Colds

What is a cold?

The common cold is an inflammation of the upper respiratory tract most often caused by one of the more than 100 types of rhinovirus. People may get multiple colds throughout their lifetimes, generally with a different rhinovirus causing a similar cluster of cold symptoms. A cold typically lasts 3-7 days but it is not uncommon for some symptoms to persist up to 2 weeks. A cold is different than “the flu” which is caused by influenza virus and is associated with high fever and more severe symptoms.

How common is the common cold?

It is estimated that in one year people in the U.S. suffer 1 billion colds. Adults average about 2 to 4 colds a year, although the range varies widely. Women, especially those aged 20 to 30 years, have more colds than men, possibly because of their closer contact with children. Colds are most prevalent among children, who average 6 to 10 colds a year.

What are the symptoms?

Symptoms of the common cold usually begin 2 to 3 days after infection and often include:

  • Runny or stuffed nose
  • Sore or scratchy throat (often occurs early on, then fades)
  • Hoarseness/headaches and muscle aches
  • Blocked/popping feeling in ears
  • Cough (often occurs 4-5 days into cold)
  • Postnasal drip
  • Watery eyes
  • Decreased appetite
  • Fatigue/malaise
  • Low grade fever

Cold symptoms can last from 2 to 14 days, but two-thirds of people recover in a week. If symptoms occur often or last much longer than 2 weeks, they may be the result of an allergy rather than a cold.

Colds occasionally can lead to secondary bacterial infections of the middle ear or sinuses, requiring treatment with antibiotics. High fever, significantly swollen glands, severe facial pain in the sinuses, and a cough that produces mucus, may indicate a complication or more serious illness requiring a medical provider's attention.

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How do you catch a cold?

People with colds carry viral particles on their hands for a couple of hours after touching their own noses. They can transmit the cold virus to another by direct contact (handshake eg) or by contaminating surfaces that others touch and then spread to their own noses, mouths, or eyes. Viral particles can also be spread when cold sufferers sneeze, cough, or just exhale. Colds are not caused by cold temperatures, but some cold viruses are acquired more often in the fall and spring, others in the winter, and still others are responsible for most colds during the summer. It is not uncommon for adults to have 2-3 colds per year, and children 5-7. 

Not everyone who is exposed to a cold virus catches a cold. Your body may have previously developed immunity to a particular rhinovirus. Other factors are age, general health, smoking, lack of sleep, and intensity and duration of the exposure. It has not been proven that stress suppresses your body’s natural immunity, but research has linked psychological stress to a greater incidence of colds.

Much of the research on the transmission of the common cold has been done with rhinoviruses, which are shed in the highest concentration in nasal secretions. Studies suggest a person is most likely to transmit rhinoviruses in the second to fourth day of infection, when the amount of virus in nasal secretions is highest. Researchers also have shown that using aspirin to treat colds increases the amount of virus shed in nasal secretions, possibly making the cold sufferer more of a hazard to others. Teenagers and children should not take aspirin for a cold because it can cause Reye syndrome, a rare but serious illness.

How are colds treated?

There is no cure for the common cold. Antibiotics, which are only effective against bacteria, are not necessary or curative for cold or flu viruses. In fact, overuse of antibiotics for colds can lead to bacteria developing resistance to antibiotics. Most treatments for colds are for symptom relief, but cannot shorten or cure the cold. The symptoms of colds are self-limited - they will go away over time, even with no treatment.

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How can I take care of myself when I have a cold?

Fluids: Keep well hydrated, a minimum of 8 glasses of water daily is reasonable.

Rest: Try to get at least 8 hours of sleep daily – “baby yourself” with extra rest if possible.

Stop or cut back on smoking: Smokers catch more colds, recover from them more slowly, and are more prone to complications. Learn more about smoking cessation.

Lozenges/cough drops/sore throat sprays: There are many brands, some with “pain numbing” features, but even hard candy can provide some coating, soothing action.

Humidifying the air: Steam in the form of hot showers, a wet towel hung in the room, a pan of water on the radiator, or best yet, a vaporizer/humidifier in your room can help congestion symptoms.

Other treatments: Zinc lozenges, Vitamin C, herbal products such as Echinacea are advertised to treat or prevent colds. While none are likely to cause harm, unless large amounts are taken over a long period, none have been consistently effective in clinical trials. 

For nasal/sinus congestion and post nasal drip:

Daytime: Try pseudoephedrine (eg, Sudagest/Sudafed) following package directions. This decongestant pill is the most effective oral decongestant, but it must be requested at stores as it is kept “behind the counter” rather than out on the shelf. Don’t take it near bedtime as some people are kept awake by it.

At bedtime: Try decongestant/antihistamine combination (eg, Aprodine/Actifed per directions), which is less likely to interfere with sleep. This is also kept “behind the counter”. Antihistamine products used alone for cold symptoms are less helpful for most people because of drying or sedating side effects.

Day or night: Decongestant nasal sprays (e.g., Afrin or generic equivalent, per package directions) can also be very effective for nasal and sinus congestion, but only for 3 days; after that some rebound congestion can occur.

Saline irrigation: Try a Neti Pot or other sinus irrigation system (e.g., McNeil Sinus Rinse) per product instructions, to clear your sinuses and posterior throat of mucus, by rinsing them out with saline solution. Especially for individuals prone to developing sinus infections after a cold, this may be a very helpful technique.

