Common cold

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Revision as of 03:40, 13 August 2012 by Ildiko Santana (talk | changes) (→‎Symptomatic: (adj. hyphenated))
Common Cold
Classification and external resources
A representation of the molecular surface of one type of human rhinovirus.
ICD-10J00.0
ICD-9460
DiseasesDB31088
MedlinePlus000678
eMedicinemed/2339
MeSHD003139

The common cold is also known as nasopharyngitis, rhinopharyngitis, acute coryza, or a cold. It is an easily spread, infectious disease of the upper respiratory system, that affects mostly the nose. The symptoms include a cough, sore throat, runny nose (rhinorrhea), and fever. These symptoms are usually over with in seven to ten days, but sometimes they can last up to three weeks. Over two hundred viruses can cause the common cold. The rhinoviruses are the most common cause.

Acute infections of the nose, sinuses, throat or larynx (upper respiratory tract infections, URI or URTI) are categorized by the areas of the body that are mostly affected. The common cold mostly affects the nose, pharyngitis the throat, and sinusitis the sinuses. The symptoms come from the immune system's response to the infection, but not from tissue destruction by the viruses themselves. Hand washing is the main way to keep an infection from happening. Some evidence supports the effectiveness of wearing face masks.

There is no cure for the common cold, but the symptoms can be treated. It is the most frequent infectious disease in humans. The average adult gets two to three colds per year. The average child gets between six and twelve colds per year. These infections have been with humans since ancient times.

Signs and symptoms

The most common symptoms of a cold include a cough, runny nose, a stuffy nose, and a sore throat. Other symptoms can include sore muscles (myalgia), feeling tired, headache, and loss of appetite.[1] A sore throat is present in around 40% of people with colds. A cough is present in around 50% of people.[2] Muscle ache happens in about half of the cases.[3] A fever is an uncommon symptom in adults, but it is common in infants and young children.[3] The cough caused by a cold is usually mild compared to a cough caused by the flu (influenza).[3] A cough and a fever indicate a higher likelihood of the flu (influenza) in adults. [4] A number of the viruses that cause the common cold may also result in no symptoms.[5][6] The color of the mucus that is coughed up from the lower airways (sputum) may vary in color from clear to yellow to green. The color of the mucus does not indicate if the infection is caused by a bacterium or a virus.[7]

Progression

A cold usually begins with feeling tired, a feeling of being chilled, sneezing, and a headache. Additional symptoms such as a runny nose and cough follow within two or more days.[1] Symptoms typically reach their worst two to three days after the infection begins.[3] Symptoms usually resolve in seven to ten days, but can last up to three weeks.[8] The cough lasts for more than ten days in 35% to 40% of cases involving children. It lasts for more than 25 days in 10% of cases involving children.[9]

Cause

Viruses

Coronaviruses are a group of viruses known for causing the common cold. They have a halo, or crown-like (corona) appearance when viewed under an electron microscope.

The common cold is an easily spread infection of the upper respiratory tract. The rhinovirus is the most common cause of the common cold. It accounts for 30% to 80% of all cases. A rhinovirus is an RNA-containing virus of the family Picornaviridae. There are 99 known types of viruses in this family of viruses.[10][11] Other viruses can also cause the common cold. The coronavirus causes 10% to 15% of cases. The flu (influenza) causes 5% to 15% of cases.[3] Other cases may be caused by human parainfluenza viruses, human respiratory syncytial virus, adenoviruses, enteroviruses, and metapneumovirus.[12] Frequently, more than one virus is present and causing the infection.[13] In total, over two hundred different viruses[k2] are associated with colds.[3]

Transmission

The common cold virus is usually spread in one of two main ways. By breathing or swallowing droplets in the air containing the virus; or by contacting infected nasal mucus or contaminated objects.[2][14] Which method of transmitting the cold is most common has not been determined.[15] The viruses may survive for a long time in the environment. Viruses may than be transmitted from the hands to the eyes or nose where infection occurs.[14] People sitting close together appear at greater risk of becoming infected.[15] Transmission is common in daycare and at school, due to the closeness of many children with little immunity and frequently poor hygiene.[16] These infections are then brought home to other members of the family.[16] There is no evidence that recirculated air during commercial flight is a method of transmission.[14] Colds caused by the rhinovirus are most infectious during the first three days of symptoms. They are much less infectious afterwards.[17]

