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Vitamin C and acute respiratory infections.

So far over 60 studies have examined the effects of vitamin C on the common cold. No effect on common cold incidence was observed in the six largest studies, indicating that vitamin C has no preventive effects in normally nourished subjects in the Western countries. There are, however, smaller studies reporting benefit. In three trials of subjects under heavy acute physical stress, common cold incidence decreased by on average 50%, and in four trials of British males common cold incidence decreased by on average 30% in the vitamin C groups. The dietary vitamin C intake in the UK is low, and consequently the benefit may be due to the correction of marginal deficiency, rather than high vitamin doses. Regular vitamin C supplementation (> or =1 g/day) has quite consistently reduced the duration of colds, but the size of the benefit has varied greatly. In the four largest studies the duration of colds was reduced only by 5%. In two of these studies, however, absence from school and work was reduced by 14-21% per episode, which may have practical importance. Three controlled studies recorded a reduction of at least 80% in the incidence of pneumonia in the vitamin C group, and one randomised trial reported substantial treatment benefit from vitamin C in elderly UK patients hospitalized with pneumonia or bronchitis. It seems that the preventive effects of supplementation are mainly limited to subjects with low dietary vitamin C intake, but therapeutic effects may occur in wider population groups. Further carefully designed trials are needed to explore the effects of vitamin C.

Ascorbic Acid↗

Correlation of cleft type with incidence of perioperative respiratory complications in infants with cleft lip and palate.

BACKGROUND: A retrospective survey of 339 infants who had undergone primary plastic surgery for cleft lip and palate was performed to evaluate the concomitant preoperative assessment based on severity grading of the common cold and the correlation of cleft type with the incidence of perioperative respiratory complications. METHODS: We assessed the severity of common cold symptoms in the preoperative period using the Common Cold Score, which comprises 10 symptoms and findings. We then determined the association of the incidence of perioperative respiratory complications with the increasing severity of common cold symptoms and also compared the complication incidence in the three cleft types in healthy infants without a common cold. RESULTS: The incidence of perioperative respiratory complications was greater in the group with a suspected presence of a common cold. Infants with severer cleft, who had bilateral cleft lip and palate, even without common cold symptoms, had a significantly higher incidence of perioperative respiratory complications (8.9%) than infants with simple cleft lip (1.7%, P < 0.05). CONCLUSIONS: Clinicians should consider postponing primary plastic surgery for cleft lip and palate in infants with a suspected presence of a common cold. Our results also suggest that the presence of a wide cleft is a risk factor for causing perioperative respiratory complications in infants with cleft lip and palate. We believe that a careful preoperative assessment of common cold symptoms in these infants can decrease the incidence of perioperative respiratory complications.

Anesthesia↗

Upper respiratory morbidity in preschool children: a cross-sectional study.

OBJECTIVES: To estimate the occurrence of and associations between upper respiratory tract infections in preschool children, and to assess constitutional and environmental factors as determinants of these infections. DESIGN: Population-based cross-sectional study. SETTING: Oslo, Norway. PARTICIPANTS: Preschool children, aged 4 to 5 years (3853 completed questionnaires). MAIN OUTCOME MEASURES: Acute and recurrent acute otitis media, tonsillopharyngitis, common cold, and rhinitis. RESULTS: Upper respiratory tract infections were common at age 4 years. During the last month, 7.1% of the children had acute otitis media and 7.5% experienced tonsillopharyngitis. Corresponding figures for common cold and rhinitis were 58.3% and 16. 4%, respectively. During the last 12 months, 9.5% of the children experienced more than 1 bout of acute otitis media, 6.9% had more than 1 tonsillopharyngitis episode, 47.7% contracted more than 2 common colds, and 3.2% had rhinitis weekly or monthly. The lifetime prevalence of recurrent acute otitis media (>/=4 episodes in any 12-month period) was 12.7% (n = 473). Bivariate correlations showed small-to-moderate relationships between the infections. Common cold was only weakly related to otitis media, tonsillopharyngitis, and chronic rhinitis. The probability for developing acute otitis media was almost 4-fold increased in children who had tonsillopharyngitis in the last year (adjusted odds ratio = 4.19; 95% confidence interval, 3.09-5.66). In logistic regression analysis, atopic disease was a strong determinant of all upper respiratory tract infections. Low birth weight increased the risk of acute otitis media. Day care attendance and the presence of siblings, which were considered to be indicators of exposure to respiratory pathogens, increased the risk of upper respiratory tract infections. CONCLUSIONS: In preschool children, acute otitis media, tonsillopharyngitis, and common cold were quite common, while chronic rhinitis was less prevalent and strongly associated with atopic disease. Attendance at day care centers increased the risk of upper respiratory tract infections in this age group, although the effect was weaker than that in younger children.

