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PubMed1998

The role of zinc lozenges in treatment of the common cold.

OBJECTIVE: To summarize and critique the medical literature on the use of zinc lozenges for treatment of the common cold. DATA SOURCES: MEDLINE searches (January 1966-June 1997) identified human clinical trials on the use of zinc lozenges for the treatment of the common cold. Bibliographies were also reviewed for relevant articles. STUDY SELECTION: Double-blind, placebo-controlled trials of zinc lozenges in adults for the treatment of the common cold, with the clinical end points of reduction in duration and/or severity of cold symptoms. DATA EXTRACTION: All double-blind placebo-controlled, human clinical trials on the use of zinc lozenges for the treatment of the common cold were included. DATA SYNTHESIS: The use of zinc lozenges in the treatment of the common cold has been suggested to reduce the duration and severity of cold symptoms. Of eight double-blind, placebo-controlled trials, four found zinc lozenges to be effective, while the other four reported no difference between zinc and placebo therapy. Potential reasons for the discrepancy between the results of these trials include inadequate placebo control, formulation of the lozenge, and the dose of zinc used. Common adverse effects include unpleasant taste, mouth irritation, and nausea. CONCLUSIONS: Treatment of the common cold with zinc gluconate lozenges, using adequate doses of elemental zinc, may be effective in reducing duration and severity of cold symptoms. The benefit appears to be maximal if the lozenges are started immediately after the onset of symptoms. The formulation of the lozenges also appears to be important because the addition of citric acid or tartaric acid may reduce efficacy due to chelation of zinc ion. Although zinc gluconate lozenges have dominated clinical trials thus far, further studies are needed to demonstrate the efficacy of zinc acetate lozenges and to determine whether their adverse effect profile is more favorable to that of zinc gluconate lozenges. Patients should play an important role in the decision-making process and must decide whether the benefit gained from treatment with zinc lozenges outweighs the potential adverse effects.

Common Cold↗
PubMed2000

Zinc and the common cold: a meta-analysis revisited.

The common cold has been estimated to cost the United States > $3.5 billion per year. Despite several randomized clinical trials, the effect of treating colds with zinc gluconate remains uncertain due to conflicting results. We conducted a meta-analysis of published randomized clinical trials on the use of zinc gluconate lozenges in colds using the random effects model of DerSimonians and Laird. Ten clinical trials of cold treatment with zinc gluconate were identified. After excluding two studies that used nasal inoculum of rhinovirus, eight trials were combined and analyzed. The summary odds ratio for the presence of "any cold symptoms" at 7 d was 0.52 (95% confidence interval, 0.25-1.2). We conclude that despite numerous randomized trials, the evidence for effectiveness of zinc lozenges in reducing the duration of common colds is still lacking.

Common Cold↗
PubMedDate not supplied

Efficacy of zinc against common cold viruses: an overview.

OBJECTIVE: To review the laboratory and clinical evidence of the medicinal value of zinc for the treatment of the common cold. DATA SOURCES: Published articles identified through Medline (1980-2003) using the search terms zinc, rhinovirus, and other pertinent subject headings. Additional sources were identified from the bibliographies of the retrieved articles. STUDY SELECTION: By the author. DATA EXTRACTION: By the author. DATA SYNTHESIS: Human rhinoviruses, by attaching to the nasal epithelium via the intracellular adhesion molecule-1 (ICAM-1) receptor, cause most colds. Ionic zinc, based on its electrical charge, also has an affinity for ICAM-1 receptor sites and may exert an antiviral effect by attaching to the ICAM-1 receptors in the rhinovirus structure and nasal epithelial cells. Clinical tests of zinc for treatment of common colds have been inconsistent, primarily because of study design, blinding, and lozenge contents. Early formulations of lozenges also were unpalatable. In three trials with similar study designs, methodologies, and efficacy assessments, zinc effectively and significantly shortened the duration of the common cold when it was administered within 24 hours of the onset of symptoms. Recent reports of trials with zinc gluconate administered as a nasal gel have supported these findings; in addition, they have shown that treatment with zinc nasal gel is effective in reducing the duration and severity of common cold symptoms in patients with established illness. CONCLUSION: Clinical trial data support the value of zinc in reducing the duration and severity of symptoms of the common cold when administered within 24 hours of the onset of common cold symptoms. Additional clinical and laboratory evaluations are warranted to further define the role of ionic zinc for the prevention and treatment of the common cold and to elucidate the biochemical mechanisms through which zinc exerts its symptom-relieving effects.