Weather

The traditional theory is that a cold is spread by staying too long in cold weather such as rain or winter conditions, which is how the disease got its name.[18] The role of body cooling as a risk factor for the common cold is controversial.[19] Some of the viruses that cause the common colds are seasonal, occurring more frequently during cold or wet weather.[20] This is believed to be due primarily to increased time spent indoors in close proximity;[21] specifically children returning to school.[16] However, it may also be related to changes in the respiratory system that result in easier infections.[22] Low humidity may increase transmission rates due to dry air allowing small easily spread droplets to disperse farther and stay in the air longer.[23]

Other

Herd immunity, immunity that occurs when an entire group of people become immune to a particular infection, occurs from previous exposure to cold viruses. Thus younger populations have greater rates of respiratory infections and older populations have lower rates of respiratory infections.[24] Poor immune function is also a risk factor for disease.[24][25] Lack of sleep and poor nutrition have also been associated with a greater risk of developing infection following rhinovirus exposure. This is believed to be due to their effects on immune function.[26][27]

Pathophysiology

The common cold is a disease of the upper respiratory tract.

The symptoms of the common cold are believed to be mostly related to the immune response to the virus.[28] The mechanism of this immune response is virus specific. For example, the rhinovirus is typically acquired by direct contact. It binds to human ICAM-1 receptors through unknown methods to trigger the release of inflammatory mediators.[28] These inflammatory mediators then produce the symptoms.[28] It does not generally cause damage to the nasal epithelium.[3] In contrast, the respiratory syncytial virus (RSV) is contacted by both direct contact and airborne droplets. It then replicates in the nose and throat before frequently spreading to the lower respiratory tract.[29] RSV does cause epithelium damage.[29] Human parainfluenza virus typically results in inflammation of the nose, throat, and airways.[30] In young children, when it affects the trachea it may produce croup, a hoarse cough and difficulty breathing. This is due to the small size of the airway in children.[30]

Diagnosis

The distinction between different upper respiratory tract infections (URTIs) is loosely based on the location of the symptoms. The common cold primarily affects the nose, pharyngitis primarily affects the throat, and bronchitis primarily affects the lungs.[2] The common cold is frequently defined as inflammation of the nose and may include varying amounts of throat inflammation.[31] Self diagnosis is common.[3] Isolation of the actual viral agent involved is rarely performed.[31] It is generally not possible to identify the virus type through symptoms.[3]

Prevention

The only effective way to prevent the common cold is by physically preventing the spread of the viruses.[32] This primarily includes hand washing and wearing face masks. In the health care environment, gowns and disposable gloves are also worn.[32] Isolating infected individuals is not possible because the disease is so widespread and symptoms are not specific. Vaccination has proved difficult because there are so many viruses involved and the viruses undergo rapid change.[32] Developing a broadly effective vaccine is very unlikely.[33]

Regular hand washing reduces the spread of cold viruses. It is most effective among children.[34] It is not known whether or not using antiviral or antibacterial agents during normal hand washing increases the benefits of hand washing.[34] Wearing face masks when near people who are infected may be beneficial. There is not enough evidence to know if keeping a greater physical or social distance is helpful or not.[34] Zinc supplementation may be effective at decreasing the number of colds a person gets.[35] Routine vitamin C supplementation does not reduce the risk or severity of the common cold. Vitamin C may reduce the duration of a cold.[36]

Management

Poster encouraging citizens to "Consult your Physician" for treatment of the common cold

There are currently no medications or herbal remedies which have been proven to shorten the duration of infection.[37] Treatment includes providing symptomatic relief.[38] This may include getting plenty of rest, drinking fluids to maintain hydration, and gargling with warm salt water.[12] Much of the benefit from treatment however is attributed to the placebo effect.[39]

Symptomatic

Treatments that help alleviate symptoms include simple pain relieving (analgesics) and fever reducing (antipyretics) medications such as ibuprofen[40] and acetaminophen/paracetamol.[41] Evidence does not show that cough medicines are any more effective than simple pain relieving medications (analgesics). [42] Cough medicines are also not recommended for use in children due to a lack of evidence supporting effectiveness and the risk for harm.[43][44] In 2009, Canada restricted the use of over-the-counter cough and cold medication in children six years old and younger due to concerns regarding risks and unproven benefits.[43] The misuse of dextromethorphan (an over-the-counter cough medicine) has led to its ban in a number of countries.[45]

