1. Current and future therapeutic approaches to the common cold
Exper. Rev.2003
R2 손재돈

2. Pathophysiology Rhinovirus : most common
Transmission : hand contact, aerosol
Hypothesis
Cooling  upper airway vasoconstriction
Inhibition defenses
converting viral colonization
Symtom is Host inflammatory response
Develop 1~2 days, Peak 2~4 days
Nasal obstruction/rhinorrhea/sore throat
Malaise/headache/ low-grade fever
2~3 wks

3. Epidemiology Most common Acute illness in all ages
Increase in medical resource
Risk factors
Stress/Day-care in preschool/smoking
Protective factors
Red wine/Day-care in early school
Frequent cold in 2~3 ages
Likely to 6/8/11/13 ages

4. Current diagnostic approaches
Based on symtoms
Recent study, assessing Common cold
No definite predictive criteria
Rhinovirus DNA in Nasal swab
Useless in daily ER or Primary office

5. Current therapeutic approaches
1. Overview
Common cold : medically important
But, Cure is not very successful
Misconception/Misprescription
Many antiviral agents are few benefit
Combine antiviral & anti-inflammatory
Improve outcome
Maximum benefit early Dx. & Tx.

6. 3. Anticholinergics agents
2. Decongestants
α-adrenergic agonist
Pseudoephedrine(액티피드) /Phenylpropanolamine
Nasal obstruction/rhinorrhea
No evidence benefit after several days
3. Anticholinergics agents
Ipratropium( atrovent, inhalation)
Rhinorrhea/sneezing

7. 4. Antihistamines 5. Cough medicines
1st Antihistamines, chlorpheniramine
페니라민
Sneezing. Rhinorrhea, cough
2nd, Antihistamines, loratadine
클라리틴
only histamine receptor affect
Not pass BBB
5. Cough medicines
Mucolytics : modest beneficial
이외에는 similar to placebo

8. 6. Mast cell stabilizes 7. NSAID Sodium cromoglycate(클레신)
inhibit ICAM-1
ICAM-1, receptor for rhinovirus
No benefit in RCT
7. NSAID
Ibuprofen(캐롤)
Headache/sneezing/myalgia and cough
Combination other drugs : more effect

9. 8. Steam inhalation 9. Vitamin C
Symptom relief, but no reduction shedding
9. Vitamin C
Controversy
Recommend : 100mg daily intake
A study, 500mg*2/day in winter
Significant reduction in the number of cold
Faster recovery
But, fail to duplicated in large group

10. 10. Zinc 11. Echinacea Controversy similar to Vit.C
called the Purple coneflowers
popularly boost immune system in america
16 study, better than placebo

11. 12. Antibiotics 13. Steroids Most patients want to antiBiotics
‘Probably effective but not routinely recommended’
Amoxicillin(오그멘틴)/azithromycin(지스로맥스)/erythromycin(에릭)
No evidence benefit in placebo test
13. Steroids
Not effective in common cold

12. 14. Antiviral agents 241 studies, interferon and other agents
No licensed effective for common cold
Pleconaril, inhibit viral uncoating
In RCT, 1 day reduction to placebo
Symptom reduction 20% to placebo
But, antiviral agents developing

13. 15. Multivitamins & minerals
Daily Vit. E & multivitamine-mineral diet in well-nourished people
No favorable effect in Acute URI
Another study in DM people
Significantly fewer infection
Subclinical deficiency in DM individuals

14. Vaccine development Ultimate goal Hampered factors
Large variety of virus
High rate of re-infection despite antigenic variation
Extensive variability in viral coat proteins
Variable efficacy in immunity state
Potential pathogenicity in neonates

15. Optimal therapy Educating patients about illness
Targeting most distress symptom
Adequate rest/humidity/take warm fluid/
well-diet/elevate head of bed
α-adrenergic agonist/anticholinergics/antihistamine
Nasal obstruction/rhinorrhea
NSAIDS or AAP : treat systemic symptom
Vit C/Zinc/echinacea : controversial
Antibiotics : No role in common cold
Pleconaril : close to achive, not yet
Multivitamine : In diabetes

16. Phamacoeconomics 20 million days missed works
22million days missed school
25$ billion dollars
25 million office visits/years

17. Factors likely to affect choice of therapy
1. Patient compliance
Recurrent/several times daily > difficult
Clinical environment less compliance compare to study
2. Drug interactions & adverse effects
Decongestants
poorly controlled hypertention ->
Phenylopropanolamine take off
d/t hemorrhagic stroke incidence raise
Rebound nasal congestants

18. 1st antihistamines NSAID Warm stream Vit C Zinc Echinacea Pleconaril
Confusion
Affect CNS system
NSAID
Renal impairment/GI bleeding/Aseptic meningitis
Warm stream
Burns/microrganism
Vit C
Diarrhea
Zinc
Nausea & 식욕저하
Echinacea
Anaphylaxis
Pleconaril
GI disturbance/menstrual irregularity

19. Conclusions Symptomatic measures -> current mainstay
Specific antiviral agent : not available
Zinc/Vit C/echinacea : controversial
Any agent start as soons as onset

20. Prescription
액티피드
클라리틴 캐롤
Betadine 가글