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Effectiveness of an antihistamine-decongestant combination for young children with the common cold: a randomized, controlled clinical trial.

We tested the hypothesis that antihistamine-decongestant combinations cause no clinically significant relief of the symptoms of upper respiratory tract infections in young children by randomly assigning 96 children to one of three treatment groups: antihistamine-decongestant, placebo, and no treatment. There were no differences among the three study groups in the proportion of children considered "better" overall by the parent 48 hours after the initial assessment (drug, 67%; placebo, 71%; no treatment, 57%; p = 0.53). There were no differences among groups in individual or composite symptom score changes. Two thirds of parents whose children were eligible for the drug trial believed that their child needed medicine for cold symptoms. In the proportion of parents believing that their child needed medicine, there was no difference between those who consented to participate and those who refused. Parents who wanted medicine at the initial visit reported more improvement at follow-up, regardless of whether the child received drug, placebo, or no treatment. We conclude that there is no clinically significant improvement in symptoms of upper respiratory tract infection, including no significant placebo effect, in young children for whom an antihistamine-decongestant is prescribed.

Brompheniramine↗

Effects of the common cold on mood and performance.

Previous research has shown that both experimentally-induced and naturally occurring upper respiratory tract illnesses (URTIs) influence mood and mental functioning. None of the previous studies of naturally occurring colds has conducted appropriate virological assays to determine the nature of the infecting agent. This is an essential methodological step in studies of malaise associated with URTIs. The aim of this research was to investigate the effects of naturally occurring colds on mood and objective measures of performance. This was done by first conducting a cross-sectional comparison of 37 healthy people and 158 volunteers with colds and then a longitudinal study in which 100 volunteers developed colds and 87 remained healthy. Virological techniques were used to identify infecting agents and comparisons made across the different groups. The results showed that having a cold was associated with reduced alertness and slowed reaction times. These effects were observed both for colds where the infecting virus was identified and those where it was not. Similar effects were obtained for both rhinovirus and coronavirus colds. One may conclude that upper respiratory tract illnesses lead to a reduction in subjective alertness and impaired psychomotor functioning. This was true for both illnesses where the infecting agent was identified and for those clinical illnesses where no virus was detected. It is now important to identify the mechanisms linking infection and illness with the behavioural changes. Similarly, the impact of these effects on real-life activities such as driving needs examining. Finally, methods of treatment need to be developed which not only treat the local symptoms of the illnesses but remove the negative mood and the performance impairments.

Adolescent↗

Pulmonary function following mild respiratory tract infections ("common cold") in teenagers.

Ventilatory function--forced vital capacity (VC)--forced expiratory volume (in 1-sec forced expiratory flows) static lung volumes, closing volume, and phase III slope (single-breath N2 test) were compared in 94 children with and 436 children without a history of recent mild acute respiratory infection. Their age ranged from 10 to 16 years; subjects with symptoms on the day of the study were excluded. We found no difference in lung function between the two groups, with the exception of a slight (inconsistently significant) increase in closing volume (CV) and the CV/VC ratio. Although the influence of a persistent increase in interstitial lung pressure leading to early small airways closure cannot be ruled out, this isolated functional abnormality probably represents a spurious positive result, arising by chance when a large number of statistical tests are done.

Acute Disease↗

Changes in human nasal mucosa during experimental coronavirus common colds.

Twenty-four adult volunteers were inoculated with nasal drops containing a coronavirus of 229E serotype to determine the differences in the clinical and physiological reactions which occur between clinically infected, sub-clinically infected and non-infected individuals. Thirteen volunteers were clinically infected, 8 had sub-clinical infections and 3 were uninfected. Nasal airway resistance and the temperature of the nasal mucosa increased in all infected subjects both with and without symptoms: the core temperature increased also but to a lesser extent. Mucosal blood flow and nasal secretion increased only in those with symptoms. The albumin content of the nasal secretion increased in the clinically infected, suggesting that it was derived, partially at least, from the circulation. The nasal cycle of variation in airway resistance between the two sides of the nose was observed in all three groups but increased only in those clinically infected.

Adult↗

From the common cold to cancer: how evolution and the modern lifestyle appear to have contributed to such eventualities.