Chemistry, Pharmaceutical↗
PubMed1997

A meta-analysis of zinc salts lozenges and the common cold.

BACKGROUND: In the United States, the common cold has been estimated to cost more than $3.5 billion a year. Despite several randomized clinical trials, the effect of treating colds with zinc salts lozenges remains uncertain because of conflicting results. OBJECTIVE: To conduct a meta-analysis of published randomized clinical trials on the use of zinc salts lozenges in colds using a random effects model. RESULTS: Eight clinical trials of treating adults with zinc salts lozenges were identified. After excluding 2 studies that used nasal inoculation of rhinovirus, 6 trials were combined and analyzed. The summary odds ratio for the presence of any cold symptoms at 7 days was 0.50 (95% confidence interval, 0.19-1.29). CONCLUSION: Despite numerous randomized trials, the evidence for effectiveness of zinc salts lozenges in reducing the duration of common colds is still lacking.

Administration, Oral↗
PubMed2001

[Common cold--risk factors, transmission and treatment].

The common cold is the most prevalent disease in humans. It is generally caused by rhinovirus. Bacterial involvement is rare, and an uncomplicated common cold does not require treatment with antibiotics. The symptoms are not caused by tissue destruction, but rather by the response of the immune system, including the release of kinins and interleukins. The intensity of transmission depends upon the amount of nasal discharge. It is mediated in part by the hands (sometimes via contaminated objects) and partly by aerosols. Rhinovirus is involved in 40% of asthma attacks in school children, and in about 60% of exacerbations in adults with chronic obstructive pulmonary disease. Smoking, stress, and a few types of social contact are all risk factors, whereas alcohol consumption seems to be protective. Exposure to a cold environment is probably of no significance in the pathogenesis. No effective cure is known. The medications in use are all directed exclusively against the symptoms, and especially for pre-school children, they are of doubtful value and potentially harmful.

Adult↗
PubMed2001

Erythromycin and common cold in COPD.

STUDY OBJECTIVES: To investigate whether erythromycin therapy lowers the frequency of the common cold and subsequent exacerbation in patients with COPD. DESIGN: Prospective, randomized, controlled, but not blinded, trial. PATIENTS: One hundred nine patients with COPD were enrolled into the study. Patients were randomly assigned to erythromycin therapy or to no active treatment in September 1997. Patients then were observed for 12 months, starting in October, during which time the risk and frequency of catching common colds and COPD exacerbations were investigated. Fifty-five patients received erythromycin at study entry (erythromycin group). The remaining 54 patients received no active treatment (control group). MEASUREMENTS AND RESULTS: The mean (+/- SE) number of common colds for 12 months was significantly lower in the erythromycin group than in the control group (1.24 +/- 0.07 vs 4.54 +/- 0.02, respectively, per person; p = 0.0002). Forty-one patients (76%) in the control group experienced common colds more than once, compared to 7 patients (13%) in the erythromycin group. The relative risk of developing two or more common colds in the control group compared with that in the erythromycin group was 9.26 (95% confidence interval [CI], 3.92 to 31.74; p = 0.0001). Thirty patients (56%) in the control group and 6 patients (11%) in the erythromycin group had one or more exacerbations. The relative risk of experiencing an exacerbation in the control group compared with that in the erythromycin group was 4.71 (95% CI, 1.53 to 14.5; p = 0.007). Significantly more patients were hospitalized due to exacerbations in the control group than in the erythromycin group (p = 0.0007). CONCLUSION: Erythromycin therapy has beneficial effects on the prevention of exacerbations in COPD patients.

Aged↗
PubMed2000

[Clinical observation on ganrening granule in treating common cold].

OBJECTIVE: To explore the therapeutic effect of Ganrening Granule (GRN) in treating common cold. METHODS: Four hundred cases of common cold were randomly divided into three groups, the GRN group (160 Patients), the control group (100 Patients) and the opened group (140 Patients). The changes in symptoms and body temperature of patients were observed before and after treatment by single blind method, and the therapeutic effect was assessed according to the "Guideline of Clinical Research of TCM New Drugs". RESULTS: The markedly effective rate and total effective rate of the GRN group were 81.25% and 96.88% respectively, while those of the control group were 44.44% and 88.00% respectively. The difference between the two groups was significant (P < 0.01). GRN showed significant effect in subsiding fever. CONCLUSION: GRN has good effect in treating common cold (Syndrome of both Weifen and Qifen). No adverse effect was found in the clinical trial.

Adolescent↗
PubMed2005

Nitric oxide and the common cold.

