Common Cold

Front 1

State/identify the viruses that cause the common cold.

Back 1

• rhinovirus types 2, 9, 14 (> 100 serotypes); 50-60% of adult illnesses
• coronavirus type 229E; 15% of adult illnesses
• respiratory syncytial virus; common in children < 5 yrs of age
• other viruses with similar symptoms - influenza type A, B, C; parainfluenza virus; adenovirus; coxsackie virus, echoviruses

Note: Double viral infection or viral infection plus bacterial infection (usually group A Streptococci) occur but are rare.

Front 2

Seasonal Pattern: “Cold Season” is late August through early April.

Back 2

Rhinoviruses: fall and spring
Parainfluenza viruses: fall and spring
RSV, adenoviruses, coronoviruses: winter and spring
Echoviruses, coxsackie virus: summer

Front 3

State how the common cold is transmitted and identify factors that increase susceptibility.

Back 3

Transmission and Susceptibility

1. Direct contact - Hand-to-hand contact with virus-laden mucus followed by self-inoculation by touching mucus membranes (eyes, nose).

2. Contact with infected surfaces - Touch an infected surface then self-inoculation by touching mucus membranes (eyes, nose). The virus lives on skin and inanimate surfaces (doorknobs, telephones, tables) for 3 hours.

3. Aerosol inhalation - Inhale infected particles; proven in lab setting and presumed possible clinically

Susceptibility - Smoking and psychological stress increases susceptibility. No proof that cold environments or sudden chilling increases susceptibility. Not spread by contact with saliva.

Front 4

Identify symptoms of the common cold

Back 4

Symptoms appear and resolve in the same sequence regardless of the infecting virus. The only difference among viruses is duration. Most patients have nasal symptoms (congestion, rhinorrhea); fewer have systemic symptoms (fever, myalgia).

Front 5

State the typical sequence and duration of common cold

Back 5

Incubation period: 24-72 hours; mean duration 7 days; peak symptoms days 2-4; viral shedding for 3 weeks

Predominate symptoms:

Day 1 Sore throat

Days 2 and 3 Nasal congestion, rhinorrhea (initially clear, thin and watery; becomes thicker; may turn yellow/green as the cold progresses), sneezing

Days 4 and 5 Cough (< 20% of patients have cough)

Front 6

Congestion/Rhinorrhea - Systemic Decongestants (pseudoephedrine, phenylephrine)

Back 6

-Use only w/ physician advice if HTN, DM, arrhythmias, glaucoma,

- prostatic hypertrophy, hyperthyroidism.

- Do not take if pregnant or breastfeeding.

- Considered “doping” – check sanctioned drug lists.

Front 7

Congestion/Rhinorrhea - Nasal Decongestants

Back 7

- Limit use to 3-5 days to avoid rhinitis medicamentosa (rebound congestion)

- Prefer intermediate- to long-acting drugs (xylometazoline, oxymetazoline)

Front 8

Congestion/Rhinorrhea - Sedating Antihistamines

Back 8

(1st generation) decrease rhinorrhea by about 30%; not routinely recommended (sedation, confusion, drying of eyes, nose, and mouth); second generation antihistamines of no benefit

Front 9

Congestion/Rhinorrhea - Nasal Ipratropium Bromide

Back 9

decreases rhinorrhea by about 30% but not routinely recommended (expensive)

Front 10

Aches and pains / fever – acetaminophen or NSAIDs.

Back 10

• Salicylates are contraindicated in children and teenagers due to risk of Reye’s syndrome (encephalopathy w/ hepatic dysfunction).

• Advise patients to not exceed the maximum daily acetaminophen dose (4 grams per day) due to risk of severe liver damage [read labels]

• Advise patients who consume three or more alcoholic drinks every day to ask their doctor before taking acetaminophen

Front 11

Pharyngitis – saline gargles, local anesthetics (benzocaine, dyclonine)

Back 11

• Local anesthetics available as lozenges, troches, mouthwashes, and sprays; efficacy varies. Counsel patients to avoid eating or drinking immediately after using local anesthetics.

• Benzocaine contraindicated in patients allergic to “caines”.

Front 12

Cough - ACCP recommendations

Back 12

American College of Chest Physicians recommends the combination of a first generation antihistamine and decongestant for cough associated with common cold and UACS

Front 13

Sneezing

Back 13

Sedating antihistamines may slightly decrease sneezing; not routinely recommended.

Front 14

Identify complications of the common cold and state how to recognize each complication.

