single most common cause of absenteeism The single most common cause of absenteeism

from school and work from school and work �� Particularly common in children younger than Particularly common in children younger than

age 6age 6�� <1 Y,O had an average of 6.7 colds per year,<1 Y,O had an average of 6.7 colds per year,

11-- 5 Y.O had 7.4 to 8.3 colds per year,5 Y.O had 7.4 to 8.3 colds per year,teenagers averaged about 4.5 colds per year, teenagers averaged about 4.5 colds per year, mothers reported 4.5 colds and fathers 3.5 mothers reported 4.5 colds and fathers 3.5 colds per year colds per year

At least with rhinovirus, the home setting is the At least with rhinovirus, the home setting is the primary site for viral transmissionprimary site for viral transmission

EPIDEMIOLOGY & TRANSMISSIONEPIDEMIOLOGY & TRANSMISSION(continue)(continue)

EPIDEMIOLOGY & TRANSMISSIONEPIDEMIOLOGY & TRANSMISSION(continue)(continue)

Transmission occur by one or more Transmission occur by one or more of three mechanisms:of three mechanisms:

�� SmallSmall--particle (<5particle (<5 µµm in diameter) aerosol in which virus m in diameter) aerosol in which virus may be suspended in air for an hour and infect by may be suspended in air for an hour and infect by inhalationinhalation

�� LargeLarge--particle (>10 particle (>10 µµm in diameter) airborne droplets that m in diameter) airborne droplets that travel less than 1 m and infect by landing on a mucosal travel less than 1 m and infect by landing on a mucosal surface such as conjunctiva or nasal mucosasurface such as conjunctiva or nasal mucosa

�� Direct transfer of virus in secretions through hand contact Direct transfer of virus in secretions through hand contact from a person with a cold to a well personfrom a person with a cold to a well person

PATHOGENESISPATHOGENESIS

�� A viral cytopathic effect destroying the nasal A viral cytopathic effect destroying the nasal mucosa (influenza virus and adenovirus)mucosa (influenza virus and adenovirus)

�� Rhinovirus and coronavirus were not found Rhinovirus and coronavirus were not found to be to be destructive of nasal epitheliumdestructive of nasal epithelium

�� The presence of Kinins (Bradykinin) and PMNs The presence of Kinins (Bradykinin) and PMNs paralleled cold symptomsparalleled cold symptoms

�� Infected cells elaborate interleukinInfected cells elaborate interleukin--8 (IL8 (IL--8), which 8), which is a chemoattractant for PMNs is a chemoattractant for PMNs

�� Increased levels of ILIncreased levels of IL--11ββ, IL, IL--6, and IL6, and IL--8 have been 8 have been detected in nasal secretions during colds detected in nasal secretions during colds

CLINICAL MANIFESTATIONSCLINICAL MANIFESTATIONS

ADULT:ADULT:�� Rhinorrhea, nasal obstruction, scratchy or sore throat, some malRhinorrhea, nasal obstruction, scratchy or sore throat, some malaise , aise ,

sneezing , nonproductive cough , sinus fullness , nasal speech asneezing , nonproductive cough , sinus fullness , nasal speech and nd hoarsenesshoarseness

�� Objective findings are usually minimalObjective findings are usually minimal

�� The symptoms usually abate in 5 to 7 daysThe symptoms usually abate in 5 to 7 days

CHILDREN:CHILDREN:�� More objective signs; fever, moderate cervical lymphadenopathyMore objective signs; fever, moderate cervical lymphadenopathy

�� The usual duration of cold symptoms is 10 to 14 days The usual duration of cold symptoms is 10 to 14 days

TREATMENTTREATMENT

�� Antibiotics neither hasten nor delay recovery from Antibiotics neither hasten nor delay recovery from the cold, nor do they reduce the frequency of the cold, nor do they reduce the frequency of bacterial complicationsbacterial complications

�� No antiviral agents are currently available for No antiviral agents are currently available for treating colds, except those caused by influenza treating colds, except those caused by influenza virus (virus (zanamivir, oseltamivir) zanamivir, oseltamivir)

�� Malaise may be relieved by analgesics Malaise may be relieved by analgesics �� Nasal congestion may be relieved by Nasal congestion may be relieved by

decongestantsdecongestants�� Oral firstOral first--generation antihistamines may provide generation antihistamines may provide

modest relief of sneezing and rhinorrheamodest relief of sneezing and rhinorrhea

PREVENTIONPREVENTION

�� Topical interferon has been shown to be Topical interferon has been shown to be moderately effective in preventing other moderately effective in preventing other family members from acquiring a coldfamily members from acquiring a cold

�� Simple hand washing, personal hygieneSimple hand washing, personal hygiene

�� Vaccination Vaccination

DIFFERENTIAL DIAGNOSIS OF COMMON COLD

1.1. Acute Rhinitis Acute Rhinitis -- Rhinosinusitis Rhinosinusitis 2.2. Acute Bacterial SinusitisAcute Bacterial Sinusitis3.3. Allergic and Nonallergic RhinitisAllergic and Nonallergic Rhinitis4.4. Streptococcal PharyngitisStreptococcal Pharyngitis5.5. LaryngotracheobronchitisLaryngotracheobronchitis6.6. Acute Bronchitis (or Tracheobronchitis)Acute Bronchitis (or Tracheobronchitis)7.7. Acute Bronchiolitis Acute Bronchiolitis 8.8. Postinfectious Cough ( Whooping Cough)Postinfectious Cough ( Whooping Cough)9.9. Hypersensitivity Pneumonitis (Hay Fever)Hypersensitivity Pneumonitis (Hay Fever)

