History

Fact Explanation
Nasal obstruction Nasopharyngitis or common cold is a viral infection of the upper respiratory tract. It is the commonest infectious disease in human which triggers an acute inflammatory disease of the upper respiratory tracts mainly nasal cavity and pharynx. The inflammation may spread to the adjacent tonsils, sinuses and conjunctiva. On average, adults get 4 to 6 colds per year, while children get 6 to 8 of them. It is caused by a variety of viral pathogens with human rhinoviruses being the most abundant ones. Inflammation of the nasal mucosa results in an edema. This edema reduces the airway patency along with nasal secretions. [1,2,3,4]
Nasal secretions Inflammation of the nasal mucosa results in initial dry feeling which accompanies with a tickling sensation of the throat. This prodrome is followed by watery and clear nasal secretion and lasts for 1-4 days. The goblet cells secrete more mucous in order to wipe out pathogens from the area. The color of nasal secretion may range from clear-opaque white-green-yellow within 2-3 days of onset of symptoms. So, yellow color mucopurulent nasal discharge does not necessarily indicates a secondary bacterial infection. But the presence of persistent, purulent nasal discharge with crusts or sores in the nares are suggestive of such infection. [1,3,4,5]
Watery red eyes Nasopharyngitis sometimes accompanies with mild viral conjunctivitis which is an inflammatory reaction in the conjunctiva. Increased tearing and red eye are the common features. This is more common the causative virus is an adenovirus rather than a rhinovirus. Influenza may evoke pain behind the eyes or pain with eye movements. [3,4]
Sore or scratchy throat Co existing pharyngitis manifests as soar throat or a tickling sensation. Some patients may complain of odynophagia or dysphagia as well. Soar throat anf the tickling sensation is more of a part of the prodrome that may last only few days. [1,2]
Low grade fever Mild fever occurs occasionally when the primary inflammation is severe or a secondary bacterial infection is present. But influenza can cause fevers as high as 40 degrees. [1,2,3,4]
Sneezing Sneezing helps in expulsion of air from the lungs through the nose and mouth which is triggered by the inflammatory agents or foreign particles irritating the nasal mucosa. Sneezing is more common in day 2-3 along with nasal obstruction and rhinorrhea. [1,2,3,4]
Cough Sore or scratchy throat is followed by a cough in only around 30% cases when the pharyngeal inflammation is so severe that it spreads to the larynx. Cough is sometimes caused by post nasal drip. It usually occurs in the later of the disease course and rarely may last for longer periods. Post viral cough is a lingering cough that follows common cold and lasting up to as many as eight weeks. [1,2,3,4]
Hyposmia Reduced ability to smell and to detect odors is caused by the nasal inflammation. edematous nasal mucosa and excessive nasal discharges prevent the stimulation of the olfactory receptors. [1,2]
Headache Co existing sinusitis results in a mild headache. The inflamed sinuses produce abundant mucous that congest or pressurize the sinus cavities. [3,4,5]
Generalized tiredness and muscle pain These are systemic features suggestive of generalized ill health. Extreme exhaustion and severe muscle pain are more signifying of influenza. [1,2,4,5]
Complications Acute otitis media, acute sinusitis, pneumonia and exacerbation of asthma are the common complications of nasopharyngitis. [1,2,3,4,5]
References
  1. WORRALL G. Common Cold Can Fam Physician [online] 2007 Oct, 53(10):1735-1736 [viewed 11 June 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2231439
  2. KENNEDY JOSHUA L, TURNER RONALD B, BRACIALE THOMAS, HEYMANN PETER W, BORISH LARRY. Pathogenesis of rhinovirus infection. Current Opinion in Virology [online] 2012 June, 2(3):287-293 [viewed 11 June 2014] Available from: doi:10.1016/j.coviro.2012.03.008
  3. SIMASEK M, BLANDINO DA. Treatment of the common cold. Am Fam Physician [online] 2007 Feb 15, 75(4):515-20 [viewed 11 June 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/17323712
  4. FASHNER,J, ERICSON K, WERNER S,Treatment of the Common Cold in Children and Adults, Am Fam Physician [online] 2012 Jul, 15,86(2),153-159. [viewed 11 June 2014] Available from: http://www.aafp.org/afp/2012/0715/p153.html
  5. OSGUTHORPE, J.D. Adult Rhinosinusitis: Diagnosis and Management, Am Fam Physician[online], 2001,63,69-76. [viewed 27 May 2014] Available from: http://www.aafp.org/afp/2001/0101/p69.html

