The common cold
A cold is not one illness but a collective name for dozens of viruses that set up home in the nose and throat.
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Medicines commonly prescribed for The common cold
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: TABLET, 500 mgActive substance: paracetamolManufacturer: Kern Pharma S.L.Prescription requiredDosage form: TABLET, 650 mgActive substance: paracetamolManufacturer: Teva B.V.Prescription not requiredDosage form: EFFERVESCENT TABLET, 1000 mgActive substance: paracetamolManufacturer: Industria Quimica Y Farmaceutica Vir S.A.Prescription required
A cold is not one illness but a collective name for dozens of viruses that set up home in the nose and throat. An adult goes through it two to four times a year and a child in nursery roughly twice as often, and that is not a sign of a weak immune system but a sign of one getting acquainted with the world. No medicine kills these viruses, and most likely none ever will: there are too many of them and they change too fast. What does exist is a perfectly sensible set of things that make the week easier, and a much more important set of signs that mean something other than a cold is hiding behind it.
The week it takes, and the cough that outstays everything
A cold does not arrive all at once. First the throat feels scratchy or raw, a day later the nose blocks up and the sneezing starts, and another day or two after that the cough joins in. Then things ease off, but not symptom by symptom in step: the nose usually clears by the end of the first week, while the cough hangs on longest and can run for two to three weeks after everything else has gone. That is the normal course of events, not a stalled one.
Along the way one thing is almost guaranteed to happen. Around day three to five the clear discharge from the nose thickens and turns yellow or greenish. The colour frightens people more than anything else and means precisely nothing. It comes not from bacteria but from your own blood cells arriving in the lining; the shade has no bearing on what treatment is chosen and is not a reason for antibiotics.
Other things that belong in the ordinary picture: a hoarse voice, a heavy blocked feeling in the ears and across the cheekbones, aching muscles, a mild temperature, loss of taste and smell while the nose is stuffed, and general flatness. In small children a cold lasts longer and looks different: the child is fretful, eats and sleeps badly, breathes through the mouth, and may vomit up a feed after a bout of coughing. On its own, none of that is cause for alarm.
Cold, flu, or something else wearing the same clothes
The difference from flu lies mainly in how fast and how hard it lands. A cold builds over two or three days, stays in the nose and throat, and lets you get on with things, even if it takes an effort. Flu flattens you within hours: high temperature, aching all over, headache, and a total collapse of energy that puts your plans off for you. The cough with flu is more often dry and gruelling, and a runny nose is not the main event.
Several other things start out looking similar and are worth telling apart:
- a sore throat with no runny nose and no cough, with a high temperature, coating on the tonsils and enlarged glands in the neck, is no longer a cold, and a throat like that needs a doctor to look at it;
- a sudden loss of smell and taste while the nose is clear is a reason to think about covid and to test, particularly if there are older people or people with serious illness nearby;
- a clear runny nose with itching in the nose and eyes, sneezing in volleys, arriving at the same time every year and without any temperature, is allergy rather than a virus;
- getting worse after five to seven days of clear improvement, with pain and a bursting pressure over the forehead or cheekbones and blockage on one side, is what sinusitis on top of a cold looks like;
- in a baby under one year, a cough with frequent wheezy breathing and difficulty feeding points to the common winter infection of the small airways, and that needs examining.
What genuinely helps, and what to handle with care
There is no way to speed up recovery, so everything you do, you do for the sake of feeling better. Not much works, but what does work is dependable.
- Sleep and rest. Taking the first few days lying down is not self-indulgence: going short of sleep measurably lengthens the illness.
- Fluids. Warm drinks soothe the throat and loosen mucus; drink to thirst, since pouring litres into yourself achieves nothing.
- Honey for a cough is one of the few home remedies with a proven effect, taken neat or stirred into a warm drink. Honey must not be given to babies under one year because of the risk of botulism.
- Saline drops or spray for the nose. These are a particular rescue in babies: instilling drops and suctioning out the mucus before a feed is often the only way to let the child eat properly.
- Humid air, a cool aired room, and the head of the bed raised at night.
- Gargling with warm salty water, for adults and for children who will reliably not swallow it.
- Painkillers and fever medicines from the paracetamol and anti-inflammatory groups take the edge off a sore throat, headache and body aches. In children the dose is worked out by weight, not by age.
