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Ascorbic acid and the common cold. Evaluation of its efficacy and toxicity.

We reviewed the clinical data relating to the efficacy and safety of pharmacologic doses of ascorbic acid in the prevention and treatment of the common cold. Although one study tentatively supports the hypothesis that such doses of ascorbic acid may be efficacious, a second study by the same group did not confirm the significant findings, and no clear, reproducible pattern of efficacy has emerged from the review of all the evidence. Similarly, there is currently little adequate evidence on either the presence or the absence of serious adverse reactions to such doses of ascorbic acid, although many such reactions have been hypothesized. The unrestricted use of ascorbic acid for these purposes cannot be advocated on the basis of the evidence currently available.

Administration, Oral↗

Evidence for correlation of objective and subjective measures of nasal airflow in patients with common cold.

OBJECTIVES: To utilize posterior rhinomanometry and conductance, as units of measurement, to further investigate the relationship between subjective and objective measures of nasal airflow. DESIGN: A prospective, observational study. SETTING: Common Cold Research Centre. PARTICIPANTS: Sixty healthy volunteers from the staff and student population of Cardiff University with an upper respiratory tract infection. MAIN OUTCOMES MEASURES: To determine correlations between visual analogue scores (VAS) and posterior rhinomanometry for total, unilateral, high and low conductance groups. RESULTS: No correlation was found between total VAS and total conductance (r = 0.17, P = 0.10). A substantially significant correlation was found between unilateral VAS and unilateral conductance (rho = 0.50, P < 0.001). The unilateral VAS and conductance were highly correlated for the low total conductance group (rho = 0.61, P < 0.001). CONCLUSIONS: Posterior rhinomanometry allows actual measurement of the combined and unilateral conductance of nasal passages. The units of conductance, as opposed to resistance, allow totally obstructed nasal passages to be included in analysis. Visual analogue scores and conductance correlate strongly in unilateral measures for participants with a low total nasal conductance. Posterior rhinomanometry and units of conductance are recommended for future studies investigating the relationship between objective and subjective measures of nasal airflow.

Common Cold↗

The effects of menthol on reaction time and nasal sensation of airflow in subjects suffering from the common cold.

The effects of sucking a lozenge containing 11 mg L-menthol on reaction time and nasal sensation were investigated in a double blind trial on 60 subjects suffering from the common cold. Reaction time was determined by measuring the response time to a stimulus presented on a microcomputer screen and nasal sensation was scored on a visual analogue scale. Menthol ingestion compared to placebo caused a significant increase in nasal sensation of airflow which persisted for up to 30 min. The simple and choice reaction times measured before ingestion of the lozenge were similar to those found in healthy uninfected subjects and there was no change in reaction time after ingestion of menthol.

Adolescent↗

The significance of the evidence about ascorbic acid and the common cold.

Only four independent double-blind studies have been reported of the effect of ascorbic acid regularly ingested in daily amounts more than 100 mg, in comparison with a placebo, in decreasing the incidence and integrated morbidity of the common cold for subjects exposed to cold viruses in the ordinary way and without colds when the test period began. A statistical analysis of these four studies leads to rejection of the null hypothesis that ascorbic acid has no more protective power than the placebo at the 99.86% level of confidence for the incidence of colds and the 99.9978% level of confidence for the integrated morbidity.

Administration, Oral↗

Vitamin C as a preventive medicine against common colds in children.

During 7 weeks in the spring of 1973 a double-blind pilot study on 172 children in the age group 8-9 was carried out to test the possible effect of 1000 mg vitamin C daily as a prophylactic agent against common colds. During the autumn of 1973, a main study was carried out on 642 children of the same age. The investigations had the same pattern and lasted for 3 months. Both studies have been processed on the same principles. The results were somewhat divergent but, like previously published studies on children, seemed to indicate that the duration and severity of the cold were reduced while, on the other hand, the incidence remained unaltered or indeed increased. The total number of days of upper respiratory tract infection was smaller for the vitamin C group only in the pilot study (not in the main study). No proven biochemical effects were obtained. Preventive treatment of healthy children with vitamin C in large doses this had no definitely proved effect against colds.

Adolescent↗

Gender differences in the perceptions of common cold symptoms.

Higher rates of reported morbidity among women are sometimes attributed to lower thresholds among women for experiencing and reporting symptoms. Gender differences in the perception of signs and symptoms of minor illness were examined on data from the MRC Common Cold Unit. Volunteers assessed the presence and severity of colds at the end of their stay in the Unit, using the same two measures as a trained clinical observer (all ratings were double blind). Even after adjustment for other variables, men were significantly more likely to 'over-rate' their symptoms in comparison with the clinical observer than were women. These data, and recent analyses from elsewhere, suggest that rather than artefactually exaggerating gender differences in morbidity, differing thresholds for perceiving and reporting symptoms may produce underestimates of gender differences in morbidity.