This hypothesis suggests that psychosocial stress is the pivotal determinator of many modern day disorders in consequence to consuming today's nutritional intakes of ascorbic acid and sodium. For it seems, as a result of our tropical African evolution, present day intakes of these essential nutrients are incompatible with the maintenance of bodily homeostasis when the body is subjected to any form of stress. In addition, the climatic conditions under which most of us live are seemingly ill-suited to experiencing stress, since it appears that a constituent part of the bodily stress response remains exclusively designed to be effective in a hot tropical environment, where the stress can be expected to be accompanied by thermoregulation sweating and an overheated body. For without such an occurrence coinciding with stress, the stress response itself appears to have been transposed into a reaction that inhibits the body's ability to resist infection and disease.

Ascorbic Acid↗

Dynamics of stress-related decrease of salivary immunoglobulin A (sIgA): relationship to symptoms of the common cold and studying behavior.

The dynamics of stress-related decrease of salivary Immunoglobulin A (sIgA) were examined with respect to whether an increase of upper respiratory tract (URT) symptoms can be observed concurrently with or subsequent to sIgA alterations and whether one can use students' studying behavior during academic examinations to predict changes in sIgA. From a 2-part medical examination of 42 students, daily measures of sIgA were obtained, and symptoms of URT infections and studying behavior were determined by means of questionnaires. Assessment periods began 7 days before each part of the academic examination began and lasted until the 6th day afterward. A control group of 24 medical students who were not undergoing examinations also responded to all questionnaires. A progressive suppression of sIgA, outlasting the examination period by more than 6 days, was observed. Time spent studying explained a significant proportion in sIgA variation. However, no relationship between sIgA and URT symptoms was observed, nor did students who took academic examinations differ from untested controls in symptom rates.

Achievement↗

Vitamin C and the common cold: a double-blind trial.

A large scale double-blind trial was conducted to test the claim that the intake of one gram of vitamin C per day substantially reduces the frequency and duration of "colds". It was found that in terms of the average number of colds and days of sickness per subject the vitamin group experienced less illness than the placebo group, but the differences were smaller than have been claimed and were statistically not significant. However, there was a statistically significant difference (P <0.05) between the two groups in the number of subjects who remained free of illness throughout the study period. Furthermore the subjects receiving the vitamin experienced approximately 30% fewer total days of disability (confined to the house or off work) than those receiving the placebo, and this difference was statistically highly significant (P <0.001). The reduction in disability appeared to be due to a lower incidence of constitutional symptoms such as chills and severe malaise, and was seen in all types of acute illness, including those which did not involve the upper respiratory tract.

Adolescent↗

Acute phase response of serum amyloid A protein and C reactive protein to the common cold and influenza.

C reactive protein (CRP) and serum amyloid A protein (SAA) are sensitive and rapid acute phase reactants, and their measurement for monitoring inflammatory disease and assessing the prognosis in secondary amyloidosis is gaining widespread acceptance. The changes in these proteins in eight subjects suffering from natural colds, 15 subjects with experimentally induced colds (rhinoviruses E1, 3, 9, 14, or 31), and eight with experimentally induced influenza (A/Eng/40/83) were studied. SAA concentration increased in 21 of the 23 subjects with natural or experimental rhinovirus colds (mean increase 95 mg/l); CRP concentration increased in 11 (mean increase 11 mg/l). All subjects with influenza showed pronounced increases in SAA concentrations (mean increase 642 mg/l) while six showed increases in CRP concentration (mean increase 22 mg/l). All these increases were highly significant (p less than 0.001). Asymptomatic excretors of both rhinovirus and influenza virus showed significant increases in SAA concentration (p = 0.015 for rhinovirus and p less than 0.001 for influenza virus) but not in CRP concentration. No changes in SAA or CRP values were seen in 12 volunteers after challenge with saline. These observations suggest that caution is required in the interpretation of estimations of SAA concentration and that it may be too sensitive an acute phase protein for clinical use as its concentration may be raised in both trivial and asymptomatic viral infections.

Amyloid↗

Development of vaccines against common colds.