Acute Disease↗

A clinical study to evaluate the efficacy of the antihistamine doxylamine succinate in the relief of runny nose and sneezing associated with upper respiratory tract infection.

Antihistamines are widely used in common cold medications, although the role of histamine in the development of common cold symptoms is unclear and the use of antihistamines for the treatment of common cold is controversial. It is clear that antihistamines do not offer a cure for common cold but they may alleviate symptoms of sneezing and runny nose. The present study was designed to investigate the efficacy of an antihistamine, doxylamine, on the symptoms of runny nose and sneezing associated with common cold. We conducted a randomized double-blind study in cold sufferers. One thousand and one volunteers with cold symptoms were screened in four centres (UK, Denmark, Belgium, Germany) and 688 satisfied the entry criteria of the study. The main reasons for excluding subjects were a low nasal secretion weight (secretion weight < 0.2g, 72%) and a low subjective rhinorrhoea score (24%). Volunteers were randomized to receive either doxylamine succinate 7.5 mg by mouth four times a day up to nine doses (n = 345) or placebo (n = 343). The principal measurements were prospectively defined as runny nose and sneezing symptom scores. Data were analysed on an intention-to-treat basis, using Cochran-Mantel-Haenszel statistics controlling for baseline symptom scores. A between-group comparison showed that doxylamine-treated volunteers benefited from a significantly greater reduction in runny nose scores (P < 0.01) and sneezing scores (P < 0.001), than those volunteers in the placebo group. Doxylamine therapy was well tolerated; the incidence of unexpected side-effects was comparable with placebo. Of the expected side-effects, 13.3% of doxylamine-treated patients reported drowsiness. The incidence of sedative effects was lower than has been reported for other commonly used first-generation antihistamines.

Common Cold↗

Assessment of antibiotic prescription in acute respiratory infections in adults. The Spanish Study Group on Antibiotic Treatments.

OBJECTIVE: This study aims to ascertain the variability in the use of antibiotics for the treatment of acute respiratoryinfections in several hospital emergency services in Spain, as well as the appropriateness of antibiotics prescription through evaluation by a panel of experts using available scientific evidence. METHOD: A cross-sectional study was carried out in the emergency services of 10 hospitals in different Spanish regions. We chose patients diagnosed as having acute respiratory infection, aged over 14 years. Among the collected variables were: type of respiratory infection, antibiotic prescription, comorbidity, qualification of the prescribing doctor and hospital admission. The consensus conference held by a panel of experts established first choice treatment and the alternative and inappropriate use for each respiratory infection, based on the available scientific evidence. All the observed prescriptions in our study were classified according to this pattern. RESULTS: A sample of 2899 acute respiratory infections was studied (5.5% of all emergencies). Antibacterial agent treatment was prescribed in 82.6% of these, varying according to the infection between 98.5% of pneumonias and 49% of croup-influenza-common cold. The most commonly used antibiotics were amoxicillin-clavulanate and cefuroxime. The global percentage of inappropriate prescription was 40.5% (95% CI; 35.4-45.5). The prescriptions were inappropriate in 16.9% of cases of pharyngotonsillitis, 17.8% of chronic bronchitis, 26.9% of acute bronchitis, 29.3% of pneumonias, 30.8% of otitis and sinusitis and in 70.8% of croup, flu, common cold and non-specified infections. Significant variability among participating centres was observed, both in choice of antibiotics and in their degree of appropriateness. CONCLUSIONS: There is excessive use of antimicrobial drugs in acute respiratory infections, and the majority are used for viral infections. There is indiscriminate use of broad spectrum antibiotics, which are valid in some infections but clearly inappropriate in others. Similarly, there are important differences in the choice of antibiotics and their degree of appropriateness among hospitals.

Acute Disease↗

Systemic therapy of malignant human melanoma tumors by a common cold-producing enterovirus, coxsackievirus a21.

