There is no such drug as a cold cure. There is no drug on the market which prevents colds or reduces their duration. But, because there is no cure, there are numerous remedies.

The common cold produces swelling and inflammation of the lining membrane of the nose which produces blockage and a runny nose. This may be accompanied by a sore throat, cough, headache, aching back or limbs and a mild fever. In an attempt to relieve these symptoms drug companies produce nose drops, inhalants, sprays, aerosols, ointments, tablets, powders, capsules, linctuses and mixtures, in all shapes, colours and sizes. Treatment is aimed at two target groups of symptoms – aches, pains and fever; blocked and runny nose.

Relief of Aches, Pains and Fever

Mild pain-relievers will relieve your aches and pains and will bring down your temperature. They must be taken according to the instructions on the package and with plenty of fluids. They will have no effect upon the duration or outcome of the cold. There are many pain-relieving preparations on the market and yet the choice boils down to paracetamol or ibuprofen with soluble aspirin as an alternative.

Aspirin should not be used for children under twelve years of age or by breast-feeding mothers because of the risk of Reye’s Syndrome (see p. 137).

Nasal Sprays

The majority of decongestant drugs belong to a group known as sympathomimetic drugs (see p. 35).

When applied locally to the surface of the nose they reduce swelling and secretions by constricting blood vessels. They are used to relieve runny nose and nasal congestion. They all share the disadvantage that their use may be followed by an increase of nasal congestion (‘rebound’ or ‘after congestion’). Some irritate the lining of the nose and sting when applied. They may produce headache and rapid beating of the heart (see warnings with oral preparations, below) and they may cause children to become hyperactive. Their repeated use may damage the lining membrane of the nose and produce permanent blockage.

The commonly used sympathomimetic drugs in nasal decongestant preparations include ephedrine, oxymetazoline (Afrazine, Dristan, Sudafed Nasal Spray, Vicks Sinex), phenylephrine (Fenox), and xylometazoline (Otradrops, Otrivine, Tixycolds). The sympathomimetic drugs in nasal decongestant sprays may be absorbed into the blood-stream through the lining of the nose and produce adverse effects. They should be used with the utmost caution in pregnancy. Do not use daily for more than seven days and only use occasionally.

Overdose of naphazoline and xylometazoline may cause coma and a fall in body temperature, especially in infants.

Nasal Decongestants by Mouth

Nasal decongestants are usually applied locally in the nose by nasal spray or drops(see above), but they may also be taken by mouth. However, the arteries supplying the lining membranes of the nose have not been shown to be more sensitive to these drugs than any other vessels in the body. Nasal decongestants taken by mouth will therefore produce constriction of other arteries in the body and increase the blood pressure. This may be dangerous in patients at risk of developing a stroke, who suffer from angina, coronary thrombosis, high blood pressure, diabetes or overworking of their thyroid glands, and in patients who are receiving monoamine oxidase inhibitor antidepressant drugs. Their adverse effects include giddiness, headache, nausea, vomiting, sweating, thirst, palpitations, difficulty in passing urine, weakness, trembling, anxiety, restlessness and insomnia. Some individuals may be very sensitive to them while others may be able to tolerate high doses. They do not cause rebound congestion of the nose when their effects have worn off but they are of doubtful value.

The main decongestants included in oral preparations are phenylephrine, phenylpropanolamine and

ephedrine (see lists above for products which contain these drugs).

Other Cold Remedies

Antimuscarinic drugs (see p. 33) reduce secretions in the upper and lower respiratory tract. They are a constituent of some cold remedies, usually in such small doses as to be ineffective. But, of course, if they were given in effective doses by mouth they would produce unpleasant adverse effects.

Antihistamines (see p. 71) are present in some common cold remedies but there is disagreement about their benefits. Some of them may cause drowsiness and interfere with your ability to drive a motor vehicle, and their effects are increased by alcohol.

Vapour rubs and inhalations may provide very transient relief of cold symptoms in some people but they should be used with caution, and not in infants under three months of age in whom strong applications may interfere with breathing.

Vitamin C. There is no convincing evidence that taking vitamin C helps to prevent colds, reduce the severity of cold symptoms or shorten the duration of a cold.

Soothing throat lozenges and pastilles may provide transient relief of symptoms in some people but there is a large ‘psychological’ element to their effectiveness. Many are high in sugar and sucking between meals may be harmful to teeth. They should not be used by diabetics unless they are sugar-free.

Antibacterial throat lozenges are of no use in treating a virus infection (the commonest cause of sore throats) and antiseptic preparations are usually so weak as to have no beneficial effect and the same criticism applies to gargles.

Catarrh

Catarrh is an inflammation of the lining membranes of the air passages. It may affect the nose (nasal catarrh), the space at the back of the nose (post-nasal catarrh), or any part of the air passages. It may be acute and caused by a cold or it may be chronic and aggravated by smoking and a dry atmosphere. It may also be caused by many other factors: for example, allergy (e.g. hayfever), a dusty dry atmosphere, or fungal spores in the air. Acute catarrh may produce a soreness of the affected area, or it may produce a mucous discharge: for example, runny nose, mucus at the back of the throat, phlegm on the chest, or snuffles in a baby. The mucus may become sticky and hard to clear and it may become yellowish-green due to secondary bacterial infection.

Treatment of Catarrh

In treating acute catarrh it is important to treat the cause, for example hayfever, to stop smoking if you smoke, and avoid dry, dusty and/or smoky atmospheres if possible. Parents of snuffly babies should not smoke in the home. This general advice also applies to the treatment of chronic catarrh.

Steam inhalation may help to clear catarrh; so may nasal decongestants but note the dangers of regular daily use and dangers in infants (see above). Vapours and inhalations may help some people but they should be used with caution, and preferably not in infants under three months of age in whom strong applications may interfere with breathing.

There is no convincing evidence from adequate and well-controlled studies that mucolytics (drugs that dissolve phlegm) are beneficial in treating chronic catarrh despite their being heavily advertised. Preparations containing more than one drug are best avoided because the dose of one drug cannot be changed without changing the dose of the other drug or drugs. Furthermore, such preparations expose you to the risk of harmful effects from more than one drug.