In adults, the symptoms of a runny nose can be reduced by first-generation antihistamines. However, first-generation antihistamines are associated with adverse side effects such as drowsiness.[38] Other decongestants such as pseudoephedrine are also effective in adults.[46] Ipratropium nasal spray may reduce the symptoms of a runny nose, but there is little effect on stuffiness.[47] Second-generation antihistamines do not appear to be effective.[48]

Due to the lack of studies, it is not known whether drinking more fluids improves symptoms or shortens respiratory illness.[49] A similar lack of data exists for the use of heated humidified air.[50] One study found chest vapor rub to be effective in providing some symptomatic relief of night-time cough, congestion, and sleep difficulty.[51]

Antibiotics and antivirals

Antibiotics have no effect against viral infections and thus have no effect against the common cold.[52] Antibiotics are often prescribed even though antibiotic side effects cause overall harm.[52][53] Antibiotics are commonly prescribed because people expect doctors to prescribe them, and doctors want to help people. Prescribing antibiotics also happens because it is difficult to exclude causes of infection that may be managed by antibiotics.[54] There are no effective antiviral drugs for the common cold even though some preliminary research has shown benefit.[38][55]

Alternative treatments

While there are many alternative treatments used for the common cold, there is not enough scientific evidence to support the use of most treatments.[38] As of 2010, there is not enough evidence to recommend for or against either honey or nasal irrigation.[56][57] Zinc supplements may reduce the severity and duration of symptoms when taken within 24 hours of their onset.[35] The effect of vitamin C on the common cold, while extensively researched, is disappointing.[36][58] Evidence about the usefulness of echinacea is inconsistent.[59][60] Different types of echinacea supplements may vary in their effectiveness.[59]

Outcome

The common cold is generally mild and goes away on its own with most symptoms improving in one week.[2] Severe complications, if they occur, are usually in the very old, the very young, or those who are immunosuppressed (have a weakened immune system).[61] Secondary bacterial infections may occur resulting in sinusitis, pharyngitis, or an ear infection.[62] It is estimated that sinusitis occurs in 8% of cases. Ear infections occur in 30% of cases.[63]

Likelihood

The common cold is the most common human disease[61] and people are affected all around the world.[16] Adults typically have two to five infections per year.[2][3] Children may have six to ten colds per year (and up to twelve colds per year for school children).[38] Rates of symptomatic infections increase in the elderly due to a weakening immune system.[24]

History

While the cause of the common cold has been known since only the 1950s, the disease has been with humanity since ancient times.[64] Its symptoms and treatment are described in the Egyptian Ebers papyrus, the oldest existing medical text, written before the 16th century BC.[65] The name "common cold" came into use in the 16th century, due to the similarity between its symptoms and those of exposure to cold weather.[66]

In the United Kingdom, the Common Cold Unit (CCU) was set up by the Medical Research Council in 1946, and it was here that the rhinovirus was discovered in 1956.[67] In the 1970s, the CCU demonstrated that treatment with interferon during the incubation phase of rhinovirus infection provided some protection against the disease.[68] No practical treatment could be developed. The unit was closed in 1989, two years after it completed research of zinc gluconate lozenges in the prevention and treatment of rhinovirus colds. Zinc was the only successful treatment developed in the history of the CCU.[69]

Economic impact

The economic impact of the common cold is poorly understood in much of the world.[70] In the United States, the common cold leads to 75 million to 100 million physician visits annually at a conservative cost estimate of $7.7 billion per year. Americans spend $2.9 billion on over-the-counter (OTC) drugs. Americans spend an additional $400 million on prescription medicines for symptomatic relief.[71] More than one-third of people who saw a doctor received an antibiotic prescription. The use of antibiotic prescriptions has implications for antibiotic resistance.[71] An estimated 22 million to 189 million school days are missed each year due to a cold. As a result, parents missed 126 million workdays to stay home to care for their children. When added to the 150 million workdays missed by employees suffering from a cold, the total economic impact of cold-related work loss exceeds $20 billion per year.[12][71] This accounts for 40% of time lost from work in the United States.[72]

Research

A number of antivirals have been tested for effectiveness in the common cold. As of 2009, none have been both found effective and licensed for use.[73] There are ongoing trials of the antiviral drug pleconaril. It shows promise against picornaviruses. There are also ongoing trials of BTA-798.[74] The oral form of pleconaril had safety issues and an aerosol form is being studied.[74]

Researchers from University of Maryland, College Park and University of Wisconsin–Madison have mapped the genome for all known virus strains that cause the common cold.[75]