PURPOSE OF REVIEW: The common cold is a clinical syndrome triggered by a variety of viral pathogens, but rhinoviruses are the most frequent cause. Complications of such infections include sinusitis, otitis media, and exacerbations of asthma and chronic obstructive lung disease. There is growing interest in host innate defence responses that may regulate the severity of viral responses. We will review recent evidence that nitric oxide is an important contributor to the host response during colds. RECENT FINDINGS: Infection of human airway epithelial cells with human rhinovirus has been shown to lead to the increased expression of inducible nitric oxide synthase both in vitro and in vivo. This increase in epithelial inducible nitric oxide synthase correlates with increased levels of nitric oxide in exhaled air. Importantly, nitric oxide can inhibit human rhinovirus-induced epithelial expression of several pro-inflammatory cytokines and can inhibit viral replication in epithelial cells in vitro. Moreover, nitric oxide can modulate several signal transduction pathways that are associated with cytokine generation. Nitric oxide can also nitrosylate viral proteases and can interact with the immune system. Consistent with these observations, pilot studies have indicated that the increased generation of nitric oxide during rhinovirus infections is associated with fewer symptoms and more rapid viral clearance. SUMMARY: Further studies are warranted to evaluate the role of nitric oxide in colds and to determine whether the administration of nitric oxide donor compounds could be a viable therapeutic approach for viral exacerbations of airway diseases.

Common Cold↗
PubMed1998

Zinc gluconate and the common cold. Review of randomized controlled trials.

OBJECTIVE: To examine the evidence of seven randomized controlled trials (RCT) on the therapeutic effectiveness of zinc gluconate lozenges for treating the common cold. DATA SOURCES: Using the MeSH headings common cold and zinc gluconate, MEDLINE was searched from 1966 on for all published RCTs evaluating use of zinc gluconate for treating the common cold. STUDY SELECTION: For this study, only double-blind RCTs were included. SYNTHESIS: Fair evidence suggests that zinc gluconate lozenges have a therapeutic effect in treating the common cold. Starting therapy with zinc gluconate lozenges within 24 to 48 hours of onset of cold symptoms reduces the duration and severity of the cold. Patients must suck lozenges every 2 hours while awake during the cold. Minimum effective dose appears to be 13.3 mg of elemental zinc per lozenge. Evidence suggests that compounds such as citric acid, sorbitol, and mannitol bind the free zinc ion in the mouth, and this could account for variations in therapeutic benefit. Bad taste and nausea are important side effects of zinc lozenges. CONCLUSION: Evidence supports use of zinc gluconate lozenges for reducing the symptoms and duration of the common cold, but the side effects, bad taste, and therapeutic protocol might limit patient compliance.

Adult↗
PubMed2003

The effect of hydrotherapy on the incidence of common cold episodes in children: a randomised clinical trial.

UNLABELLED: Few interventions have proved to be effective in the prevention and treatment of common colds. Anecdotal reports suggest the possible beneficial effect of hydrotherapy (stimulation of the body surface with warm and cold water). This study's objective was to evaluate the clinical effect of hydrotherapy on common colds in children. Children aged 3-7 years with six or more common cold episodes during the preceding 12 months were randomised to receive either daily inhalation of normal saline in the control group or daily inhalation plus daily hydrotherapy in the experimental group for 12 months. The main outcome measurements were incidence, duration and severity of common cold episodes as reported by the children's parents in a daily symptom diary. Groups did not differ at baseline with regard to age, gender, or number of cold episodes in the year before the study. Diaries were available from 81 patients in the control group and 65 patients in the experimental group. In the study period, there were no significant differences in the incidence of colds (control vs. experimental group, mean +/- SD, 4.8+/-3.5 vs. 4.1+/-3.3 episodes) or the average duration of episodes (7.7+/-3.5 vs. 7.6+/-3.8 days). CONCLUSION: This study does not demonstrate any beneficial effect of hydrotherapy on preschool children with frequent common colds.

Administration, Inhalation↗
PubMed1987

Prospective epidemiological study of common colds and secretory otitis media.

To evaluate how often a common cold induces secretory otitis media (SOM) two groups of young children were studied. One comprised 373 children aged 9 months to 7 years who were being minded in institutions. The other group consisted of 210 children not minded in day institutions or private day care. This latter group was subdivided into children minded at home or in private day care attended by not more than 2 children (117 children), and the remainder (93 children). Common colds were defined as nasal discharge, and tympanometry was carried out 6 times at 2-week intervals. Among the 1-year-olds common colds induced SOM in 83% of those minded in institutions and in 56% of those minded at home. At the age of 5 years this applied to 20% of both groups.