Back 14

• sinusitis*
• bronchitis
• Eustachian tube dysfunction
• bacterial pneumonia
• middle ear infection
• asthma exacerbation
• secondary bacterial infection
• COPD exacerbation

Greatest risk for complications: very young, very old, chronic illnesses, malnourished, immunosuppressed.

Front 15

Self-Exclusions Common Cold

Back 15

1. Patients with multiple medical problems
2. Patients with chronic underlying diseases (asthma, CHF, COPD, diabetes, chronic immunosuppression)
3. Frail elderly
4. Infants

Front 16

Non-drug Therapy for Common Cold

Back 16

1. Increase fluid intake (unless fluid restricted)
2. Adequate rest
3. Nutritious diet
4. Humidification (cool or warm vapor mist); Caution – may worsen allergies ( molds & dust mites)
5. Saline gargles (unless sodium restricted)
6. Saline nose drops
7. Devices (Vick’s Breathe Right nasal strips)
8. Aromatics (Sudacare Shower Soothers, Vicks VapoRub etc)

Front 17

Current Issues:

Reformulated Products - CAUTION: Read the package label closely

Back 17

• Diphenhydramine in place of dextromethrophan

• Phenylephrine in place of pseudoephedrine

• Acetaminophen deleted/added

Front 18

Current Issues:

Pediatric Labeling

Back 18

• 21 CFR monograph labeling: Do not use for children under 2 years of age

• Manufacturer’s voluntary labeling: Do not use for children under 4 years of age

Front 19

Current Issues:

Pediatric Sedation

Back 19

• Do not use cough and cold medicines to sedate or make a child sleepy

Front 20

Current Issue:

Sedating Antihistamines

Back 20

• Published studies flawed but FDA-approved drugs include clemestine, doxylamine, diphenhydramine, and chlorpheniramine.
Efficacy (except for sneezing) is based on anticholinergic properties (drying effect) rather than antihistaminic effect; is the benefit worth the risk?

Front 21

Current Issues:

Combination Products

Back 21

• Convenient but expensive and expose patients to unnecessary risk from drugs that are not needed. Cannot titrate dosages. FDA would like to limit to less than or equal to 3 active ingredients.

Front 22

Current Issues:

Milk Products

Back 22

No evidence that milk products increase mucus production.

Front 23

Current Issues:

Vitamin C

Back 23

• May decrease the number of colds in patients with vitamin C deficiency or for those under extreme physical stress (e.g., military in extreme weather/physical stress or long-distance runners); role in the general population unproven despite numerous clinical trials.

• Some data suggest that megadoses (1-4 grams/day) may decrease the duration and severity by about 22% if taken early in the course; efficacy in the general population unknown. [Doses > 4 grams/day associated with significant GI side effects (diarrhea, stomach upset).]

Front 24

Pseudoephedrine Restrictions (Combat Methamphetamine Epidemic Act of 2005) - Sales limit

Back 24

• Daily sales limited to 3.6 grams per purchaser (equivalent to 146 30-mg pseudoephedrine HCL tablets).

• Retail sales limited to 9 grams per customer during a 30-day period.

• Mail-order and mobile vendor sales limited to 7.5 grams per customer during a 30-day period.

Front 25

Pseudoephedrine Restrictions (Combat Methamphetamine Epidemic Act of 2005) - Packaging

Back 25

• Non-liquid forms must be packaged in 2-unit blisters.

Front 26

Pseudoephedrine Restrictions (Combat Methamphetamine Epidemic Act of 2005) - Sales limit

Back 26

• Products must be placed “behind the counter”.

Front 27

Pseudoephedrine Restrictions (Combat Methamphetamine Epidemic Act of 2005) - Sales limit

Back 27

• The seller must maintain a written or electronic sales logbook that identifies products by
name, quantity sold, name and address of purchaser, and date and time of sales.
• The purchaser must sign the logbook and enter their name, address and date and time of
sale.
• The seller must enter the name of the product and quantity sold.
• The logbook must be maintained for not fewer than two years.

Front 28

Pseudoephedrine Restrictions (Combat Methamphetamine Epidemic Act of 2005) - Sales limit

Back 28

• The potential purchaser must present a photographic identification card issued by a state
or the Federal government. Mail-order sellers must confirm identity of purchaser prior to
shipping the product.

Front 29

Pseudoephedrine Restrictions (Combat Methamphetamine Epidemic Act of 2005) - Self-certification & training

Back 29

• Seller self-certification and training required.