References

  1. ↑ 1.0 1.1 Eccles Pg. 24
  2. ↑ 2.0 2.1 2.2 2.3 2.4 Arroll, B (2011 Mar 16). "Common cold". Clinical evidence. 2011 (03). PMID 21406124. {{cite journal}}: Check date values in: |date= (help)
  3. ↑ 3.00 3.01 3.02 3.03 3.04 3.05 3.06 3.07 3.08 3.09 Eccles R (2005). "Understanding the symptoms of the common cold and influenza" (PDF). Lancet Infect Dis. 5 (11): 718–25. doi:10.1016/S1473-3099(05)70270-X. PMID 16253889. {{cite journal}}: Unknown parameter |month= ignored (help)
  4. ↑ Eccles Pg.26
  5. ↑ Eccles Pg. 129
  6. ↑ Eccles Pg.50
  7. ↑ Eccles Pg.30
  8. ↑ Heikkinen T, Järvinen A (2003). "The common cold". Lancet. 361 (9351): 51–9. doi:10.1016/S0140-6736(03)12162-9. PMID 12517470. {{cite journal}}: Unknown parameter |month= ignored (help)
  9. ↑ Goldsobel AB, Chipps BE (2010). "Cough in the pediatric population". J. Pediatr. 156 (3): 352–358.e1. doi:10.1016/j.jpeds.2009.12.004. PMID 20176183. {{cite journal}}: Unknown parameter |month= ignored (help)
  10. ↑ Palmenberg, A. C.; Spiro, D; Kuzmickas, R; Wang, S; Djikeng, A; Rathe, JA; Fraser-Liggett, CM; Liggett, SB (2009). "Sequencing and Analyses of All Known Human Rhinovirus Genomes Reveals Structure and Evolution". Science. 324 (5923): 55–9. doi:10.1126/science.1165557. PMID 19213880.
  11. ↑ Eccles Pg.77
  12. ↑ 12.0 12.1 12.2 "Common Cold". National Institute of Allergy and Infectious Diseases. 27 November 2006. Retrieved 11 June 2007.
  13. ↑ Eccles Pg.107
  14. ↑ 14.0 14.1 14.2 editors, Ronald Eccles, Olaf Weber, (2009). Common cold (Online-Ausg. ed.). Basel: Birkhäuser. p. 197. ISBN 9783764398941. {{cite book}}: |last= has generic name (help)CS1 maint: extra punctuation (link) CS1 maint: multiple names: authors list (link)
  15. ↑ 15.0 15.1 Eccles Pg.211
  16. ↑ 16.0 16.1 16.2 16.3 al.], edited by Arie J. Zuckerman ... [et (2007). Principles and practice of clinical virology (6th ed. ed.). Hoboken, N.J.: Wiley. p. 496. ISBN 9780470517994. {{cite book}}: |edition= has extra text (help); |first= has generic name (help)
  17. ↑ Gwaltney JM Jr; Halstead SB. {{cite journal}}: |contribution= ignored (help); Cite journal requires |journal= (help); Missing or empty |title= (help); Unknown parameter |author-separator= ignored (help) Invited letter in "Questions and answers". Journal of the American Medical Association. 278 (3): 256–257. 16 July 1997. Retrieved 16 September 2011.
  18. ↑ Zuger, Abigail (4 March 2003). "'You'll Catch Your Death!' An Old Wives' Tale? Well..." The New York Times.
  19. ↑ Mourtzoukou, EG (2007 Sep). "Exposure to cold and respiratory tract infections". The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease. 11 (9): 938–43. PMID 17705968. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
  20. ↑ Eccles Pg.79
  21. ↑ Eccles Pg.80
  22. ↑ Eccles Pg.80
  23. ↑ Eccles Pg. 157
  24. ↑ 24.0 24.1 24.2 Eccles Pg. 78
  25. ↑ Eccles Pg.166
  26. ↑ Cohen S, Doyle WJ, Alper CM, Janicki-Deverts D, Turner RB (2009). "Sleep Habits and Susceptibility to the Common Cold". Arch. Intern. Med. 169 (1): 62–7. doi:10.1001/archinternmed.2008.505. PMC 2629403. PMID 19139325. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  27. ↑ Eccles Pg.160–165
  28. ↑ 28.0 28.1 28.2 Eccles Pg. 112
  29. ↑ 29.0 29.1 Eccles Pg.116
  30. ↑ 30.0 30.1 Eccles Pg.122
  31. ↑ 31.0 31.1 Eccles Pg. 51–52
  32. ↑ 32.0 32.1 32.2 Eccles Pg.209
  33. ↑ Lawrence DM (May 2009). "Gene studies shed light on rhinovirus diversity". Lancet Infect Dis. 9 (5): 278. doi:10.1016/S1473-3099(09)70123-9.
