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Proper hygiene should be a top priority in patients suffering from the common cold as it reduces the transmission of cold viruses. The Centers for Disease Control and Prevention (CDC) encourages frequent hand cleansing with soap or soap sub- stitutes, such as hand sanitizers, to limit virus exposure and spread. Disinfectant wipes should also be utilized on popularly used inanimate objects (doorknobs, countertops, toys, etc.) in order to further reduce the risk of transmission and spread.
The diagnosis of a cold is clinical, based upon reported symptoms and/or observed signs. Physical examination may reveal conjunctival injection, nasal mucosal swelling, nasal congestion, and pharyngeal erythema. Adenopathy is typically absent or minimal; in the absence of secondary bron- chospasm, the lung examination is typically clear. Several clinical scoring systems are available that help differentiate the common cold from other similar upper respiratory disorders. These include the Wisconsin Upper Respiratory Symptom Survey (WURSS) and the Jackson cold scale, but generally have inadequate sensitivity and specificity for use in clinical practice. Differential diagnosis is extremely important when evaluating a patient for the common cold due to other conditions that mimic similar clinical signs and symptoms. The differential diagnosis should include allergic rhinitis, bacterial pharyngitis or tonsilli- tis, bacterial sinusitis, influenza, and pertussis. The common cold can be differentiated from simple rhinitis by the pres- ence of a sore throat and cough and from bacterial tonsillitis by the presence of prominent rhinorrhea and nasal stuffiness. Patients with acute rhinosinusitis generally experience a level of facial pain in conjunction with purulent discharge. Patients with influenza typically have a high fever, headache, and myal- gias. The main difference between pertussis and the common cold is that pertussis is associated with prolonged coughing, mostly paroxysmal, and with vomiting and sometimes apnea. DIAGNOSIS OF THE COMMON COLD
PHARMACOLOGICAL APPROACH FOR THE COMMON COLD
Currently, there is no known cure for colds; the goal of ther- apy is to reduce bothersome symptoms and prevent the transmission of cold viruses to other persons. Most colds are self-limiting, so symptoms usually resolve on their own in 7-14 days. For a majority of patients, targeted nonprescrip- tion therapy will relieve their cold symptoms. Antibiotics are ineffective against viral infections and the mainstay of ther- apy is nonpharmacological treatment, as mentioned above. If a patient does decide to self-treat, there are five main cat- egories of drugs that target specific symptoms and are preferred over the use of combination products, because symptoms appear, peak, and resolve at different times throughout the course of the infection. Possible pharmaco- logic therapy options include decongestants, antihistamines, local anesthetics, systemic analgesics, antitussives and protussives (expectorants), and combination products. DECONGESTANTS These agents specifically treat sinus and nasal con- gestion. Decongestants are adrenergic agonists and stimulate alpha-adrenergic receptors, which constrict blood vessels and decrease sinusoid vessel engorgement and mucosal edema. These agents are indicated for the tempo- rary relief of nasal and eustachian tube congestion and for cough associated with postnasal drip. These agents are not approved by the U.S Food and Drug Administration (FDA) to self-treat nasal congestion associated with sinusitis. Three types of decongestants are available: direct-act- ing, indirect-acting, and mixed-acting. Direct-acting decongestants include phenylephrine, oxymetazoline, and tetrahydrozoline; they work by binding directing to adrenergic receptors. Indirect-acting decongestants, like ephedrine, dis- place norepinephrine from storage vesicles in prejunctional nerve terminals and tachyphylaxis can develop as stored neu- rotransmitters are depleted. Mixed-acting decongestants, like pseudoephedrine, have both direct and indirect activity. The fol- lowing are the common decongestants and their dosage forms:
NON-PHARMACOLOGICAL APPROACH FOR THE COMMON COLD
Although evidence of efficacy is lacking, popular nonpharma- cological measures include increased fluid intake, adequate rest, increased humidification (steamy showers, vaporizers, humidifiers), and a nutrition diet as tolerated. Saline nasal sprays help moisten irritated mucosal membranes and aid in the loosening of encrusted mucus. Gargling salt water is also another common method and may ease a sore throat. Hot tea with lemon and honey, chicken soup, and vegeta- ble and other broths may induce a soothing effect as well. Nondrug therapy for all patients, especially infants, should include upright positioning to enhance nasal drainage. Due to children not being able to blow their own noses until the approx- imate age of 4 years, careful clearing of the nasal passageways with a nasal aspirator is indicated with an accumulation of mucus interferes with sleeping or eating. Nasal aspirators may be mechanically or manually operated (e.g., bulb syringe). To use a bulb syringe and avoid harm to the child, the caregiver should squeeze the large end of the bulb before inserting it, continue to compress the bulb while gently inserting the tip into the infant’s nose, and then slowly release the squeezing pressure to draw out the fluid. After the pressure is completely released, the syringe is removed from the infant’s nose and the fluid is expelled from the syringe by again compressing the bulb.
Systemic Nasal Decongestants • Phenylephrine HCL • Phenylephrine bitartrate • Pseudoephedrine
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