PURPOSE: The incidence of malignant melanoma continues to increase worldwide; however, treatment of metastatic melanoma remains unsatisfactory, and there is an urgent need for development of effective targeted therapeutics. A potential biological target on the surface of malignant melanoma cells is the up-regulated expression of intercellular adhesion molecule (ICAM)-1 and decay-accelerating factor (DAF), relative to surrounding benign tissue. Coxsackievirus A21 (a common cold virus) targets and destroys susceptible cells via specific viral capsid interactions with surface-expressed virus receptors comprising ICAM-1 and DAF. EXPERIMENTAL DESIGN: The oncolytic capacity of a genetically unmodified wild-type common cold-producing human enterovirus (Coxsackievirus A21, CAV21) was assessed against in vitro cultures and in vivo xenografts of malignant human melanoma cells. RESULTS: In vitro studies established that human melanoma cells endogenously express elevated levels of ICAM-1/DAF and were highly susceptible to rapid viral oncolysis by CAV21 infection, whereas ICAM-1/DAF-expressing peripheral blood lymphocytes were refractile to infection. In vivo studies revealed that the tumor burden of nonobese diabetic severe combined immunodeficient mice bearing multiple s.c. melanoma xenografts was rapidly reduced by oncolysis mediated by a single administration of CAV21. The antitumor activity of CAV21 was characterized by highly efficient systemic spread of progeny CAV21, with oncolysis of tumors also occurring at sites distant to the primary site of viral administration. CONCLUSIONS: Overall, the findings presented herein demonstrate an important proof of principle using administration of replication-competent CAV21 as a potential biological oncolytic agent in the control of human metastatic melanoma.

Animals↗

Triggers of relapse in steroid-dependent and frequently relapsing nephrotic syndrome.

An awareness of the triggers of relapse is critical for the control of steroid-dependent, frequently relapsing nephrotic syndrome (SDFRNS). We have investigated the triggers, usually described as 'episodes', to such relapses within a temporal context. Thirty-five patients with SDFRNS were analyzed retrospectively. A total of 442 relapses occurred in 2499 patient-months. The relapses were classified into two groups: those with episodes (E+) and those without episodes (E-). There were 135 E+ relapses and 296 E- relapses. The common cold was the most common episode (52%) of E+ relapse, followed by school events (18%). These E+ relapses occurred almost evenly throughout the 4 weeks between each follow-up visit. Conversely, 161 (55%) of the 296 E-z relapses occurred within the 3-day period preceding the patient's appointment (relapse-related hospital visit, RRHV). McNemar's test revealed that the concentration of relapses in this period was statistically significant (P < 0.00011). In addition, 15 out of 26 RRHV without additional therapy showed a spontaneous remission. From a chronological perspective, the common cold and school events as well as up-coming hospital visits may trigger relapses in SDFRNS patients.

Adolescent↗

Immunohistochemical examination of olfactory mucosa in patients with olfactory disturbance.

The olfactory mucosa was examined by immunohistochemistry in patients with olfactory disturbance: anosmia due to choanal atresia and chronic sinusitis, early-stage common cold, late-stage common cold, and head trauma. The results indicate that the olfactory mucosa of patients with olfactory disturbance shows specific kinds of immunoreactive patterns and that immunohistochemistry is useful for examining the degree of degeneration of pathologic human olfactory mucosa and for clarification of prognosis.

Choanal Atresia↗

Predictive value of parent-reported symptoms in the assessment of otitis media with effusion during infancy.

OBJECTIVE: To determine the predictive value of parent-reported symptoms in the assessment of otitis media with effusion (OME) during infancy. DESIGN: Prospective longitudinal study that compared the results of questionnaire-based parental reports with the state of the middle ear assessed by otoscopy and tympanometry at 3-month intervals from birth to the age of 2 years. SETTING: Outpatient Department, University Hospital Maastricht, The Netherlands. SUBJECTS: One hundred and fifth healthy-born infants. MAIN OUTCOME MEASURES: Sensitivity, specificity, positive and negative predictive values of parent-reported ear infection, hearing loss, mouth breathing, snoring and common cold. RESULTS: Prevalence rates showed the following ranges: OME, 39%-53%, parent-reported ear infection, 2%-20%, hearing loss 2%-7%, mouth breathing, 30%-41%, snoring, 31%-41% and common cold, 65%-81%. Common cold demonstrated the highest sensitivity (83%) with a low specificity of 36%. Hearing loss gave the highest positive predictive value (PPV) (70%) with a moderate negative predictive value (NPV) (54%). PPV increased with the number of anamnese questions answered positively. CONCLUSIONS: The diagnostic value of parent-reported ear infection, hearing loss and common cold was found to be limited. Combinations of positively-reported symptoms gives increased diagnostic validity while the absence of parent-reported symptoms does not necessarily indicate the absence of OME.

