Cold and cough
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common cold and cough symptoms treatment 2025
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Here is a thorough overview of the common cold and cough based on authoritative medical textbooks:
Common Cold and Cough
What Is the Common Cold?
The "common cold" is not a single entity but a group of similar illnesses caused by different viruses. All colds share rhinitis (nasal inflammation) with variable pharyngitis as their core features. It is the most prevalent infectious illness in humans.
Causative Viruses (from Fishman's Pulmonary Diseases):
| Syndrome | Associated Viruses |
|---|---|
| Common cold | Rhinovirus, other picornaviruses, RSV, PIV, Coronavirus, Adenovirus |
| Pharyngitis | Rhinovirus, Influenza, EBV, CMV, HSV, HIV |
| Tracheobronchitis | Influenza, Adenovirus, Rhinovirus |
Rhinovirus is the most common cause, responsible for up to 50% of all common colds, especially in early fall (Swanson's Family Medicine Review).
Symptoms
- Nasal stuffiness, sneezing, runny nose (rhinorrhea)
- Sore throat (pharyngitis)
- Cough and hoarseness (variably present; more frequent in the elderly)
- Chills (fever is NOT typical in uncomplicated colds in adults; more common in children)
- Symptoms typically peak early but can last up to 14 days (median ~9-10 days in adults)
Cough in Colds - Pathogenesis
The mechanisms behind viral cough include:
- Direct damage to respiratory mucosa
- Release of inflammatory mediators
- Increased mucus production or decreased clearance
- Stimulation of airway irritant receptors
- Enhanced airway reactivity to cold air and irritants
A post-infectious cough can persist for up to 2 months after the illness.
(Fishman's Pulmonary Diseases)
Complications
- Secondary bacterial sinusitis
- Otitis media (~2% of adult cases, higher in children)
- Exacerbations of asthma, chronic bronchitis, or emphysema
- Eustachian tube dysfunction
- Transient sinus mucosal thickening (seen in up to 77% of acute cold cases on imaging)
Treatment
Adults (Harrison's 22E, 2025)
| Symptom | Treatment |
|---|---|
| Fever, myalgias, sore throat | Acetaminophen or NSAIDs (ibuprofen) |
| Rhinorrhea | Ipratropium bromide (nasal) |
| Nasal congestion | Oxymetazoline nasal spray (max 5 days), or pseudoephedrine (oral) |
| Cough | Dextromethorphan or benzonatate (Tessalon Perles) |
| General | Rest, plenty of fluids, combined decongestant/analgesic products |
Note on cough suppressants: Evidence is weak but dextromethorphan and benzonatate are used. Opioids (codeine) are effective for cough but carry risks of somnolence, dysphoria, constipation, and dependence.
For bronchitis/tracheobronchitis: rest, aspirin (for fever in adults), cold-mist vapor inhalation, and a cough syrup with guaifenesin + dextromethorphan.
Children
- Do NOT use cough and cold medicines in children under 6 years - risk of adverse effects with no proven benefit
- Honey (for children >1 year) can soothe sore throat
- Cool-mist humidifiers for breathing comfort
- Saline nasal drops + bulb suctioning for congestion
What Does NOT Work (or is of Questionable Benefit)
Per Harrison's 22E (2025), the following have ineffective, questionable, or significant adverse effects:
- Echinacea
- Zinc
- Inhaled steam
- Vitamin C / Vitamin D
- Garlic
- Antihistamine monotherapy
- Chinese medicinal herbs
- Intranasal corticosteroids
- Saline nasal irrigation
- Antiviral drugs (for the common cold)
Antibiotics - NOT Indicated
Antibiotics are ineffective for the common cold and should not be prescribed. A 2025 Cochrane systematic review confirms this (PMID: 41277585). Antibiotic use is more likely to cause an adverse reaction in an individual patient than to prevent complications.
Red Flags - Seek Medical Care If:
- Fever >102°F (38.9°C)
- Chest pain, shortness of breath, dizziness, or confusion
- New ear or sinus pain
- Symptoms lasting >14 days
These may signal bacterial superinfection (sinusitis, otitis media) or a different diagnosis altogether.
Transmission & Contagiousness
- Spread by respiratory droplets or contact with contaminated surfaces
- Most contagious during the first 2-3 days but infectious as long as symptoms persist (up to ~2 weeks)
- Handwashing and avoiding close contact are the main preventive measures
Sources: Harrison's Principles of Internal Medicine 22E (2025), Fishman's Pulmonary Diseases and Disorders, Swanson's Family Medicine Review, CDC
Recent evidence note: A 2025 Cochrane review (PMID: 41277585) reaffirms that antibiotics provide no benefit for the common cold and increase adverse effects. A 2025 meta-analysis (PMID: 40311928) on Echinacea purpurea in children with upper respiratory infections found some benefit for reducing complications of otitis media, though evidence remains limited.
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