The Medical Minute: The common cold -- no cure in sight

October 24, 2006

By John Messmer
Penn State Family & Community Medicine
Penn State Milton S. Hershey Medical Center
Penn State College of Medicine

What's the best treatment for a cold? Some say rest and lots of liquids, others say to feed a cold and starve a fever. But what if a person has a cold with a fever? Does medication help?

Cold remedies have proliferated like the viruses that cause them since the days of Hippocrates who noticed colds are more common in winter. To date, there is no cure for the common cold, but that has not stopped people from hawking one thing or another as a sure-fire treatment. Herbs, vitamins, heat, minerals and more have been proposed to relieve or cure colds.

To understand the whys and wherefores of cold treatment, it's important to understand what a cold is and is not. The nose, throat and sinuses can be infected by viruses or bacteria. Colds are caused by one of a couple hundred strains of virus that can infect the lining of the respiratory tract.

Typically, a cold begins with a sense of scratchiness in the throat and irritation in the nose. There often is a runny nose and stuffiness in the first day and there may be some pressure in the cheeks or eyes from early sinus irritation as the body begins to react to the infection. The ears might feel clogged or uncomfortable. As the immune system reacts to the virus, people feel achy or tired and may start to get a low fever. By the second day, people often feel much worse, with much more nasal congestion and drainage, a cough and more sinus pressure and ear congestion and possibly higher fever. The symptoms begin to subside a bit by the third or fourth day, and people are left with stuffy nose, sinus pressure, ear fullness or pain, possibly low fever, fatigue, sore throat and a cough. By the 10th to 14th day, if people have not developed a secondary infection, they get well.

The viruses that cause colds make people more susceptible to infection from bacteria that are already in their noses and throats or that they contract from the environment. Other risk factors, such as, smoking, asthma and other respiratory diseases, diabetes and so on also reduce the ability to resist these secondary infections. Signs people have a secondary infection include worsening of symptoms or persistence beyond two weeks.

Nothing will kill the cold virus except people's immune systems, but it takes about two weeks before the respiratory tract gets back to normal. Most traditional cold remedies are not designed to cure a cold, just to make people feel a little better. Decongestants shrink swollen membranes and reduce drainage. Pain medications like Tylenol, Advil and Aleve help to reduce the aches and pressure people might feel. Antihistamines dry the drainage, perhaps too much. Dextromethorphan might help with coughing, but that is in dispute. Some studies show tea and cocoa do a better job as cough suppressants than dextromethorphan which can cause drowsiness.

Zinc, vitamin C and echinacea have been touted as treatments to stop colds in the early stages, but, to date studies done have failed to support those claims. It's possible that having a strong belief in the efficacy of such things is what actually helps. If so, it's reasonable to try them. Singing and dancing have been shown to increase antibodies that fight colds, but a positive attitude also helps.

As in so much of medicine, prevention is much better than treatment. People don't really "catch" colds; we give them to ourselves. Unless someone coughs or sneezes directly at a person the cold will not be spread to them. Doctors see dozens of patients with colds during the season and rarely catch their patients' colds.

Cold air, drafts, chills, wet hair and so on do not cause colds. The usual way the virus gains entry to peoples' systems is by touching their nose, mouth or eyes with their fingers. When people touch other people's hands or things they have touched, they get the virus on their own hands, then they inoculate ourselves.

The "secret" to cold prevention, then, is clean hands and never touching the mouth, nose or eyes unless the hands have been sanitized first. Studies in day-care settings and in schools have proven that attention to hand washing reduces the incidence of colds. To be effective, hands should be rubbed vigorously with soap and water for 30 seconds. Alternatively, alcohol gel hand sanitizers kill cold viruses in a second and are just as effective as vigorous hand washing.

If, despite their best efforts, people do catch a cold, several things can help: Extra rest helps the immune system fight the infection and more fluids keep the drainage thin. Treating symptoms might help people to feel better, but people with other medical conditions should ask their doctors if decongestants, antihistamines or cough suppressants are acceptable for them. Nasal decongestant sprays are fine for a few days, but after five days, they can cause rebound congestion that is harder to treat and may cause addiction to the spray. Smoking increases the chance of a secondary infection. If symptoms are getting progressively worse or are not gone in two weeks, it's time to call the doctor.

With a good diet, reasonable rest and attention to keeping our hands clean, people might go the entire winter without a single cold.

(Media Contacts)

Last Updated March 19, 2009