What are the causes and treatments for cough and cold symptoms?

Causes and Treatment of Cough and Cold

Causes

Most short-term coughs and colds are caused by viral upper respiratory tract infections and do not require antibiotics, even when producing phlegm. 1

Common Viral Causes

• Viral rhinosinusitis is the most common cause, affecting both nasal and sinus mucosal surfaces simultaneously 1
• CT studies show that 87% of patients with recent-onset colds have maxillary sinus abnormalities, which resolve spontaneously in 79% of cases by days 13-20 without antibiotics 1

Typical Symptoms

• Nasal congestion and rhinorrhea 1
• Sore throat with inflamed pharynx 1
• Mild fever and body aches 1
• Fatigue and general malaise 1

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Treatment Approach

First-Line Treatments

For acute cough and cold symptoms, first-generation antihistamine/decongestant combinations (brompheniramine with sustained-release pseudoephedrine) are the most effective evidence-based treatment. 1

• Naproxen can be added to help decrease cough severity 1
• Simple home remedies like honey and lemon should be recommended as initial therapy before prescription medications 1, 2
• Dextromethorphan (60 mg for maximum effect) is the preferred antitussive due to superior efficacy and better side effect profile compared to codeine 1, 2, 3, 4
• Menthol lozenges or vapor provide short-term symptomatic relief 1, 2, 3
• Paracetamol (acetaminophen) for fever and body aches 1

What NOT to Use

Newer generation non-sedating antihistamines are completely ineffective for cold-related cough and should not be used. 1

• Antibiotics do not help viral coughs and colds, even with colored phlegm 1, 3
• Over-the-counter cough and cold medications should never be used in children under 4 years due to potential harm without benefit 5, 6
• Expectorants, mucolytics, and bronchodilators are not recommended for acute nonproductive cough 3

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Important Clinical Pitfalls

Bacterial Sinusitis Misdiagnosis

Do not diagnose bacterial sinusitis during the first week of symptoms, as viral infections cause identical sinus imaging abnormalities that resolve spontaneously 1. Clinical judgment is required after one week if symptoms persist or worsen 1.

Natural History

• Approximately 25% of patients continue to have cough symptoms at day 14, which is normal for viral infections 1
• This postinfectious cough may require active intervention with first-generation antihistamine/decongestant combinations rather than just waiting 1

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When to Seek Medical Attention

Patients should see a doctor immediately if they experience: 1, 2, 3

• Coughing up blood (hemoptysis)
• Breathlessness or respiratory distress
• Prolonged fever with systemic illness
• Underlying conditions (COPD, heart disease, diabetes, asthma)
• Recent hospitalization
• Symptoms persisting beyond 3 weeks

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Special Populations

Children

• Honey (for children ≥1 year old) is safe and effective 7
• Vapor rub containing camphor, menthol, and eucalyptus oils can be beneficial 7
• Never use OTC cough/cold medications in children <4 years due to risk of serious adverse events including death 5, 6

Adults with Chronic Conditions

• Patients with COPD, heart disease, diabetes, or asthma require medical evaluation even for seemingly simple colds 1

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Additional Recommendations

• Stop smoking immediately as it worsens cough symptoms 1, 3
• Practice good hand hygiene to prevent transmission 1
• Use handkerchiefs and wash hands to avoid spreading infection 1, 3
• Adequate hydration helps manage symptoms 2, 3