Ambulatory Care↗

Effect of terfenadine on the plasma concentrations of substance P and vasoactive intestinal polypeptide in volunteers.

The effect of terfenadine on the plasma concentrations of substance P and vasoactive intestinal polypeptide (VIP) was studied in 7 healthy subjects and 8 subjects with the common cold. Before terfenadine administration, the mean plasma substance P concentration of the subjects with the common cold was significantly higher than that of the healthy subjects. The increased mean plasma substance P concentration of the subjects with the common cold was decreased after terfenadine administration. In the healthy subjects, the mean plasma substance P concentration was unchanged by terfenadine administration. The mean plasma VIP concentration of the subjects with common cold was slightly higher than that of the healthy subjects before and after terfenadine administration, with no significant difference.

Administration, Oral↗

[The correlation between the exacerbation of bronchial asthma and picornavirus (human rhino virus) infection in throat gargles by RT-PCR].

Viral infection is one of important factors to cause the exacerbation of bronchial asthma. We have investigated 167 adults of asthmatics to clarify the correlation between viral infection and exacerbation of asthma. Patients were classified to four group by the symptoms of common cold and asthma attack. Furthermore, we have examined Picornavirus and Human rhino virus RNA from throat gargles of patients using RT-PCR (reverse transcription--polymerase chain reaction) method. Forty of 65 (61.5%) asthmatics with common cold revealed asthma attack and common cold was significantly associated with acute exacerbation of asthma (p < 0.01). We identified Picornavirus RNA, which include 113 of Human rhino virus serotypes and enterovirus, from the samples of 16 of 52 (30.8%) patients who had acute exacerbation. It was significantly higher than the detection rate of viral RNA from patient without asthma attack. Furthermore, we analyzed Human rhino virus RNA from the same samples by RT-PCR and 93.7% of Picornavirus were identified as Human rhino virus. Taken together, these findings suggest that common cold is significantly associated with the exacerbation of bronchial asthma. Human rhino virus infection might be one of important virus in this procedure.

Adult↗

Zinc lozenges: cold cure or candy? Solution chemistry determinations.

Common colds were shortened by 7 days in a 1984 clinical trial using zinc gluconate throat lozenges each 2 h. Between then and 2004, 10 other double-blind, placebo-controlled clinical trials showed widely varying results. This re-analysis of these trials presents solution chemistry methods to elucidate differences in efficacy. Statistically significant correlation was shown between total daily dosages of positively charged zinc species and reductions in median (p = 0.005) and mean duration (p < 0.02) of common colds in these trials.

Cations↗

Immune responses induced by intranasal imiquimod and implications for therapeutics in rhinovirus infections.

Notwithstanding the progress recently made in immunology and virology, there is yet no effective, specific treatment for the common cold. Symptomatic treatment is minimally effective. An anecdotal report of rapid clearing of the common cold of recent onset after intranasal application of imiquimod in several subjects by one of the authors, made us test the hypothesis that this treatment works through the secretion of interferon by the nasal mucosa. We decided to do an animal study in primates (Indian Macaca Mulata): 5 treatment and 3 control animals were used. Imiquimod or placebo was massaged into the nares of the animals and periodic samples of post-nasal fluid were taken and measurements for Interferon alpha (IFNalpha) and Tumor Necrosis Factor alpha (TNFalpha) were made by ELISA methods, and kinetic studies. mRNA IFNalpha was also isolated and analyzed by quantitative competitive RT-PCR. The internal standard was constructed to be complementary to and compete with oligonucleotide primers and for amplification of target sequences. One intranasal application of imiquimod rapidly (1-4 Hours) induced high levels of mRNA for IFNalpha, and minimal levels in the control animals. Rapid induction of INFalpha, and proportional increase of TNFalpha sustained for 4 and 6 hours respectively were noted. No adverse reactions to treatment were found in macaques during this short period of intranasal imiquimod usage (except in one macaque with a short period of lacrimation). No animal had cytotoxic effects when examined at 6 hr, 12 hr, 24 hr or 48 hr, except one animal, which had an episode of lacrimation for 6 hr post treatment. Thus both safety and efficacy of short treatment with imiquimod is proven in this animal model. Proof of principle for intranasal treatment of the common cold with imiquimod is shown. We think that this work will encourage a number of double blind clinical trials to confirm the effectiveness of the intranasal treatment of the common cold with imiquimod.

