NAME: AKALYA ATPUTHANANTHAN

GROUP NO : 605

INTRODUCTION

The common cold is a viral infection of your nose and throat (upper respiratory tract). It's usually harmless. Many types of viruses can cause a common cold.

Risk factors

These factors can increase your chances of getting a cold:•Age. Children younger than six are at greatest risk of colds,

Weakened immune system. Having a chronic illness or otherwise weakened immune system increases your risk.

•Time of year. Both children and adults are more susceptible to colds in fall and winter

•Smoking. You're more likely to catch a cold and to have more severe colds if you smoke.

•Exposure. If you're around many people, such as at school or on an airplane, you're likely to be exposed to viruses that cause colds.

Symptoms: the common coldDay 1: sore or “scratchy” throat, +/- low grade fever

Day 2-3: nasal obstruction, rhinorrhea, sneezing

• thick purulent nasal discharge does NOT mean bacterial sinusitis!

Day 4-5: cough becomes bothersome, nasal symptoms less severe

• Average duration: 3-7 days

• Virus-induced changes in airway reactivity can persist for up to 4 weeks

Symptoms: the common cold*Day 1

Symptoms: the common cold*Day 2 to 3

Symptoms: the common cold*

Day 4 to 5 • thick purulent nasal discharge does NOT mean bacterial sinusitis!

50%

15%

15%

5%5% 10% Rhinovirus

Coronavirus

Influenza

RSV

Parainfluenza

Adeno, Entero

Virology

Seasonal Patterns

Fall, late spring : RhinovirusParainfluenza

Winter, spring: RSV, coronavirus

Summer: Enterovirus (year)

Adenovirus: Outbreaks in Military facilities daycare centers, hospital

Facts: the common cold

• Incubation period 24 to 72 hours

•Average duration 3 – 7 days

•Virus-induced changes in airway reactivity can persist for up to 4 weeks(Rhinovirus )

• 2 to 3 episodes /per year

FACTS: transmission

• Hand –to- hand

• most efficient = direct contact

• virus can survive for 2 hours on human skin

• also aerosol

• NOT via saliva – kissing is OK!

(in 90% of people with colds, no detectable virus in saliva)

But how do I know it’s just a cold?

COLD INFLUENZAFever Rare 39-40o

Headache Rare UsualMyalgia Mild SevereMalaise Mild May last 3 wksExtreme fatigue Unusual UsualNasal congestion Common CommonSneezing Common SometimesSore throat Common CommonChest discomfort/ cough

Mild Mod-Severe

When to see a doctor

For adults — seek medical attention if you have:•Fever greater than 101.3 F (38.5 C)•Fever lasting five days or more or returning after a fever-free period•Shortness of breath•Wheezing•Severe sore throat, headache or sinus pain

Diagnosis

•Symptoms and a physical examination are all the doctor needs to diagnose the common cold.•Usually, no blood tests or X-ray are necessary.•During the physical examination, the doctor will pay careful attention to the head, neck, and chest.•Examine the eyes, ears, throat, and chest to help determine if a bacterial source is causing the illness.

Diferential diagnosis: the common cold

•Allergic or seasonal rhinitis •Bacterial pharyngitis or tonsillitis (Centor criteria) •Sinusitis •Influenza

Treatment: the common cold

• the ONLY “A” recommendation is NOT to use antibiotics to treat the common cold.

• everything else is “B” (inconsistent or limited quality evidence)

Treatment: what might work

NASAL CONGESTION:

• topical or oral decongestant – phenylephrine or pseudoephedrine

• small benefit of single dose, NO benefit of repeated use over several days

• topical intranasal spray - oxymetazoline and phenylephrine

•humidified air and fluid intake *3

• inconsistent results, but no harm!

•PAIN RELIEVERS

Treatment: what might work

COUGH:

• dextromethorphan (DM) – cough suppressant

•guaifenesin (Benylin E, Robitussin) – expectorant

Treatment: the common cold

COMPLEMENTARY/ ALTERNATIVE:

• Vitamin C

• no effect if started after onset of symptoms

• inconsistent results if started before: may slightly decrease cold duration if 200mg daily

Treatment: the common cold

COMPLEMENTARY/ ALTERNATIVE:

• Echinacea

• no evidence in well-designed studies

• Zinc

• inhibits viral growth in vitro

• inconsistent study results

Zinc side effects include a bad taste and nausea.

Complications

•Acute ear infection (otitis media). This occurs when bacteria or viruses enter the space behind the eardrum. Typical signs and symptoms include earaches and, in some cases, a green or yellow discharge from the nose or the return of a fever following a common cold.•Asthma. A cold can trigger an asthma attack.•Acute sinusitis. In adults or children, a common cold that doesn't resolve can lead to inflammation and infection of the sinuses (sinusitis).•Other secondary infections. These include strep throat (streptococcal pharyngitis), pneumonia, and croup or bronchiolitis in children. These infections need to be treated by a doctor.

FACTS: the common cold

• you can be re-infected by the same virus, but subsequent illness will be milder and shorter

• NO evidence that cold climate increases susceptibility to respiratory illness

FACTS: the common cold

• huge economic burden

• annual work absence in the US = 23 million lost days/ year

Therefore …

• huge potential for drug companies to make big money!!

• 1 in 4 US adults had taken a cough or cold medication in the last 7 days

• in Canada, >700 OTC cough and cold medications

CASE: Mr. Sniffle, 35 y.o. male

• complaining of feeling tired and achy for few days

• today: congested, thick yellow nasal discharge

• non-productive cough started this morning

• no fever

• requesting an antibiotic

• wants to know what OTC products will work for his symptoms

QUIZ

What is the most likely diagnosis?

a. influenza

b. acute bacterial sinusitis

c. the common cold

d. pneumonia

e. asthma

QUIZ

What is the most likely diagnosis?

a. influenza

b. acute bacterial sinusitis

c. the common cold

d. pneumonia

e. asthma

QUIZ: the common cold

What is the most common culprit?

a. rotavirus

b. coronavirus

c. rhinovirus

d. echovirus

e. influenza virus

QUIZ: the common cold

What is the most common culprit?

a. rotavirus

b. coronavirus

c. rhinovirus d. echovirus

e. influenza virus

QUIZ: the common cold

Mr. Sniffles wants to know if his girlfriend will catch this if he kisses her. You tell him the virus is:

a. Likely to transmit by kissing

b. Unlikely to transmit by kissing

QUIZ: the common cold

Mr. Sniffles wants to know if his girlfriend will catch this if he kisses her. You tell him the virus is:

a. Likely to transmit by kissing

b. Unlikely to transmit by kissing*

QUIZ: the common cold

Mr. Sniffles only wants to spend his money on treatments that he can be sure will help his symptoms. What do you suggest?

a. Antibiotics

b. Antihistamine

c. Codeine

d. Dextromethorphan

e. Pseudoephedrine

f. D. or E.

g. None of the above – just rest and fluids

QUIZ: the common cold

Mr. Sniffles only wants to spend his money on treatments that he can be sure will help his symptoms. What do you suggest?

a. Antibiotics

b. Antihistamine

c. Codeine

d. Dextromethorphan

e. Pseudoephedrine

f. D. or E.

g. None of the above – just rest and fluids

Case Conclusion: Mr. Sniffle

• you reassure Mr. Sniffle that he has just a common cold

• you educate him about why antibiotics are not a good idea

• after you expound upon the evidence (or lack of) for various remedies, he chooses to try intranasal atrovent

• you also suggest hydration, rest, and not to waste his money on OTC products

THANK YOU