For fever, body aches, headache, sore throat:

Acetaminophen (Tylenol) regular strength 325 mg tabs – 2 tabs every 4-6 hours as needed.**
OR
Acetaminophen (Tylenol) extra strength 500 mg
tabs – 2 tabs every 6 hours as needed.**
OR
Ibuprofen (Advil, Motrin, Nuprin e.g.) over the counter strength – 200 mg tabs – 2 tabs every 4 hours as needed with food, or 3 tabs every 6 hours with food.**
OR as directed by your provider.

**Do not take more than 4000 mg acetaminophen daily or more than 2400 mg ibuprofen daily.
**Some over-the-counter cold products contain acetaminophen or ibuprofen in combination with other products, so be careful to read labels to avoid excessive doses. Similarly, read labels to make sure you know whether you are taking regular or extra strength acetaminophen, as this medicine is toxic at excessive doses. 

For cough:

There is debate among experts about the usefulness of cough suppressants and expectorants for cough that comes along with a cold. Generally, a wet, productive cough that produces mucus is good as it clears secretions. If your cough disturbs your sleep, try a hot drink, elevating your head a little on pillows, and humidifying your room.

An OTC cough medicine with dextromethoraphan (“DM”) (eg, Robitusin DM or generic equivalent, per package directions) may help some people who have bothersome dry, spasmodic cough. Guaifenisin (eg, Mucinex, taken per package directions), an expectorant, is available either by itself or as a common ingredient in cough/cold OTC remedies. Some people find this product helps to thin and mobilize mucus. 

See your provider if your cough is worsening, keeps you up without relief, or is associated with wheezing or shortness of breath. Other prescription medicine may be indicated. Brown students can make an appointment at Health Services by calling 401.863-3953. 

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Is there a cold vaccine?

No. The development of a vaccine that could prevent the common cold has reached an impasse because of the discovery of many different cold viruses. Each virus carries its own specific antigens, substances that induce the formation of specific protective proteins (antibodies) produced by the body. Until ways are found to combine many viral antigens in one vaccine, or take advantage of the antigenic cross-relationships that exist, prospects for a vaccine are dim. Evidence that changes occur in common-cold virus antigens further complicate development of a vaccine. Such changes occur in some influenza virus antigens and make it necessary to alter the influenza vaccine each year.

How do I prevent a cold? 

Hand washing, with soap and water or alcohol-based hand cleaners, is highly effective in preventing the spread of colds. Wash hands after touching communal surfaces, before touching your own eyes, nose, and mouth. Avoid sharing eating and drinking utensils. If possible, you should avoid close, prolonged exposure to people who have colds. If you have a cold, sneeze or cough into your crooked elbow to contain the spread of viral particles and/or use tissues, which should be promptly disposed of, and hands washed.

When should I see a medical provider about my cold? 

Most colds are self-limited and even if some symptoms last up to 2 weeks, there is some improvement gradually over time. Less commonly, some cold viruses can suppress the immune response and secondary infection with a new virus or bacteria may occur, usually after the cold has been lingering for some time. Examples of such complications of colds include sinus infection, bronchitis, pneumonia, ear infection.

The appearance of thick yellow-green nasal discharge is a normal phase of the common cold and in and of itself does not suggest that a cold has developed into a sinus infection. 
Also, most people will have some pain/pressure in the face in the first 4-5 days of a cold. It should resolve as the cold improves.

Regarding fevers, for adults/young adults, only a temperature over 99.6 is considered a fever, even in people whose usual temperature fall below 98.6 (a normal finding). Low-grade fevers associated with familiar symptoms of a cold are usually not concerning, and are often lower in the morning, creeping up in the afternoon. 

The symptoms that follow suggest that you may not have a simple common cold, or that a complication of cold may be occurring. See your medical provider (Brown students should call Health Services at 401.863-3953 for an appointment ) if you experience:

  • Fever of 100 for over 3 days, especially with very sore throat
  • Fever of 101 or more at any time
  • Neck pain or stiffness
  • Severe pain in chest, face, head, ears, throat
  • Wheezing or shortness of breath
  • Cold symptoms lasting over 2 weeks, which steadily worsen instead of improving
  • Painful swelling of neck glands
  • White patches on your throat or tonsils
  • Exacerbation of asthma symptoms
  • If you catch a cold but also have a serious chronic illness or immunosuppression 

Can I make an appointment at Health Services?

If you are a Brown student and you are concerned about your cold symptoms, you can make a confidential appointment at Health Services by calling 401.863-3953.  Health Services provides a range of services including general health care and emergency medical care. You can request a medical provider by gender or by name. We are located at 13 Brown Street on the corner of Brown and Charlesfield Streets.

Links you can use

National Institute of Allergies and Infectious Diseases
This site has information and fact sheets on preventing, diagnosing, and treating infectious and immune-mediated illnesses, including the common cold.

MEDLINE Plus
This site has several articles on common colds, including general overviews, treatment and prevention.

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Disclaimer: BWell Health Promiotion is part of Health Services at Brown University. Health Promotion maintains this site as a resource for Brown students. This site is not intended to replace consultation with your medical providers. No site can replace real conversation. Health Promotion offers no endorsement of and assumes no liability for the currency, accuracy, or availability of the information on the sites we link to or the care provided by the resources listed. Health Services staff are available to treat and give medical advice to Brown University students only. If you are not a Brown student, but are in need of medical assistance please call your own health care provider or in case of an emergency, dial 911. Please contact us if you have comments, questions or suggestions.