Respiratory tract viruses are particularly significant causes of illness and death in children and in the elderly. Vaccines offer the possibility of decreasing the severity and complications of viral respiratory disease, but development has been delayed by numerous factors. First, there are more than 200 serologically distinct RNA and DNA virus species and strains which cause an essentially similar spectrum of disease. Some re-infect at high efficiency despite little antigenic variation, while others exhibit extensive coat protein variability. Vaccine candidates show variable efficacy in partially immune adults, the immunocompromised and the elderly, and may be ineffective or pathogenic in neonates or in the presence of maternal antibodies. However, effective childhood vaccines are essential to prevent severe disease due to respiratory syncytial virus (RSV) and parainfluenza and to reduce virus transmission to adults. A number of promising vaccines are in clinical trial, and it is likely that vaccines against RSV and parainfluenza will be licensed within the next 5-10 years. Mucosal delivery and the use of novel adjuvants offers the prospect of better vaccines against influenza. The ultimate goal is to develop multivalent mucosal vaccines offering protection against a spectrum of respiratory infections.

Common Cold↗

Psychological stress and susceptibility to the common cold.

BACKGROUND: It is not known whether psychological stress suppresses host resistance to infection. To investigate this issue, we prospectively studied the relation between psychological stress and the frequency of documented clinical colds among subjects intentionally exposed to respiratory viruses. METHODS: After completing questionnaires assessing degrees of psychological stress, 394 healthy subjects were given nasal drops containing one of five respiratory viruses (rhinovirus type 2, 9, or 14, respiratory syncytial virus, or coronavirus type 229E), and an additional 26 were given saline nasal drops. The subjects were then quarantined and monitored for the development of evidence of infection and symptoms. Clinical colds were defined as clinical symptoms in the presence of an infection verified by the isolation of virus or by an increase in the virus-specific antibody titer. RESULTS: The rates of both respiratory infection (P less than 0.005) and clinical colds (P less than 0.02) increased in a dose-response manner with increases in the degree of psychological stress. Infection rates ranged from approximately 74 percent to approximately 90 percent, according to levels of psychological stress, and the incidence of clinical colds ranged from approximately 27 percent to 47 percent. These effects were not altered when we controlled for age, sex, education, allergic status, weight, the season, the number of subjects housed together, the infectious status of subjects sharing the same housing, and virus-specific antibody status at base line (before challenge). Moreover, the associations observed were similar for all five challenge viruses. Several potential stress-illness mediators, including smoking, alcohol consumption, exercise, diet, quality of sleep, white-cell counts, and total immunoglobulin levels, did not explain the association between stress and illness. Similarly, controls for personality variables (self-esteem, personal control, and introversion-extraversion) failed to alter our findings. CONCLUSIONS: Psychological stress was associated in a dose-response manner with an increased risk of acute infectious respiratory illness, and this risk was attributable to increased rates of infection rather than to an increased frequency of symptoms after infection.

Adolescent↗

Combined antiviral-antimediator treatment for the common cold.

A randomized, controlled, double-masked clinical trial was conducted with a combination antiviral-antimediator treatment for experimental rhinovirus colds. In all, 150 healthy men and women (aged 18-51 years) were randomly assigned to 1 of 3 groups: intranasal interferon (IFN)-alpha2b (6 x 10(6) U every 12 h x 3) plus oral chlorpheniramine (12 mg extended release) and ibuprofen (400 mg) every 12 h for 4.5 days (n=59 subjects); intranasal placebo plus oral chlorpheniramine and ibuprofen (n=61 subjects); or intranasal and oral placebos (n=30 subjects). Treatment was started 24 h after intranasal viral challenge. During the 4.5 days of treatment with IFN-alpha2b, chlorpheniramine, and ibuprofen, the daily mean total symptom score was reduced by 33%-73%, compared with placebo. Treatment reduced the severity of rhinorrhea, sneezing, nasal obstruction, sore throat, cough, and headache and reduced nasal mucus production, nasal tissue use, and virus concentrations in nasal secretions. IFN-alpha2b added to the effectiveness of chlorpheniramine and ibuprofen and was well tolerated.