  34. ↑ 34.0 34.1 34.2 Jefferson, T (2011 Jul 6). "Physical interventions to interrupt or reduce the spread of respiratory viruses". Cochrane database of systematic reviews (Online) (7): CD006207. doi:10.1002/14651858.CD006207.pub4. PMID 21735402. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
  35. ↑ 35.0 35.1 Singh, M (2011 Feb 16). "Zinc for the common cold". Cochrane database of systematic reviews (Online) (2): CD001364. doi:10.1002/14651858.CD001364.pub3. PMID 21328251. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
  36. ↑ 36.0 36.1 Hemilä, Harri; Chalker, Elizabeth; Douglas, Bob; Hemilä, Harri (2007). Hemilä, Harri (ed.). "Vitamin C for preventing and treating the common cold". Cochrane database of systematic reviews (3): CD000980. doi:10.1002/14651858.CD000980.pub3. PMID 17636648.
  37. ↑ "Common Cold: Treatments and Drugs". Mayo Clinic. Retrieved 9 January 2010.
  38. ↑ 38.0 38.1 38.2 38.3 38.4 Simasek M, Blandino DA (2007). "Treatment of the common cold". American Family Physician. 75 (4): 515–20. PMID 17323712.
  39. ↑ Eccles Pg.261
  40. ↑ Kim SY, Chang YJ, Cho HM, Hwang YW, Moon YS (2009). Kim, Soo Young (ed.). "Non-steroidal anti-inflammatory drugs for the common cold". Cochrane Database Syst Rev (3): CD006362. doi:10.1002/14651858.CD006362.pub2. PMID 19588387.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  41. ↑ Eccles R (2006). "Efficacy and safety of over-the-counter analgesics in the treatment of common cold and flu". Journal of Clinical Pharmacy and Therapeutics. 31 (4): 309–319. doi:10.1111/j.1365-2710.2006.00754.x. PMID 16882099.
  42. ↑ Smith SM, Schroeder K, Fahey T (2008). Smith, Susan M (ed.). "Over-the-counter medications for acute cough in children and adults in ambulatory settings". Cochrane Database Syst Rev (1): CD001831. doi:10.1002/14651858.CD001831.pub3. PMID 18253996.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  43. ↑ 43.0 43.1 Shefrin AE, Goldman RD (2009). "Use of over-the-counter cough and cold medications in children". Can Fam Physician. 55 (11): 1081–3. PMC 2776795. PMID 19910592. {{cite journal}}: Unknown parameter |month= ignored (help)
  44. ↑ Vassilev, ZP (2010 Mar). "Safety and efficacy of over-the-counter cough and cold medicines for use in children". Expert opinion on drug safety. 9 (2): 233–42. doi:10.1517/14740330903496410. PMID 20001764. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
  45. ↑ Eccles Pg. 246
  46. ↑ Taverner D, Latte J (2007). Latte, G. Jenny (ed.). "Nasal decongestants for the common cold". Cochrane Database Syst Rev (1): CD001953. doi:10.1002/14651858.CD001953.pub3. PMID 17253470.
  47. ↑ Albalawi, ZH (2011 Jul 6). "Intranasal ipratropium bromide for the common cold". Cochrane database of systematic reviews (Online) (7): CD008231. doi:10.1002/14651858.CD008231.pub2. PMID 21735425. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
  48. ↑ Pratter, MR (2006 Jan). "Cough and the common cold: ACCP evidence-based clinical practice guidelines". Chest. 129 (1 Suppl): 72S–74S. doi:10.1378/chest.129.1_suppl.72S. PMID 16428695. {{cite journal}}: Check date values in: |date= (help)
  49. ↑ Guppy, MP (2011 Feb 16). "Advising patients to increase fluid intake for treating acute respiratory infections". Cochrane database of systematic reviews (Online) (2): CD004419. doi:10.1002/14651858.CD004419.pub3. PMID 21328268. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
  50. ↑ Singh, M (2011 May 11). "Heated, humidified air for the common cold". Cochrane database of systematic reviews (Online) (5): CD001728. doi:10.1002/14651858.CD001728.pub4. PMID 21563130. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