Child↗
PubMed1998

The common cold: effects of intranasal fluticasone propionate treatment.

OBJECTIVE: A double-blind, randomized, placebo-controlled trial was conducted to study the effect of the intranasal corticosteroid, fluticasone propionate (FP), in the naturally occurring common cold. METHODS: One hundred ninety-nine young adults received high-dose FP (200 microg four times daily) or placebo beginning 24 to 48 hours after onset of the common cold for 6 days. All symptoms were recorded on diary cards on days 1 to 20, and clinical examinations were carried out on days 1, 7, and 21. Nasopharyngeal aspirates were collected on days 1 and 7 for detection of rhinoviruses (found in 105 subjects) and Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis (found in 52 subjects) in the nasopharynx. RESULTS: In general, FP treatment had no clinically recognizable effects on the symptoms of the common cold, although it significantly reduced nasal congestion and cough on some study days. After treatment, rhinoviruses were cultured more often in the FP treatment group (37% vs 14%, p < 0.001), but this had no effect on the symptoms of common cold. FP treatment produced no changes in the colonization of pathogenic bacteria in the nasopharynx. Some symptoms of common cold were significantly more severe during days 1 to 10 (p < 0.05) in subjects found to have positive cultures for S. pneumoniae, H. influenzae, or M. catarrhalis in the nasopharynx on day 1 (n = 33). CONCLUSION: FP treatment does not have any marked effects on the symptoms of the common cold. FP treatment induced prolonged shedding of viable rhinoviruses. Some symptoms of the common cold were significantly more severe in subjects with pathogenic bacteria in the nasopharynx.

Administration, Intranasal↗
PubMed1988

Diagnosis and patterns of incidence of influenza, influenza-like illness and the common cold in general practice.

The incidence of influenza, influenza-like illness and the common cold during the influenza epidemics of 1972 and 1976 as reported to the weekly returns service of the Royal College of General Practitioners was examined by three regional areas and by age group. The results of a postal questionnaire concerned with diagnostic criteria used by participating doctors were also analysed. These two analyses were used to explore the validity of these diagnostic terms as reported in the weekly returns service.The two influenza epidemics peaked at about the same time throughout the country and in all age groups simultaneously, although the severity of the epidemic seemed to wane from south to north in 1976. The reported incidence of influenza-like illness and of the common cold was less in the central region than in the north and south during both the two epidemic years. Influenza incidence was maximal in age groups 15-44 and 45-64 years, whereas the reported incidence of influenza-like illness and the common cold was maximal in pre-school children.Additionally, influenza-like illness and the common cold appeared to a fairly uniform extent every winter whereas influenza was truly epidemic.From the questionnaire to general practitioners, the symptoms of rigors, malaise and myalgia and the recognition of an epidemic were the important criteria which differentiated influenza from influenza-like illness.We conclude that in general practice the distinction between influenza and influenza-like illness is reliably made and has validity in the clinical context and meaning of these diagnostic terms.

Cohort Studies↗
PubMed2002

Acute cooling of the body surface and the common cold.

There is a widely held belief that acute viral respiratory infections are the result of a "chill" and that the onset of a respiratory infection such as the common cold is often associated with acute cooling of the body surface, especially as the result of wet clothes and hair. However, experiments involving inoculation of common cold viruses into the nose, and periods of cold exposure, have failed to demonstrate any effect of cold exposure on susceptibility to infection with common cold viruses. Present scientific opinion dismisses any cause-and-effect relationship between acute cooling of the body surface and common cold. This review proposes a hypothesis; that acute cooling of the body surface causes reflex vasoconstriction in the nose and upper airways, and that this vasoconstrictor response may inhibit respiratory defence and cause the onset of common cold symptoms by converting an asymptomatic subclinical viral infection into a symptomatic clinical infection.

Animals↗
PubMed2006

The effect of vitamin E on common cold incidence is modified by age, smoking and residential neighborhood.