ACUTE RHINITISACUTE RHINITIS-- RHINOSINUSITISRHINOSINUSITIS

�� The cardinal symptoms are nasal discharge, nasal The cardinal symptoms are nasal discharge, nasal obstruction, sore throat, and coughobstruction, sore throat, and cough

�� The median duration of illness is 1 week, 25% of The median duration of illness is 1 week, 25% of cases last up to 2 weekscases last up to 2 weeks

�� 0.5 to 5% of cases are complicated with 0.5 to 5% of cases are complicated with secondary otitis media or bacterial sinusitis secondary otitis media or bacterial sinusitis

�� Antibiotics are not indicatedAntibiotics are not indicated

�� Give antihistamine and NSAID for symptoms Give antihistamine and NSAID for symptoms

�� No role for vitamin C or oral/intranasal zincNo role for vitamin C or oral/intranasal zinc

ACUTE BACTERIAL SINUSITISACUTE BACTERIAL SINUSITIS

�� The most common local predisposing cause The most common local predisposing cause of suppurative sinusitis is a viral ARIof suppurative sinusitis is a viral ARI

�� Other factors are nasal polyps, allergic Other factors are nasal polyps, allergic rhinitis, foreign bodies, and septal pathologyrhinitis, foreign bodies, and septal pathology

�� Predisposing systemic factors include Predisposing systemic factors include malnutrition, diabetes mellitus and malnutrition, diabetes mellitus and …………..

ACUTE BACTERIAL SINUSITISACUTE BACTERIAL SINUSITIS(continue)(continue)

�� Imaging is not useful in uncomplicated Imaging is not useful in uncomplicated cases cases

�� Antibiotics (high failure rate TMP/SMX, Antibiotics (high failure rate TMP/SMX, doxycycline, macrolides).doxycycline, macrolides).

�� Use oral decongestants/saline rinses Use oral decongestants/saline rinses

�� Avoid topical steroidsAvoid topical steroids

UNCOMPLICATED COLDUNCOMPLICATED COLD

ALLERGIC AND NONALLERGIC RHINITISALLERGIC AND NONALLERGIC RHINITIS

�� Allergic rhinitis (episodic, seasonal and Allergic rhinitis (episodic, seasonal and perennial)perennial)

�� Nonallergic Rhinitis Nonallergic Rhinitis -- Nonallergic Hyperplastic RhinosinusitisNonallergic Hyperplastic Rhinosinusitis-- Nonallergic, Noninflammatory RhinopathyNonallergic, Noninflammatory Rhinopathy-- Nonallergic Rhinitis With Eosinophilia Nonallergic Rhinitis With Eosinophilia

SyndromeSyndrome

MANAGEMENT OF ALLERGIC RHINITISMANAGEMENT OF ALLERGIC RHINITIS

MANAGEMENTINDICATION

Allergen avoidance plus as-needed antihistamines/decongestantsMild disease

Allergen avoidance plus continuous cromolyn or topical steroids with or without as-needed antihistamines/decongestants

Moderate disease

Allergen avoidance plus continuous topical steroids with or without immunotherapy and with or without as-needed antihistamines/decongestants

Severe disease

Ipratropium bromideDifficult to control rhinorrhea

High-dose guaifenesinThick secretions

LARYNGOTRACHEOBRONCHITISLARYNGOTRACHEOBRONCHITIS

�� Laryngotracheobronchitis (croup) is usually Laryngotracheobronchitis (croup) is usually caused by a viral infectioncaused by a viral infection

�� The peak incidence is in late fallThe peak incidence is in late fall

�� Related to the prevalence of parainfluenzaRelated to the prevalence of parainfluenza

�� Occurs in the first halfOccurs in the first half--decade of lifedecade of life

Level of Evidence Summary Statement

Randomized controlled trialsNo utility of humidification.

Randomized controlled trialsNebulized racemic epinephrine.

Randomized controlled trialsAdminister corticosteroids; various routes effective.

Expert opinion.Maintain airwayNo role for antibiotic therapy.

MANAGEMENT OF LARYNGOTRACHEOBRONCHITIS

ACUTE BRONCHITIS ACUTE BRONCHITIS (OR TRACHEOBRONCHITIS)(OR TRACHEOBRONCHITIS)

MANAGEMENT OF ACUTE BRONCHITIS

Level of Evidence Summary Statement

Conflicting results (controlled clinical trials)

Antibiotics not recommended.

Randomized controlled trials

Administer first-generation antihistamines.

Randomized controlled trials

Administer NSAID.

POSTINFECTIOUS COUGH POSTINFECTIOUS COUGH (WHOOPING COUGH) (WHOOPING COUGH)

�� Have initial catarrhal stage followed by Have initial catarrhal stage followed by

paroxysmal and convalescent stagesparoxysmal and convalescent stages

�� Usually lasts 4 to 6 weeks Usually lasts 4 to 6 weeks

�� Clues to the diagnosis include leukocytosis Clues to the diagnosis include leukocytosis and lymphocytosisand lymphocytosis

ACUTE BRONCHIOLITISACUTE BRONCHIOLITIS

respiratory syncytial virus bronchiolitisrespiratory syncytial virus bronchiolitis

HYPERSENSITIVITY PNEUMONITIS HYPERSENSITIVITY PNEUMONITIS (HAY FEVER)(HAY FEVER)