Colds: Management

Management of colds

For most people, symptoms are self-limited without interventions. The condition is usually uncomplicated; however, occasionally, complications may develop such as sinusitis, lower respiratory tract disease, asthma exacerbations, and acute otitis media.

The management of colds depends on the severity of symptoms:

Mild symptoms:

Most patients with mild symptoms do not need any symptomatic treatments. Such patients should be advised to return for review if their condition worsens or exceeds the expected time for recovery.^1,2

Moderate to severe symptoms

Symptomatic therapy is the mainstay of common cold management. Patients with moderate to severe symptoms may use a variety of therapies to relieve symptoms such as nasal symptoms, fever, pain and cough.³

Symptomatic treatment of colds

Nasal symptoms

There are many different formulations of decongestants and/or antihistamines available OTC for the treatment of nasal symptoms (i.e. rhinorrhoea , congestion, and sneezing). This includes single-agent and combination formulations.

In adults, decongestants and/or antihistamines proved to be the best option for patients with bothersome nasal symptoms.³

Decongestant monotherapy:

Sympathomimetic decongestants are available in oral (e.g. pseudoephedrine) or intranasal (e.g. oxymetazoline) formulations.³ They may offer mild relief of nasal congestion associated with the common cold when used alone.^4,5

Xylometazoline and Oxymetazoline nasal sprays have been shown to have an effect in reducing airways resistance. Xylometazoline should be used for a maximum of 7 – 10 consecutive days (depending on the strength/formulation) whilst Oxymetazoline should be used for a maximum of 10 consecutive days, due to the risk of chronic/rebound nasal congestion (rhinitis medicamentosa).^6,⁷

Antihistamine monotherapy:

A Cochrane systematic review found that first-generation antihistamines are associated with relief of sneezing and rhinorrhoea, but not nasal congestion. However, patients may experience sedation as a common adverse effect.⁸

Antihistamine/decongestant combinations:

Antihistamines and decongestants are often combined, with or without an analgesic. The combination of antihistamines and decongestants may be more beneficial than either component alone. They were found to improve rhinorrhoea, congestion and sneezing.⁴

Intranasal ipratropium bromide:

Ipratropium, an antimuscarinic agent, has been shown to be effective for the treatment of nasal symptoms such as rhinorrhoea and sneezing. A systematic review found low-quality evidence to suggest ipratropium nasal spray is effective for rhinorrhoea compared with placebo, but not for nasal congestion.⁹

Fever and pain

Paracetamol is recommended for fever and/or pain. Evidence suggests that it may also help with nasal congestion and rhinorrhoea, but not sore throat, malaise, sneezing, or cough.¹⁰

Paracetamol is one of the most widely used analgesic/antipyretic agents, and is a first choice for many clinicians for the management of pain and fever in both adults and children.¹¹

A review of non-steroidal anti-inflammatory drugs (NSAIDs) found that they do reduce discomfort, but provide no benefit in terms of improving respiratory symptoms.¹²

Analgesics are available as single-agent or combination (with decongestants and/or antihistamines) formulations.

Cough

Many different cough suppressants or expectorants are available, including single-agent and combination formulations (often combined with decongestants and/or antihistamines).

There is no evidence to support or refute the use of OTC antitussive drugs, expectorants, or mucolytic agents to reduce the incidence of cough in adults or children, particularly young children.^13,14 However, the American College of Chest Physicians recommends against the use of OTC cough and cold medicines for the treatment of coughs.¹⁵

Cough and cold medications that include opioids, such as codeine or hydrocodone, should not be used in children aged 18 years or younger as the risks (slowed or difficult breathing, misuse, abuse, addiction, overdose, and death) outweigh the benefits when used for cough in these patients.¹⁶

Honey has been shown to offer more relief of cough symptoms compared to no treatment, placebo, and diphenhydramine in children aged 1 to 18 years, but is not better than dextromethorphan.^15,17

A review of inhaled corticosteroids for acute and sub-acute cough found insufficient evidence to recommend their routine use for acute respiratory tract infections in adults.¹⁸

The advantages of a topical vs oral decongestant^19-26

A nasal spray can deliver fast and effective targeted relief,¹⁹ but 52% of cold sufferers do not choose this topical option:²⁷

Multi-symptom remedies may contain unnecessary ingredients (e.g. cough suppressants, antihistamines)^28,29and needlessly expose users to medications that won’t help them with their nasal congestion
Oral decongestants are unlikely to offer the same rapid onset as topical decongestants, as they must first be systemically absorbed via the small intestine before they can achieve their action on nasal blood vessels²⁹

ORAL DECONGESTANTS	Vs	TOPICAL NASAL SPRAY
Systemic – dissolves in the stomach, enters the blood and acts throughout the body	MODE OF ACTION	Local – acts directly on the nasal mucosa at the source of cold symptoms
May take 30 minutes¹⁹	ONSET OF RELIEF	Immediate (within 2 to 5 minutes)¹⁹
3 to 6 hours^20-24	DURATION	10 to 12 hours¹⁹
Less likely than topical agents to cause rhinitis medicamentosa (rebound congestion) with prolonged use	ADVANTAGES	Unlike oral decongestants, topical nasal sprays are minimally absorbed, therefore systemic side effects are milder and occur less frequently²⁵ Less risk of sleep disturbance²⁶
Slower onset of action Risk of cardiovascular and central nervous system adverse events	DISADVANTAGES	Excessive or prolonged use can cause rhinitis medicamentosa (rebound congestion)