BACKGROUND: We have previously found a 28% reduction in common cold incidence with 50 mg/day vitamin E supplementation in a subgroup of the Alpha-Tocopherol Beta-Carotene Cancer Prevention (ATBC) Study cohort: older city-dwelling men (> or =65 years) who smoked only 5-14 cigarettes/day. OBJECTIVE: To carry out more detailed analyses to explore the modification of vitamin E effect by age, smoking, and residential neighborhood. METHODS: We examined the effect of vitamin E on common cold risk in subjects consisting of the placebo and vitamin E arms (n = 14,573) of the ATBC Study, which recruited males aged 50-69 years who smoked > or =5 cigarettes/day at the baseline. The ATBC Study was conducted in southwestern Finland in 1985-1993; the active follow-up lasted for 4.7 years (mean). We modeled common cold risk as a function of age-at-follow-up in the vitamin E arm compared with the placebo arm using linear splines in Poisson regression. RESULTS: In participants of 72 years or older at follow-up, the effect of vitamin E diverged. Among those smoking 5-14 cigarettes per day at baseline and living in cities, vitamin E reduced common cold risk (RR = 0.54; 95% CI 0.37-0.80), whereas among those smoking more and living away from cities, vitamin E increased common cold risk (RR = 1.58; 1.23-2.01). CONCLUSIONS: Vitamin E may cause beneficial or harmful effects on health depending on various modifying factors. Accordingly, caution should be maintained in public health recommendations on vitamin E supplementation until its effects are better understood.

Age Factors↗
PubMedDate not supplied

Ineffectiveness of zinc gluconate nasal spray and zinc orotate lozenges in common-cold treatment: a double-blind, placebo-controlled clinical trial.

BACKGROUND: Zinc gluconate and zinc acetate lozenges have been reported to shorten the duration of common colds in a dose-response manner when the amount of the active ingredient, positively charged zinc ions, is sufficient. OBJECTIVE: To improve results using a zinc gluconate nasal spray with zinc orotate lozenges. DESIGN: Double-blind, placebo-controlled clinical trial. SETTING: Private physician's clinic in Austin, Texas. PARTICIPANTS: Seventy-seven volunteers, all of whom had 2 or more signs and symptoms of common colds (with at least 1 nasal symptom) on enrollment in the study. METHODS: Zinc gluconate nasal spray (10 mmol) or placebo was used every 15 to 30 minutes, and lozenges were used each several hours to reduce duration and severity of common colds. An intention of treatment was to keep the nasal tissues wet with zinc gluconate solution during wakeful hours. RESULTS: After 7 days of treatment, 10 of 16 (63%) zinc-treated patients were asymptomatic compared to 9 of 17 (53%) placebo-treated patients (P = .57). This treatment caused olfactory region pain in some patients and did not reduce the duration or severity of common colds. Treatment did not produce anosmia, which has been reported in other studies following olfactory region administration of ionic zinc in many species and in humans from zinc nasal sprays and gels. CONCLUSION: We contend that it is unethical to introduce any potentially permanent anosmia-inducing agent such as zinc or other heavy metals into the interior of the nose in a manner that could result in contact with the olfactory region to treat a temporary discomfort such as a common cold or allergy. We found no reason to recommend intranasal zinc gluconate or zinc orotate lozenges in treating common colds.

Administration, Intranasal↗
PubMed2004

Preventive and curative effects of acupuncture on the common cold: a multicentre randomized controlled trial in Japan.

OBJECTIVE: To determine the preventive and curative effects of manual acupuncture on the symptoms of the common cold. METHOD: Students and staff in five Japanese acupuncture schools (n=326) were randomly allocated to acupuncture and no-treatment control groups. A specific needling point (Y point) on the neck was used bilaterally. Fine acupuncture needles were gently manipulated for 15 s, evoking de qi sensation. Acupuncture treatments were performed four times during the 2-week experimental period with a 2-week follow-up period. A common cold diary was scored daily for 4 weeks, and a common cold questionnaire was scored before each acupuncture treatment and twice at weekly intervals. A reliability test for the questionnaire was performed on the last day of recording. RESULTS: Five of the 326 subjects who were recruited dropped out. The diary score in the acupuncture group tended to decrease after treatment, but the difference between groups was not significant (Kaplan-Meier survival analysis, log rank test P=0.53, Cox regression analysis, P>0.05). Statistically significantly fewer symptoms were reported in the questionnaire by the acupuncture group than control group (P=0.024, general linear model, repeated measure). Significant inter-centre (P<0.001, general linear model) and sex (P=0.027, general linear model) differences were also detected. Reliability tests indicated that the questionnaire with 15 items was sufficiently reliable. No severe adverse event was reported. CONCLUSION: This is the first report of a multi-centre randomized controlled trial of acupuncture for symptoms of the common cold. A significantly positive effect of acupuncture was demonstrated in the summed questionnaire data, although a highly significant inter-centre difference was observed. Needling on the neck using the Japanese fine needle manipulating technique was shown to be effective and safe. The use of acupuncture for symptoms of the common cold symptoms should be considered, although further evidence from placebo controlled RCTs is required.

Acupuncture Points↗