Adolescent↗

Effects of pseudoephedrine and triprolidine, alone and in combination, on symptoms of the common cold.

A total of 466 healthy adults from four different regions of England entered a double-blind, randomised trial to test the effectiveness of an antihistamine (triprolidine) and a decongestant (pseudoephedrine), alone or in combination, in relieving symptoms of the common cold. During the study 199 subjects reported a total of 243 colds. Subjects recorded the severity of 12 symptoms during treatment and noted separately the severity of a further seven symptoms that represented unwanted effects of treatment or served as an index of suggestibility. They were then asked about their overall improvement in symptoms during treatment and whether they thought they had taken placebo. Sneezing, nasal obstruction, and overall response to treatment were significantly improved (p <0.01) with psuedoephedrine or pseudoephedrine and triprolidine compared with placebo.

Clinical Trials as Topic↗

Consumers' self-care algorithms for the common cold: implications for health education interventions.

Two hundred ninety-seven young adults enumerated a self-care plan with at least seven behaviors for the management of a cold with a fever. They summarized satisfaction with their self-care activities and the role of self-care after a lecture on self-care in managing the common cold. Half of the participants relied solely on self-care, and the other half said they would seek medical attention. Having a fever directed two thirds of the sample in their decision making concerning treatment. Five percent would change their self-care behaviors as a consequence of the instruction. Methodological and theoretical implications for self-care interventions are discussed.

Adolescent↗

A proprietary extract from the echinacea plant (Echinacea purpurea) enhances systemic immune response during a common cold.

In a previous paper, it was reported that Echinilin (Factors R & D Technologies, Burnaby, British Columbia, Canada) a formulation prepared from freshly harvested Echinacea purpurea plants and standardized on the basis of three known active components (alkamides, cichoric acid and polysaccharides) is effective for the treatment of a naturally acquired common cold. However, the mechanism by which this effect is achieved remains unknown. In the present study, Echinilin or placebo were administered to volunteers at the onset of their cold for a period of 7 days, with eight doses (5 mL/dose) on day 1 and three doses on subsequent days. Fasting blood samples were obtained before and during their colds. The decrease in total daily symptomatic score was more evident in the echinacea group than in the placebo group. These effects of echinacea were associated with a significant and sustained increase in the number of circulating total white blood cells, monocytes, neutrophils and NK cells. In the later part of the cold, the echinacea treatment suppressed the cold-related increase in superoxide production by the neutrophils. These results suggest that Echinilin, by enhancing the non-specific immune response and eliciting free radical scavenging properties, may have led to a faster resolution of the cold symptoms.

Adolescent↗

Changes in nasal nitric oxide concentration associated with symptoms of common cold and treatment with a topical nasal decongestant.

Nitric oxide (NO) is known to play a role in the non-specific host defence mechanism. Furthermore, it has been proposed that NO may be important in respiratory defence against the viruses which cause the common cold. Indeed, elevated NO levels have previously been observed in orally expired air during upper respiratory tract infection (URTI). We wanted to investigate further the role of NO in the host response to URTI. Total nasal airway resistance (tNAR) and nasal NO levels were obtained during symptomatic URTI in 97 subjects. Of these, 80 received treatment with either oxymetazoline or a placebo spray. Post-treatment tNAR and NO levels were obtained 60 min after treatment. Measurements of NO were also repeated 4-6 weeks later, when subjects were healthy, (n = 82). NO levels were measured using a chemiluminescence gas analyse whilst tNAR was measured using posterior rhinomanometry. The mean pre-treatment NO level (1063 +/- 541 ppb) was shown to be reduced significantly after treatment with oxymetazoline (827 +/- 373ppb), p < 0.0001. The mean pre-treatment tNAR, 0.42 Pa cm-3 sec-1, was also reduced significantly to 0.21 Pa cm-1 sec-1 (p < 0.001) after treatment with oxymetazoline. There was no significant correlation between the change in NO levels and change in tNAR following treatment with oxymetazoline (p. corrected for ties = 0.011, p = 0.98. No significant difference was found between NO levels obtained during URTI (1130 +/- 444 ppb) when compared to values obtained when healthy (1197 +/- 361 ppb), p = 0.25. These results demonstrate that treatment with a topical nasal decongestant spray causes a reduction in nasal NO levels. We propose that this occurs as an indirect consequence of the vasoconstrictor actions of oxymetazoline. Since no change in NO levels was observed during URTI, we propose that the NO synthase responsible for NO production in the nose responds in a different manner to that in the lungs.

