Several of my patients have developed nasty colds in the last few weeks, so it seemed like a good time to cover this perennial source of misery. Even though the cold is one of the most common illnesses, many people are still confused about how to treat it and how to distinguish it from other illnesses.
Colds typically cause a scratchy or sore throat, runny or congested nose, cough and fatigue. There is usually no fever.
Colds are caused by viruses, typically rhinovirus, coronavirus or respiratory syncitial virus, though many other viruses can be the culprit.
There is no specific test that is usually done to diagnose a cold. The diagnosis is usually made by the presence of typical symptoms in the absence of symptoms suggesting another diagnosis.
The treatment of colds causes much misunderstanding and grief. Antibiotics don’t help, and in fact nothing has been found that decreases the duration of symptoms. The cold always resolves which makes it a prime candidate for quackery, since whatever you take for your cold you’ll definitely improve. Nevertheless, many of my patients swear by vitamin C and Echinacea despite the consistent evidence for their lack of efficacy. The best you can do is to treat the symptoms so as to minimize the misery until the cold resolves on its own.
Pseudoephedrine (Sudafed and generic store brands) is fairly effective for treating nasal congestion. That can also help decrease the sore throat and the cough that are frequently caused by post-nasal drip. In California, pseudoephedrine is no longer on the shelf. Patients need to ask for it at the pharmacy counter and show identification. This has also caused much confusion as patients have mistakenly purchased phenylephrine (Sudafed PE) which is available on the shelf but is less effective. Pseudoephedrine should be used with caution in patients with high blood pressure and in men over 50. It also makes some people feel jittery and can cause insomnia. For patients who can not tolerate pseudoephedrine, there is a safe alternative by prescription.
Over the counter cough suppressants (containing dextromethorphan) can help decrease coughing, though they are usually only modestly effective. Pain relievers can help with sore throat. Non-medicinal alternatives like inhaling steam can help loosen mucous and can soothe irritated airways.
Colds are very infectious, and no prevention method is perfect. Frequent hand washing and avoiding people with the cold are probably the most effective steps.
Some other diagnoses that should be excluded
- Streptococcal pharyngitis, or Strep throat, is usually marked by a severe sore throat, fever and swollen lymph nodes in the neck. Nasal symptoms and cough are usually absent. Viruses frequently cause these same symptoms and a rapid Strep test or throat culture should be done to confirm the presence of Strep. Strep throat requires antibiotic treatment.
- Otitis media (middle ear infection) usually causes pain in one ear. Fever and nasal congestion may be present. It is usually diagnosed by the doctor looking at the eardrum. It is usually treated with antibiotics.
- Influenza (the flu) causes high fevers, chills, cough and diffuse body aches. It can be diagnosed with a nasal swab and treated with antiviral medicines, ideally in the first 48 hours of symptoms, so call your doctor right away.
- Acute sinusitis (sinus infection) causes pain or pressure in the cheeks or forehead or upper tooth pain, and usually fever. Antibiotics used to be the standard of care for sinusitis, but current recommendations are to use nasal decongestants and pain medicine for 7 days and to prescribe antibiotics only if symptoms persist after that.
- Acute bronchitis is an infection of the airways marked by a productive cough and usually low-grade temperatures. It is usually caused by viruses and resolves without antibiotics.
- Pneumonia is a lung infection, usually marked by high fever, shaking chills, a productive cough and sometimes shortness of breath. It requires medical attention and usually is treated with antibiotics.
Now that you’re an expert at managing the common cold, your medical education is well on its way. Next week you’ll be performing organ transplants.
My review of acute bronchitis