Adolescent↗

Vitamin C, the common cold, and iron absorption.

A sizable segment of the population was found to be taking large quantities of vitamin C to reduce the number or severity of upper respiratory infections. To determine the affect of this supplementation on iron balance, multiple radioiron absorption tests were performed in 63 male subjects. The increase in iron absorption from a semisynthetic meal was directly proportional to the amount of ascorbic acid added over a range of 25 to 1,000 mg. The ratio of iron absorption with/without ascorbic acid at these two extremes was 1.65 and 9.57, respectively. The relative increase was substantially less when the test meal contained meat. A large dose of vitamin C taken with breakfast did not effect iron absorption from the noon or evening meal. A telephone survey of 100 individuals revealed that 67 were taking supplemental ascorbic acid in doses ranging as high as 2 g daily. The average intake of supplemental ascrobic acid in this population was 280 mg daily. If taken only with breakfast, this level of supplementation would produce a nearly 2-fold increase in the amount of iron absorbed daily. If taken in divided doses with each mean, the increase in iron absorption would be more than 3-fold.

Adolescent↗

Is an antihistamine-decongestant combination effective in temporarily relieving symptoms of the common cold in preschool children?

OBJECTIVE: To determine whether an antihistamine-decongestant combination (ADC) is superior to placebo in temporarily relieving symptoms of upper respiratory tract infection (URI) in preschool children. DESIGN: Randomized, double-blind, placebo-controlled trial. SETTING: Four pediatric offices in the Seattle, Wash, area. PARTICIPANTS: Children 6 months through 5 years of age with a URI of less than 7 days' duration. METHODS: Children were randomly assigned to receive an ADC (brompheniramine maleate-phenylpropanolamine hydrochloride) or placebo as needed for URI symptoms. Two hours after each dose of study medication, changes in the child's runny nose, nasal congestion, cough, and sleep status were assessed by means of a standardized questionnaire. RESULTS: A total of 175 responses were recorded for 59 patients. There were no statistically significant differences in symptom improvement between the ADC and the placebo group (runny nose, p = 0.48; nasal congestion, p = 0.94; cough, p = 0.66). However, the proportion of children asleep 2 hours after receiving the ADC was significantly higher than the proportion receiving placebo (46.6% vs 26.5%; p = 0.01). Results were unchanged after control for the correlated nature of repeated responses, age, symptom duration, use of acetaminophen, time that the medication was given, and parental desire for medication. CONCLUSIONS: The ADC was equivalent to placebo in providing temporary relief of URI symptoms in preschool children. However, the ADC did have significantly greater sedative effects than did placebo.

Brompheniramine↗

[Cough induction by high-frequency chest percussion in healthy volunteers and patients with common cold].

BACKGROUND: In patients with chronic obstructive pulmonary disease, chest percussion is often used to facilitate the drainage of respiratory secretions which may be removed from the airway by coughing. The cough reflex is believed to be mediated by mechanically sensitive rapidly adapting receptors (RARs). Chest percussion stimulation may stimulate RAR cough receptors, but there is no evidence that mechanical airway stimulation in man induces cough. The aim of this study was to determine if cough can be induced by high-frequency chest percussion in healthy subjects and in patients with acute upper respiratory tract infection (URTI). METHODS: Two groups were studied: 15 healthy subjects and 29 subjects with URTI, mean age 22 years. Percussion stimulation (70 Hz) was applied to the chest. Cough frequency and latency were recorded. All subjects were asked to complete a questionnaire about how they felt after the chest percussion by questionnaires. RESULTS: The results demonstrate that high-frequency chest percussion causes cough in human subjects with a recent history of URTI, but induces relatively little cough in healthy subjects. In URTI subjects there was a significant increase in the number of coughs after three periods of airway vibration, whereas in healthy subjects there was no change in cough. Furthermore, analysis of the questionnaires showed that more of the subjects with URTI felt an urge to cough compared to the healthy subjects in the subjective questionnaires. CONCLUSIONS: This study demonstrates that cough can be induced in subjects with URTI by chest percussion. This method of inducing cough in subjects with URTI may be useful for studies on the mechanism of cough and for studies on antitussive medicines.