Administration, Topical↗

Aircraft cabin air recirculation and symptoms of the common cold.

CONTEXT: In recent years, new commercial aircraft have been designed to recirculate approximately 50% of the cabin air to increase fuel efficiency. Some older aircraft use only fresh air. Whether air recirculation increases the transmission of infectious disease is unknown; some studies have demonstrated higher rates of the common cold among persons working in buildings that recirculate air. OBJECTIVE: To evaluate the role of air recirculation as a predictor of postflight upper respiratory tract infections (URIs). DESIGN, SETTING, AND PARTICIPANTS: A natural experiment conducted among 1100 passengers departing the San Francisco Bay area in California and traveling to Denver, Colo, during January through early April 1999, and who completed a questionnaire in the boarding area and a follow-up telephone interview 5 to 7 days later. Forty-seven percent traveled aboard airplanes using 100% fresh air for ventilation, and 53% traveled aboard aircraft that recirculated cabin air. MAIN OUTCOME MEASURE: Incidence of reporting new URI symptoms within 1 week of the flight. RESULTS: Passengers on airplanes that did and did not recirculate air had similar rates of postflight respiratory symptoms. The rates of reporting a cold were 19% vs 21% (P =.34); a runny nose and a cold, 10% vs 11%, (P =.70); and an aggregation of 8 URI symptoms, 3% in both groups (P>.99). Results were similar after statistical adjustment for potential confounders. CONCLUSION: We found no evidence that aircraft cabin air recirculation increases the risk for URI symptoms in passengers traveling aboard commercial jets.

Adult↗

Clinical, double-blind, placebo-controlled study investigating the combination of acetylsalicylic acid and pseudoephedrine for the symptomatic treatment of nasal congestion associated with common cold.

It was the aim of this clinical study to demonstrate the efficacy of 1000 mg acetylsalicylic acid (ASA, CAS 50-78-2) in combination with 60 mg pseudoephedrine (PSE, CAS 90-82-4), compared with placebo, in the symptomatic treatment of nasal congestion associated with the common cold. A further aim was to demonstrate the efficacy of 500 mg ASA + 30 mg PSE and of 1000 mg paracetamol (CAS 103-90-2) + 60 mg PSE (active control) in the symptomatic treatment of nasal congestion. The study was designed as a randomized, two-center, double-blind, double-dummy, placebo-controlled, parallel-group, single-dose efficacy and safety trial over 6 h and was carried out in the USA. In total, at two centers, 643 patients who had a history and diagnosis of acute upper respiratory tract infection (URTI), were included; they showed symptoms such as nasal congestion, scratchy/sore throat, headache, generalized muscle ache, earache, runny nose, fever, sneezing etc. The investigational drugs ASA and PSE were both provided as granules in sachets and the granules were dissolved in water before administration; the combined preparation of paracetamol + PSE was administered as commercially available tablets encapsulated for blinding. For all preparations, matching placebos were provided. The primary efficacy variable was the area under the curve for differences from baseline on a nasal congestion scale in the first 2 h after treatment. To be eligible for the study, otherwise healthy volunteers were to present with nasal stuffiness of recent onset that reached a score of at least 6 on the 11-point scale for nasal congestion (0 = not stuffy, 10 = very stuffy). The primary analysis of the primary efficacy variable was calculated by analysis of variance including treatment group, severity (moderate/severe) and center as main strata. The analysis was performed using the intent-to-treat population. All active treatments proved to be statistically significantly superior to placebo with regard to the primary efficacy variable. Significant superiority of active treatment compared with placebo could also be demonstrated for an interval of up to 6 h after intake of the drug and for the relief of nasal congestion. The lower dose did not reveal significant different results compared with placebo for relief of nasal congestion in patients with a severe nasal congestion score at baseline. As well in patients with moderate nasal congestion score (NCS) at start of the study the difference from baseline in the NCS compared with placebo was not statistically significant. Thus a trend towards better efficacy in the higher dose could be assumed. No difference was found between 1000 mg ASA + 60 mg PSE and the active control. There were no differences between the two centers. The treatment proved to be safe and well tolerated, without relevant differences between the four treatment groups. Main adverse events were found to be related to the upper respiratory tract infection or were of gastrointestinal nature. In conclusion, the combination of ASA with PSE can be considered as an effective and safe remedial for the symptomatic treatment of the nasal congestion during URTI.

Acetaminophen↗