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 For adults, there's little evidence that decongestants help with
congestion, one of the most bothersome cold symptoms. For kids,
there is no clear evidence they work at all, but plenty of research
showing mild or potentially dangerous side effects, the study team
writes in The BMJ.
"The common cold is very common and affects everyone all over the
world," said lead author Dr. Mieke van Driel of the University of
Queensland in Brisbane, Australia.
The common cold is caused by a virus and tends to run its course in
7 to 10 days, the authors write. Typically, children have about six
to eight colds per year, and adults have two to four.
To see what symptoms patients find most bothersome, van Driel and
colleagues asked 10 customers seeking over-the-counter treatments at
a community pharmacy in Belgium what concerned them the most.
"Evidence about health is only relevant if it addresses things that
matter to patients," van Driel said by email. "We wanted to make
sure our evidence summary was useful to them and asked them to guide
us."
The customers heavily emphasized nasal symptoms, so the research
team decided to focus their research review on treatments for
congestion, a runny nose and sneezing.
The researchers looked at studies assessing the effects of
decongestants, antihistamines, analgesics, intranasal
corticosteroids, herbal remedies, vitamins and minerals such as
zinc, as well as saline nasal rinses, vapor rub and inhaled steam.
Overall, they found little evidence to support the idea that any
over-the-counter cold treatments help nasal symptoms significantly,
and the drugs tend to have side effects such as insomnia,
drowsiness, headache, and stomachache.
They also found few trials in children under age 12. One study found
low evidence that saline irrigations or drops could be safe for
young children. A few small studies reported contradictory results
for the effectiveness of decongestants and antihistamines in kids.
In one review, which covered four randomized controlled trials with
a total of 1,466 adult participants, sedating antihistamines helped
with runny nose and sneezing symptoms but not nasal congestion. With
non-sedating antihistamines, however, none of the symptoms seemed to
improve.
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Antibiotics and intranasal corticosteroids were not shown to improve
symptoms either.
When it comes to more "natural" remedies, the researchers found that
clinical trials investigating Echinacea, vitamin C, zinc lozenges,
and heated humidified steam did not even address nasal symptoms. One
review concluded that saline irrigations were not likely to be
effective. Zinc was shown to reduce the overall duration but not the
severity of cold symptoms.
"Vitamin C is usually perceived as an effective, harmless and
inexpensive therapeutic alternative," said Angela Ortigoza of
Pontifical Catholic University in Santiago, Chile, who wasn't
involved in the current study.
Although vitamin C does help the immune system, taking it to prevent
a common cold usually won't work, they said.
"It might be difficult to make patients desist from such deep-rooted
preconceived ideas, even considering the certainty of this evidence,
so variability in decision-making is to be expected," she said.
The study team didn't find any studies of probiotics, garlic,
Chinese medicinal herbs, vapor rub, eucalyptus oil, honey, ginseng
or increased fluid intake for nasal cold symptoms.
There are 17 ongoing trials investigating common cold treatments,
including 12 for adults, four for kids and one for all ages. Five
trials will report on nasal symptoms, including one for kids, van
Driel noted.
"There are some trials in the pipeline studying herbal remedies, but
we think it is unlikely that these products will be effective enough
to make a real difference in well-being and illness," van Driel
said. "The search for a 'magic bullet for the common cold' may need
to take another approach."
SOURCE: https://bit.ly/2Cqasf3 BMJ, online October 10, 2018.
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