Adolescent↗

Assessment of the antitussive efficacy of codeine in cough associated with common cold.

Codeine is generally accepted as the standard antitussive against which new antitussive medications are compared. This presents a problem because the support for codeine's antitussive activity comes from studies on cough in animals, and chronic and induced cough models in man, whereas antitussives are almost exclusively used for the treatment of cough associated with acute upper respiratory tract infection (URTI). The aims of this study were twofold. Firstly, to study the antitussive efficacy of codeine in cough associated with URTI and, secondly, to validate a sound meter as tool for quantifying cough. The efficacy of codeine was assessed in a double-blind, stratified, placebo-controlled, parallel-group, clinical trial using three different measures of cough: cough sound-pressure levels (CSPLs) measured on a sound meter; subjective scores of cough severity; and cough frequency recorded by means of a microphone connected to an ink-pen recorder. A group of 82 subjects (51 females and 31 males; mean age 23.5 years, range 18-46 years) with cough owing to acute URTI were included in the study. The study took place on two separate study days. On study day 1 cough measurements were made before and 90 min after treatment with a single dose of either 50 mg codeine or matched placebo in capsule form. The same three measures of cough were repeated 2-5 days later (study day 2). On study day 1 a highly significant (P < 0.0001) decrease in all three measures of cough was found after treatment with both placebo and codeine yet there was no significant difference between the treatment groups. A highly significant (P < 0.0001) decrease in the three measures of cough was also found between days 1 and 2. The results demonstrate that codeine is no more effective than placebo in reducing cough associated with acute URTI, as measured by CSPLs, cough frequency or subjective symptom scores. This result might be explained on the basis of two central pathways for cough; a reflex pathway via the brain-stem which is sensitive to codeine and a voluntary pathway via the cortex which is unaffected by codeine. The results also demonstrate that the sound-level meter appears to be a potentially useful investigative tool for the assessment of cough and antitussive efficacy.

Adolescent↗

The "common cold" in frail older persons: impact of rhinovirus and coronavirus in a senior daycare center.

OBJECTIVE: To evaluate the incidence and impact of rhinovirus and coronavirus infections in older persons attending daycare. DESIGN: Prospective descriptive study. SETTING: Three senior daycare centers in Rochester, New York. PATIENTS: Frail older persons and staff members of the daycare centers who developed signs or symptoms of an acute respiratory illness. MEASUREMENTS: Demographic, medical, and physical findings were recorded on subjects at baseline and during respiratory illness. Nasopharyngeal specimens for viral culture as well as acute and convalescent sera for coronavirus 229E enzyme immunoassay (EIA) were obtained for all illnesses. RESULTS: During the 44 months of study, 352 older persons experienced 522 illnesses. Thirty-five (7%) of 522 cultures were positive for rhinovirus and 37 (8%) of 451 serologies were positive for coronavirus 229E infection. The clinical syndromes associated with rhinovirus and coronavirus infection were similar and characterized by nasal congestion, cough, and constitutional symptoms. No patient died or was hospitalized, but approximately 50% had evidence of lower respiratory tract involvement. The average illness lasted 14 days. During the same period, 113 staff developed 338 respiratory illnesses. Eight percent were identified as coronavirus and 9% as rhinovirus. Cough, sputum production, and constitutional symptoms were significantly more common among older persons. CONCLUSIONS: Rhinovirus and coronavirus 229E are common causes of moderately debilitating acute respiratory illnesses among older persons attending daycare.

Adult↗

Common community respiratory viruses in patients with cancer: more than just "common colds".

Community respiratory viruses long have been recognized as primary respiratory pathogens among infants and young children. More recently, it has become clear that these viruses cause a considerable disease burden throughout life. The consequences of repeated infections are most evident in elderly and immunocompromised persons. Even in otherwise healthy persons, reinfections often require medical attention but generally are undiagnosed and unrecognized. These reinfections may spread from healthy persons to those at highest risk. Control requires a multifaceted approach combining vaccination, chemoprophylaxis, and aggressive early antiviral treatment of high-risk individuals, as well as education of all populations affected by these viruses.

Community-Acquired Infections↗