  51. ↑ Paul IM, Beiler JS, King TS, Clapp ER, Vallati J, Berlin CM (2010). "Vapor rub, petrolatum, and no treatment for children with nocturnal cough and cold symptoms". Pediatrics. 126 (6): 1092–9. doi:10.1542/peds.2010-1601. PMID 21059712. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  52. ↑ 52.0 52.1 Arroll B, Kenealy T (2005). Arroll, Bruce (ed.). "Antibiotics for the common cold and acute purulent rhinitis". Cochrane Database Syst Rev (3): CD000247. doi:10.1002/14651858.CD000247.pub2. PMID 16034850.
  53. ↑ Eccles Pg.238
  54. ↑ Eccles Pg.234
  55. ↑ Eccles Pg.218
  56. ↑ Oduwole, O (2010 Jan 20). "Honey for acute cough in children". Cochrane database of systematic reviews (Online) (1): CD007094. doi:10.1002/14651858.CD007094.pub2. PMID 20091616. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
  57. ↑ Kassel, JC (2010 Mar 17). "Saline nasal irrigation for acute upper respiratory tract infections". Cochrane database of systematic reviews (Online) (3): CD006821. doi:10.1002/14651858.CD006821.pub2. PMID 20238351. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
  58. ↑ Heiner, Kathryn A; Hart, Ann Marie; Martin, Linda Gore; Rubio-Wallace, Sherrie (2009). "Examining the evidence for the use of vitamin C in the prophylaxis and treatment of the common cold". Journal of the American Academy of Nurse Practitioners. 21 (5): 295–300. doi:10.1111/j.1745-7599.2009.00409.x. PMID 19432914.
  59. ↑ 59.0 59.1 Linde K, Barrett B, Wölkart K, Bauer R, Melchart D (2006). Linde, Klaus (ed.). "Echinacea for preventing and treating the common cold". Cochrane Database Syst Rev (1): CD000530. doi:10.1002/14651858.CD000530.pub2. PMID 16437427.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  60. ↑ Sachin A Shah, Stephen Sander, C Michael White, Mike Rinaldi, Craig I Coleman (2007). "Evaluation of echinacea for the prevention and treatment of the common cold: a meta-analysis". The Lancet Infectious Diseases. 7 (7): 473–480. doi:10.1016/S1473-3099(07)70160-3. PMID 17597571.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  61. ↑ 61.0 61.1 Eccles Pg. 1
  62. ↑ Eccles Pg.76
  63. ↑ Eccles Pg.90
  64. ↑ Eccles Pg. 3
  65. ↑ Eccles Pg.6
  66. ↑ "Cold". Online Etymology Dictionary. Retrieved 12 January 2008.
  67. ↑ Eccles Pg.20
  68. ↑ Tyrrell DA (1987). "Interferons and their clinical value". Rev. Infect. Dis. 9 (2): 243–9. doi:10.1093/clinids/9.2.243. PMID 2438740.
  69. ↑ Al-Nakib, W; Higgins, PG; Barrow, I; Batstone, G; Tyrrell, DA (1987). "Prophylaxis and treatment of rhinovirus colds with zinc gluconate lozenges". J Antimicrob Chemother. 20 (6): 893–901. doi:10.1093/jac/20.6.893. PMID 3440773. {{cite journal}}: Unknown parameter |month= ignored (help)
  70. ↑ Eccles Pg.90
  71. ↑ 71.0 71.1 71.2 Fendrick AM, Monto AS, Nightengale B, Sarnes M (2003). "The economic burden of non-influenza-related viral respiratory tract infection in the United States". Arch. Intern. Med. 163 (4): 487–94. doi:10.1001/archinte.163.4.487. PMID 12588210.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  72. ↑ Kirkpatrick GL (1996). "The common cold". Prim. Care. 23 (4): 657–75. doi:10.1016/S0095-4543(05)70355-9. PMID 8890137. {{cite journal}}: Unknown parameter |month= ignored (help)
  73. ↑ Eccles Pg.218
  74. ↑ 74.0 74.1 Eccles Pg.226
  75. ↑ "Genetic map of cold virus a step toward cure, scientists say". Val Willingham. CNN. 2009. Retrieved 28 April 2009. {{cite news}}: Unknown parameter |month= ignored (help)
References
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