Managing colds in babies³⁰

How to treat colds in babies³⁰
Methods for treating nasal congestion in babies

There are a variety of ways to treat nasal congestion in babies, depending on country habits, the age of the baby, and the seriousness and cause of the congestion, including:³⁰

Non-medicated sprays or drops (physiological serum, saline solutions)

Breast milk

Manual nasal aspirators (“Chicco” type)

Mouth pump nasal aspirators (“Otrivin Baby” type (not yet available in SA))"

Water

Decongesting creams/rubs

Inhalations

Cotton buds

Tissues

Some serious nasal congestion cases may require medicated nasal sprays

Treating children with natural products (treatments that are perceived to be gentle and chemical-free with no side effects) is a widespread practice.³¹

Favoured product attributes are:³⁰

Work fast

Easy to buy/widely available

Include clear dosing/usage instructions

Effective for a good night’s sleep

Are not messy

Will not trigger anxiety in the child

From a trusted brand/source

Is appropriate for their child’s specific symptoms

Doesn’t dry out the nasal passage

Doesn’t irritate or redden the nose

Doesn’t cause allergies

The Otrivin Baby nasal care solution combines the use of a saline solution (to liquefy the mucus).³⁰

Advice on how to avoid colds^32,33

Spreading colds to others may be limited by physical measures, including:

Hand-washing
Covering the mouth and nose when sneezing or coughing
Efficient disposal of tissues carrying nasal secretions
Staying away from work or school

Otrivin – Formulated to meet different consumer needs, with both medicated and options with natural ingredients, for infants, children and adults providing fast and long-lasting relief¹⁹

Colds

Find out more about colds.

Find out more

Causes and mechanisms

Find out about the causes and mechanisms of colds.

Find out more

Signs and symptoms

Explore an overview of the signs and symptoms of colds.

Find out more

Patient care resources

Download resources for your patients.

Find out more

The Otrivin range

Find out how the Otrivin range can help your patients.

Find out more

Learning Lab

Find out more in the learning lab.

Find out more

References

Tan T et al. BMJ 2008; 337:a437
National Institute for Health and Care Excellence. Respiratory tract infections (self-limiting): prescribing antibiotics. July 2008. Available at: https://www.nice.org.uk/guidance/cg69 (Accessed January 2020).
van Driel ML et al. BMJ 2018; 363:k3786.
De Sutter AI et al. Cochrane Database Syst Rev 2012; 2:CD004976.
Taverner D et al. Cochrane Database Syst Rev 2007; 1:CD001953.
Eccles R et al. Curr Med Res Opin 2010; 26:889-899.
Allan GM et al. CMAJ 2014; 186:190-199.
De Sutter A et al. Cochrane Database Syst Rev 2015; 11:CD009345.
AlBalawi ZH et al. Cochrane Database Syst Rev 2013; 6:CD008231.
Li S et al. Cochrane Database Syst Rev 2013; 7:CD008800.
Eccles R. J Clin Pharm Ther 2006; 31:309-319.
Kim SY et al. Cochrane Database Syst Rev 2015; 9:CD006362.
Isbister GK et al. J Paediatr Child Health 2012; 48:91-98.
Smith SM et al. Cochrane Database Syst Rev 2014; 11:CD001831.
Malesker MA et al. Chest 2017; 152:1021-1037.
Food and Drug Administration. FDA drug safety communication: FDA requires labeling changes for prescription opioid cough and cold medicines to limit their use to adults 18 years and older. 2018. (Accessed January 2020).
Oduwole O et al. Cochrane Database Syst Rev 2018; 4:CD007094.
El-Gohary M et al. Fam Pract 2013; 30:492-500.
Eccles R et al. Am J Rhinol 2008; 22:491–496.
Latte J et al. Clin Exp Pharmacol Physiol 2004; 31:429–432.
Roth RP et al. Ann Otol Rhinol Laryngol 1977; 86:235–242.
Kollar C et al. Clin Ther 2007; 29:1057–1070.
Hatton RC et al. Ann Pharmacother 2007; 41:381–390.
Kanfer I et al. Pharmacotherapy 1993; 13:116S–128S.
McMahon WA et al. US Pharmacist 2009; 34:33–36.
Connell JT et al. Am J Rhinol 1987; 1:87–94.
Ipsos market research, 2017.
Graf P et al. Expert Opin Pharmacother 2009; 10:889–908.
Eccles R. In: Eccles R, Weber O (eds). 2009. Common cold. Birkhäuser advances in infectious diseases. Basel: Birkhäuser, pp. 249−273.
The Otrivin Baby Launch Toolkit, Consumer Health OTC 2007; pages 10 & 12.
Chirico G et al. Minerva Pediatr 2014; 66:549–557.
Jefferson T et al. Cochrane Database Syst Rev 2011; 7:CD006207.
Hübner NO et al. BMC Infect Dis 2010; 10:250

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Colds: Management

Management of colds

Symptomatic treatment of colds

Nasal symptoms

Fever and pain

Cough

Managing colds in babies30

Methods for treating nasal congestion in babies

Advice on how to avoid colds32,33

Otrivin – Formulated to meet different consumer needs, with both medicated and options with natural ingredients, for infants, children and adults providing fast and long-lasting relief19

Colds

Causes and mechanisms

Signs and symptoms

Patient care resources

The Otrivin range

Learning Lab

References

Managing colds in babies³⁰

Advice on how to avoid colds^32,33

Otrivin – Formulated to meet different consumer needs, with both medicated and options with natural ingredients, for infants, children and adults providing fast and long-lasting relief¹⁹