Examination

Fact Explanation
Inflamed nasal mucosa Erythematous and edematous nasal mucosa can be observed during inspection. [1,2,3]
Nasal secretions Copious nasal secretions are more suggestive of a viral nasopharyngitis. The color of nasal secretion may range from clear to opaque white to green to yellow even in the absence of a secondary bacterial infection. If the purulent discharge accompanies with crusts or sores in the nares, secondary bacterial infection is a possibility. [1,2,4]
Low grade fever Mild fever is a less prominent in viral nasopharyngitis. Influenza is an exception when the body temperature is as high as 40 degrees. [3,4]
Sinus tenderness Inflammation in the mucosal layer of sinuses causes tenderness.If the frontal sinuses are affected the the tenderness can be elicited in the mid of the forehead. The tenderness can be demonstrated around the nasal bridge if the infection affects the sphenoid sinus. Maxillary tenderness can be elicited in maxillary sinusitis. [1,2.3,5]
References
  1. WORRALL G. Common cold Can Fam Physician [online] 2007 Oct, 53(10):1735-1736 [viewed 11 June 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2231439
  2. KENNEDY JOSHUA L, TURNER RONALD B, BRACIALE THOMAS, HEYMANN PETER W, BORISH LARRY. Pathogenesis of rhinovirus infection. Current Opinion in Virology [online] 2012 June, 2(3):287-293 [viewed 11 June 2014] Available from: doi:10.1016/j.coviro.2012.03.008
  3. OSGUTHORPE, J.D. Adult Rhinosinusitis: Diagnosis and Management, Am Fam Physician[online], 2001,63,69-76. [viewed 27 May 2014] Available from: http://www.aafp.org/afp/2001/0101/p69.html
  4. SIMASEK M, BLANDINO DA. Treatment of the common cold. Am Fam Physician [online] 2007 Feb 15, 75(4):515-20 [viewed 11 June 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/17323712
  5. FASHNER,J, ERICSON K, WERNER S,Treatment of the Common Cold in Children and Adults, Am Fam Physician [online] 2012 Jul, 15,86(2),153-159. [viewed 11 June 2014] Available from: http://www.aafp.org/afp/2012/0715/p153.html

Differential Diagnoses

Fact Explanation
Allergic rhinitis Allergic rhinitis is an allergic inflammation of the nasal airways characterized by rhinorrhea, nasal congestion and obstruction. Symptoms are spontaneously caused by exposure to allergens and triggering factors, and may be reversible. [1]
Pharyngitis Most of the times pharyngitis is of viral in origin and the remainder caused by bacterial or fungal infections or irritants. Sore throat, fever, difficulty of swallowing are common symptoms along with Joint pain, muscle aches and cervical lymphadenopathy. [2]
Tonsillitis Tonsillitis is most commonly caused by viral or bacterial infection. Symptoms and signs may include sore throat, fever and difficulty in swallowing with swollen tonsils. [3]
Sinusitis Sinusitis is an infectious or non-infectious inflammation of one or more para nasal sinuses. The infection may be bacterial, viral or fungal. Non-infectious sinusitis is allergic in origin. Fever, headache, cough, nasal discharge and nasal congestion are characteristic features. [4]
Influenza Influenza commonly called “the flu” is a highly contagious infection of the nose, throat, bronchial tubes, and lungs. Influenza is caused by influenza viruses. It spreads through the air, most often when an infected person sneezes, cough, or speaks. Abrupt fever, muscle aches, severe tiredness, cough, sore throat, runny or stuffy nose and headache are the common symptoms. [5]
References
  1. WANG DE Y. Management of allergic rhinitis in general practitioners. Asia Pac Allergy [online] 2012 Oct, 2(4):233-6 [viewed 26 May 2014] Available from: doi:10.5415/apallergy.2012.2.4.233
  2. RENNER B, MUELLER CA, SHEPHARD A. Environmental and non-infectious factors in the aetiology of pharyngitis (sore throat). Inflamm Res [online] 2012 Oct, 61(10):1041-52 [viewed 11 June 2014] Available from: doi:10.1007/s00011-012-0540-9
  3. GEORGALAS CC, TOLLEY NS, NARULA A. Tonsillitis Clin Evid (Online) [online] :0503 [viewed 11 June 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2907808
  4. DESROSIERS M, EVANS GA, KEITH PK, WRIGHT ED, KAPLAN A, BOUCHARD J, CIAVARELLA A, DOYLE PW, JAVER AR, LEITH ES, MUKHERJI A, SCHELLENBERG RR, SMALL P, WITTERICK IJ. Canadian clinical practice guidelines for acute and chronic rhinosinusitis Allergy Asthma Clin Immunol [online] , 7(1):2 [viewed 27 May 2014] Available from: doi:10.1186/1710-1492-7-2
  5. LU S, ZHENG Y, LI T, HU Y, LIU X, XI X, CHEN Q, WANG Q, CAO Y, WANG Y, ZHOU L, LOWRIE D, BAO J. Clinical findings for early human cases of influenza A(H7N9) virus infection, Shanghai, China. Emerg Infect Dis [online] 2013 Jul, 19(7):1142-6 [viewed 11 June 2014] Available from: doi:10.3201/eid.1907.130612

