The Common Cold

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Abstract
The articles prior to January 2008 are part of the back file collection and are not available with a current paid subscription. To access the article, you may purchase it or purchase the complete back file collection here Ronald B Turner, MD The common cold is a mild and self-limited illness associated with an enormous economic burden, both in lost productivity and in expenditures for treatment. These illnesses result in approximately 23 million days of school absence and 25 million days of work absence in the United States annually. Each year we make approximately 27 million physician visits and spend almost $2 billion for overthe-counter (OTC) cough and cold medications to treat symptoms of the common cold. A survey of a representative sample of children 27 to 48 months of age found that 35% of these children had received an OTC cold remedy in the preceding 30 days. EPIDEMIOLOGY The pathogens most frequently associated with common cold symptoms are the rhinoviruses. Other important pathogens include the coronaviruses and respiratory syncytial virus (RSV). Influenza, parainfluenza, and adenoviruses may cause cold symptoms; however, these agents typically cause lower respiratory or systemic symptoms in addition to nasal symptoms characteristic of the common cold. Colds occur year-round, but have a decreased incidence during summer months. The "respiratory virus season" usually begins with an increase in rhinovirus infections in August or September and ends following the spring peak of rhinovirus infections in April or May. This period of increased disease is caused by sequential and relatively discreet outbreaks of different viral pathogens.1 A rise in the symptoms of the common cold is associated with each of these outbreaks. However, other clinical syndromes are usually also present in the community during epidemics caused by pathogens other than rhinovirus or coronavirus. Symptoms of the common cold generally begin 1 to 2 days after the onset of viral infection and peak at 2 to 4 days. The onset of illness and the time to peak symptoms is approximately 1 day later for the coronavirus infections than for infections caused by rhinoviruses or RSV. Nasal obstruction, rhinorrhea, and sneezing are present early in the course of the cold. However, a sore or "scratchy" throat is frequently reported as the most bothersome symptom on the first day of illness. The sore throat resolves quickly and by the second and third day of illness nasal symptoms are predominant. Cough is associated with approximately 30% of colds and typically does not become the most bothersome symptom until the fourth or fifth day of illness when nasal symptoms decrease. The usual cold lasts approximately a week although 25% last 2 weeks. Virus shedding persists after the resolution of symptoms and virus may be cultured from 10% to 20% of subjects for 2 to 3 weeks after infection. The average incidence of the common cold in preschool children is 5 to 7 per year but 10% to 15% of children will have at least 12 infections per year. The incidence of illness decreases with age and averages 2 to 3 per year by adulthood. The incidence of common colds in young children is increased in those who attend day care centers. The difference in the incidence of illness decreases as the length of time spent in day care increases. However, the incidence of illness remains higher in the day care group through at least the first 3 years of life. Although the frequency of the common cold suggests that person-to-person spread must be fairly efficient, natural transmission of rhinovirus appears to be relatively inefficient. A transmission rate of 38% was reported in a study in which one partner of a married couple was infected with rhinovirus and then the spouse, documented to be susceptible to the virus, was observed for acquisition of infection. In another study, exposure of susceptible recipients to donors infected experimentally resulted in… 10.3928/0090-4481-19981201-06