Adjuvants, Immunologic↗

CATCHING cold.

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Common Cold↗

Recognizing and treating common cold-induced injury in outdoor sports.

We briefly review the physiology of cold exposure, the spectrum and prevention of common cold-induced injuries (especially in athletes participating in outdoor sports), and the potentially harmful side effects of localized cryotherapy. Severe cold affects all organ systems and especially the central nervous and cardiovascular systems; many biochemical reactions and pathways become distorted or slowed at low body core temperatures and can thus affect athletic performance. Low body shell temperature, too, can interfere with athletic ability by weakening and slowing muscle contractions, by delaying nerve conduction time, and by facilitating injury. Cold-induced injuries may be local or systemic, but they can usually be prevented by knowledge, good physical condition, appropriate nutrition and equipment, and avoidance of moisture.

Athletic Injuries↗

Lower airways inflammatory response during rhinovirus colds.

Human rhinovirus (HRV) causes the majority of common colds and possibly also asthma exacerbations. Mechanisms linking viruses to changes in airway reactivity are not defined and we hypothesized that changes in endobronchial cell populations may be implicated. Bronchial mucosal biopsies taken before, during and after experimental infections with HRV serotype 16 were examined and histamine reactivity was measured in 17 adult volunteers (6 atopic asthmatics). Biopsies were examined for mast cells, eosinophils, lymphocytes and neutrophils by immunohistochemical techniques. Increases in histamine responsiveness (PC20) were found (p = 0.048), accompanied by an increase in submucosal lymphocytes (p = 0.05). There was a significant increase in epithelial eosinophils with the cold (p = 0.042), and in asthmatics this appeared to persist into convalescence. Rhinoviral common colds are associated with a bronchial mucosal lymphocytic and eosinophilic infiltrate that may be related to changes in airway responsiveness and asthma exacerbations.

Adult↗

[Epidemiological survey on bronchial asthma in Henan province].

OBJECTIVE: To survey asthma prevalence, correlation factors for prevention, treatment, and for policy decision of asthma control. METHODS: Done with TB epidemiological survey synchronously, sampling by stratified-cluster-random method. 43 points were selected and distributed in all 18 prefectures in Henan province. Sampling population was 75 134, and 65 033 (97.0%) were investigated actually. RESULTS: In this survey, 682 asthma patients were found. The total prevalence rate was 1.05%, the rate for children was 1.71%, and that for adult was 0.82%; the rates for male and female were 1.16%, 0.94% respectively. The ratio of male to female was 1.23:1. When asthmatic chronic bronchitis cases were regarded as asthma cases and included in total asthma cases, the overall prevalence rate of asthma would increase up to 1.73%, raised by 65%. The higher prevalence were in 0 approximately 3 years old age group (4.48%) and >/= 65 years old age group (1.43%), the lowest prevalence was in 15 approximately 24 years old age group (0.36%). For 90% of asthmatic children, the initiative age of asthma was before 7 years old, and for 1/3 adult patient, it was in childhood. The prevalence of asthma in rural area was higher than that of urban area. Cold air, common cold, stimulation of smoking and cooking, and room dust were the 4 main inducing factors. Seasonal attack of asthma accounted for 67.2%, and that in winter and spring was 65.4%. 60.6% of asthma cases showed history of allergic diseases including allergic rhinitis, dermatitis, and drug allergy; 34.3% asthma family history. CONCLUSIONS: The rate of prevalence and inducing factors of asthma in Henan province were gained in this survey. The results may basically reflect the present status and be provided for asthma control as reference. According to the prevalence, asthma cases would be up to 0.98 approximately 1.6 million in whole Henan province and more attention should be paid to this situation.

Adolescent↗