Investigations - for Diagnosis

Fact Explanation
Full blood count Nasopharyngitis is more of a clinical diagnosis. Investigations do not have a value in almost all the instances. When the common cold delays in resolving and in case of suspicion of developing complications such as pneumonia, investigations may play a role. Blood count may normal in viral nasopharyngitis. Neutrophilic leucocytosis is found in some patients due to secondary bacterial infection. Leukopenia and relative lymphopenia are typical findings of influenza. [1,2,3,4]
Erythrocyte sedimentation rate (ESR) Above normal due to infection and ongoing inflammation. But this is rarely performed. [2,4]
Culture of nasal secretions This is of limited value in diagnosing or management as nasopharyngitis is viral in origin and the nasal cavity resides many organisms. [2,3]
Plain sinus x-ray When sinis symptoms present for a long time with slow resolvement, a sinus x-ray is performed to exclude sinusitis. Mucosal thickening, air fluid levels, and complete opacification of the involved sinus are the common findings indicative of acute sinusitis. [4,5]
Chest x-ray To exclude pneumonia which may arise as a complication of severe nasopharyngitis. [1,2,4]
References
  1. WORRALL G. Common cold Can Fam Physician [online] 2007 Oct, 53(10):1735-1736 [viewed 11 June 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2231439
  2. MELTZER EO, HAMILOS DL. Rhinosinusitis Diagnosis and Management for the Clinician: A Synopsis of Recent Consensus Guidelines Mayo Clin Proc [online] 2011 May, 86(5):427-443 [viewed 27 May 2014] Available from: doi:10.4065/mcp.2010.0392
  3. OSGUTHORPE, J.D. Adult Rhinosinusitis: Diagnosis and Management, Am Fam Physician[online], 2001,63,69-76. [viewed 27 May 2014] Available from: http://www.aafp.org/afp/2001/0101/p69.html
  4. WORRALL G. Acute sinusitis Can Fam Physician [online] 2008 Jan, 54(1): 82 - 83 [viewed 27 May 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2293324
  5. SIMASEK M, BLANDINO DA. Treatment of the common cold. Am Fam Physician [online] 2007 Feb 15, 75(4):515-20 [viewed 11 June 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/17323712

