Common Cold

 

The common cold can affect all population groups. It is most common in children and is especially common in younger children.  Adults experience an average of 2–3 colds per year.  Children experience an average of 5–6 colds per year.  The common cold is much more frequent in winter months, a trend that is seen in all countries of the northern hemisphere. Rhinovirus, the most common cause, shows peaks of activity in late autumn and early spring. Colds caught in the summer months are more likely to be caused by other viruses, such as coronavirus, and parainfluenza virus. So far there is no generally accepted explanation for the observed seasonality of the common cold

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Diagnosis in adults and older children

NOTE Most adults and older children reliably self-diagnose the common cold within a day of developing symptoms. Diagnosis is made through clinical history

Common symptoms include:

  1. Sore or irritated throat — often the first symptom,typically has a sudden onset and resolves rapidly
  2. Nasal irritationcongestionnasal discharge (rhinorrhoea), and sneezing — nasal discharge is often profuse and clear, but may become thicker and darker as the infection progresses (although this does not usually indicate that bacterial infection is present)
  3. Cough develops in about 30% of people, typically after nasal symptoms have cleared
  4. Hoarse voice caused by associated laryngitis
  5. General malaise

The onset of symptoms is usually rapid, over 1–2 days

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Less common symptoms include:

  1. Fever — this is unusual in adults and is typically low-grade
  2. Headache and myalgia — more often associated with influenza rather than the common cold
  3. Loss of taste and smell, eye irritability, and a feeling of pressure in the ears or sinuses (due to obstruction or mucosal swelling)

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Assessment:

  1. Consider the person's previous medical history, relevant co-morbidities (such as asthma or chronic obstructive pulmonary disease) and smoking status
  2. Exam the person to exclude a complication or alternative diagnosis, and manage appropriately

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NOTE:  Investigations (such as nasal and throat swabs) are not necessary to diagnose the common cold

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Diagnosis in younger children and infants

Ask about the child's symptoms. Parents may report the following:

  1. Restlessness or irritability
  2. Nasal congestionnasal discharge (rhinorrhoea), and sneezing — severe nasal congestion may interfere with feeding, breathing, and sleep
  3. Cough — occasionally, vomiting may follow a bout of coughing
  4. Fever

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Examine the child to exclude a complication or alternative diagnosis and manage appropriately

  1. Check the temperature — a fever of 38–39°C is common in preschool children with a common cold
    1. Children younger than 3 months with a temperature of 38°C or higher are in a high-risk group, and children aged 3–6 months with a temperature of 39°C or higher are in an intermediate-risk group for serious illness. See the CKS topics on Feverish children - risk assessment and Feverish children - management for more information
  2. Examine the:
    1. Fontanelle — a bulging fontanelle with high-pitched crying may indicate meningism. See the CKS topic on Meningitis - bacterial meningitis and meningococcal disease for more information
    2. Cervical lymph nodes — these may be mildly enlarged but are typically non-tender
    3. Ears — look for signs of acute otitis media, such as a red, yellow, or cloudy tympanic membrane. See the CKS topic on Otitis media - acute for more information
    4. Throat — there may be a non-specific erythematous inflammation of the pharynx (unusual). An inflamed throat in the absence of nasal symptoms is more likely to indicate a streptococcal infection. See the CKS topic on Sore throat - acute for more information

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NOTE:  Investigations (such as nasal and throat swabs) are not necessary to diagnose the common cold

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Management

  1. If the person is at risk of complications because of pre-existing co-morbidity or other risk factors arrange follow-up as appropriate  
  2. Explain that symptom relief and rest are the most appropriate management
  3. Advise the person or carer to use paracetamol or ibuprofen as an antipyretic and/or analgesic if needed for the following:
    1. Adults and children aged 5 years and over, if the person has a headache, muscle pain, or fever
    2. Children aged under 5 years,  if the child has a fever and appears distressed. When using paracetamol or ibuprofen in children with fever, advise the carer to:
      1. Continue only as long as the child appears distressed
      2. Consider changing to the other agent if the child's distress is not alleviated
      3. Not to give both agents simultaneously
      4. Only consider alternating these agents if the distress persists or recurs before the next dose is due

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Follow up

Advise that a follow-up appointment is needed if:

  • Symptoms are worsening (for example after 3–5 days)
  • Symptoms are persisting (for example after 7–14 days)

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Consider advising an earlier review for:

  • People with risk factors for complications
  • Young children and babies — advise parents or carers to return if their child develops dehydration, laboured breathing, or prolonged fever

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Advice and Guidance is being made available for all specialties, and is being provided by consultant specialists at East Kent Hospitals.  To make a request or to check to if a query has been answered, you will need to log in via the electronic Referral System (eRS)

Click here for the "how to access" e-Referral Advice and Guidance Manual for instructions on how to make a request and check responses

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