Management - General Measures

Fact Explanation
Adequate hydration Management of nasopharyngitis is primarily symptomatic. Adequate hydration should be maintained to prevent dehydration. Fluid intake are considered benign and possibly beneficial for the relief of common cold symptoms. [1]
Instillation of nasal cavities with normal saline It is a simple, inexpensive treatment that relieves the symptoms of nasal congestion. The procedure involves flushing the nasal cavity with saline solution, which promotes improved mucociliary clearance by moisturizing the nasal cavity and removing encrusted material. Evidence shows that pulsating saline lavage can remove bacteria also. [2]
Steam inhalation It is a common home therapy for upper respiratory tract infections though there is a lack of evidence to show that it helps. There's also a risk of burns and scalds. [3]
Nasal decongestants Topical vasoconstrictive agents such as nasal sprays, nose drops, tablets, and liquids may help to relieve symptoms. They're available over-the-counter and can help unblock the nose, allowing to breathe more easily. It gives only a symptomatic relief. There is a risk of rebound congestion with the long term use of topical decongestants. Therefore long term usage is not recommended. Oxymetazoline and phenylephrine are among the commonly used decongestants. Nasal decongestants are not recommended below 2 years of age. [1,2,3,4]
Antihistamines Antihistamines inhibit the action of histamine by either blocking its attachment to histamine receptors, or inhibiting the enzymatic activity of histidine decarboxylase and thus relieves classic symptoms of an allergic reaction such as runny nose and watery eyes. They also relieve the nasal congestion by reducing the mucous production. The first generation antihistamines such as antihistamines Some studies shows that antihistamines do not alleviate cold-related sneezing or nasal symptoms to a clinically significant degree. Though first generation antihistamines such as Chlorphenamine are widely recommended, there may be side effects such as sedation than the therapeutic benefit. [1,5,6,7]
Oral analgesics/antipyretics Analgesic effect of non steroidal anti inflammatory drugs is used in improving sneeze, relieving headache and myalgia during common cold. They may improve fever in the presence of it. [1,5,6]
Vapor rub Mentholated topical petrolatum-based gel is applied to the chest and neck has been shown to improve cough severity and quality of sleep. [1,2,5,6,7]
Vitamin C Though it is widely used in common cold, there is no sufficient evidence that suggest vitamin C has a beneficial effect on symptomatic relief. Some studies shows that Vitamin C prophylaxis may reduce the duration and severity of the common cold. It is thought to reduce the incidence in those who are exposed to physical and environmental stresses. [1,4,5,6]
Zinc sulfate Though it is not widely used, zinc has been shown to inhibit viral growth. It has an effect in reducing the duration of cold symptoms. [1,5,6,7]
Echinacea products They are herbal medicine. Commercially available echinacea products come in many forms including tablets, juice, and tea. There is no firm evidence that Echinacea products help treat or prevent the common cold. [7,8]
Ipratropium bromide Topical ipratropium, a prescription anticholinergic, relieves nasal symptoms. It is approved only for children older than six years and adults. [7,9]
Steroids Topical and systemic steroids often prescribed for reducing mucosal swelling. Inhaled corticosteroids are beneficial in some children who develop wheezing along with cold. Usually a high dose is needed. It may decrease frequency and duration of wheezing episodes. [1,4,5,6]
Guaifenesin Guaifenesin is an expectorant. It helps loosen congestion. Guaifenesin is thought to act as an expectorant by increasing the volume and reducing the viscosity of secretions in the trachea and bronchi. Guaifenesin may even improve cough. [1,4,5]
Codeine Codeine is an opiate used for its analgesic, antitussive effects. It may work for post viral cough rather than the acute cough associated with nasopharyngitis. [1,4,6]
Antibiotics Antibiotics have no effect against common cold as it is primarily a viral infection. Antibiotics are recommended only if a significant bacterial infection is present or complications such as otitis media, acute sinusitis or pneumonia develop. [1,5,6]
Prevention The most important and and easiest preventive measure is hand washing. Regular and proper hand washing has been proved to be effective in reducing the transmission of viruses especially among children. Wearing face mask helps to prevent transmitting via infective droplets. Though it is said that vitamin C and zinc have a role in prevention of common cold, the evidences are not sufficient enough. [1,4,5,9]
References
  1. SIMASEK M, BLANDINO DA. Treatment of the common cold. Am Fam Physician [online] 2007 Feb 15, 75(4):515-20 [viewed 11 June 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/17323712
  2. PAPSIN B, MCTAVISH A. Saline nasal irrigation: Its role as an adjunct treatment. Can Fam Physician [online] 2003 Feb:168-73 [viewed 27 May 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/12619739
  3. BAARTMANS M, KERKHOF E, VLOEMANS J, DOKTER J, NIJMAN S, TIBBOEL D, NIEUWENHUIS M. Steam inhalation therapy: severe scalds as an adverse side effect Br J Gen Pract [online] 2012 Jul, 62(600):e473-e477 [viewed 27 May 2014] Available from: doi:10.3399/bjgp12X652337
  4. ARROLL B. Common cold Clin Evid (Online) [online] :1510 [viewed 11 June 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2907967
  5. MULKERN PD. The Effects of Drugs on the Common Cold J Coll Gen Pract [online] 1964 Mar, 7(2):253-257 [viewed 11 June 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1878007
  6. AFSHAR, ES. Oral Antihistamine/Decongestant/Analgesic Combinations for the Common Cold, Am Fam Physician[online]. 2012 Nov, 1,86(9),812-813.[viewed 11 June 2014] Available from: http://www.aafp.org/afp/2012/1101/p812.html
  7. NAHAS R, BALLA A. Complementary and alternative medicine for prevention and treatment of the common cold. Can Fam Physician [online] 2011 Jan, 57(1):31-6 [viewed 11 June 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/21322286
  8. BARRETT B, BROWN R, RAKEL D, MUNDT M, BONE K, BARLOW S, EWERS T. Echinacea for treating the common cold: a randomized trial. Ann Intern Med [online] 2010 Dec 21, 153(12):769-77 [viewed 11 June 2014] Available from: doi:10.7326/0003-4819-153-12-201012210-00003
  9. GAFFEY MJ, HAYDEN FG, BOYD JC, GWALTNEY JM JR. Ipratropium bromide treatment of experimental rhinovirus infection. Antimicrob Agents Chemother [online] 1988 Nov, 32(11):1644-7 [viewed 11 June 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/2855297

Management - Specific Treatments

Fact Explanation
Antiviral therapy Though antiviral therapy may have a role in treatment, it is not routinely used, as symptomatic management is sufficient for cure and the antivirals are expensive and not freely available. [1]
References
  1. ECCLES R, MEIER C, JAWAD M, WEINMüLLNER R, GRASSAUER A, PRIESCHL-GRASSAUER E. Efficacy and safety of an antiviral Iota-Carrageenan nasal spray: a randomized, double-blind, placebo-controlled exploratory study in volunteers with early symptoms of the common cold. Respir Res [online] 2010 Aug 10:108 [viewed 11 June 2014] Available from: doi:10.1186/1465-9921-11-108