Now for the things that call for more caution. Decongestant drops and sprays really do clear the nose, but they must not be used for more than a few days in a row: the lining answers withdrawal with even more swelling, and the person ends up dependent on the bottle. Ready-made combination cold powders and tablets almost always contain paracetamol, so taking paracetamol separately alongside them makes it easy to exceed the safe daily dose, which is the commonest cause of accidental liver poisoning. Combination cough and cold remedies are not given at all to children under six, and between six and twelve only on the advice of a pharmacist or doctor. Aspirin is not given to children or teenagers with a viral illness at all: it is linked to a rare but lethal form of damage to the liver and brain. The exact age cut-off is written differently from country to country, so it is simpler to remember the rule whole: a child with a cold does not get aspirin. Breathing steam over a bowl of boiling water is best avoided, especially with children, since the benefit is close to nil and scalds happen regularly; sitting in the bathroom with a hot shower running is safer.
Vitamin C, echinacea and garlic have not shown in studies that they prevent colds or shorten them appreciably. Zinc preparations have some evidence behind them, but the effect is modest, while nausea and a metallic taste are common; zinc preparations must never be used in the nose, as cases of lasting loss of smell have been described.
A separate word on antibiotics: in a cold they are useless. An antibiotic acts on bacteria, and what is at work here is a virus, which will not soften and will not shorten the illness, while the risk of diarrhoea, rash, allergy and growing bacterial resistance remains, to be met for real later on. Neither green discharge nor a lingering cough justifies an antibiotic on its own.
The signs that cannot wait until morning
Call the emergency services, which across Europe means 112, or take the person to urgent care if any of the following appears:
- breathing has become difficult: breathlessness at rest, an inability to finish a sentence, rapid shallow breathing; in a child, flaring nostrils, skin pulling in between and below the ribs, grunting on the out-breath, the head bobbing in time with each breath;
- the lips, tongue, face or fingertips have turned blue or grey;
- chest pain, especially crushing pain or pain tied to breathing;
- confusion, delirium, difficulty waking the person, or a child who is limp and not responding as usual;
- a seizure;
- a rash that does not fade when a clear glass is pressed against it;
- a sudden severe headache with a stiff neck and an inability to tolerate light;
- signs of dehydration: dry mouth, no urine for many hours, and in a baby a dry nappy, no tears when crying, a sunken soft spot on the head;
- a temperature of 38 degrees or above in a baby under three months, which at that age always means being seen within the hour, however calm the child appears.
A non-urgent appointment within the next day or so is worth arranging if the temperature lasts more than three days or comes back after a clear recovery; if things worsen again after a week of improvement; if there is no improvement at all by day ten; if the cough runs beyond three weeks; if an ear becomes painful or starts discharging; or if the throat hurts on one side badly enough to make swallowing and opening the mouth difficult. Do not put off getting advice even for ordinary-looking symptoms if you have chronic heart, lung or kidney disease or diabetes, if your immune system is weakened by treatment, if you are pregnant, or where a very young child or an older person is concerned: in them the picture can be muted and the complications fast.
Keeping it from travelling round the household
The virus scatters in droplets during coughing, sneezing and talking, and it also travels on hands: from a door handle, a mug, a toy or a handrail it can reach a mucous membrane hours after it landed there. A person is infectious from roughly a day before symptoms appear and throughout the first week, and children stay infectious longer.
What is worth doing:
- washing hands with soap, unhurriedly, and doing it after coughing, after sneezing and on getting home;
- sneezing and coughing into a tissue or the crook of the elbow, and binning the tissue straight away;
- not sharing towels, mugs or spoons, and not passing other children toys that have been in the mouth;
- airing rooms, since the virus survives longer in the stale air of a closed space;
- staying home where possible while the temperature lasts, and keeping away from newborns, older people and anyone on treatment that suppresses the immune system;
- not smoking, and not smoking near a child: tobacco smoke prolongs a cough and raises the risk of ear infection.
The flu vaccine offers no protection against colds, since these are different viruses. It does sharply cut the chance of catching flu, which in those same at-risk groups runs an incomparably heavier course, so it is well worth having.
Online consultation
Three things are convenient to work through remotely. The first is whether this is an ordinary cold or a picture that calls for an in-person examination and tests: the doctor will ask about timing, temperature, the character of the cough and the breathing, and will say whether to wait or to go in. The second is what you personally can take: how to avoid doubling up on paracetamol, what is suitable in pregnancy and while breastfeeding, how to calculate a child's dose by weight, and what to use instead of decongestant drops when the nose has been blocked for a week. The third is what to do when a cold lands on top of a chronic condition: whether the usual medicines need adjusting and when to raise the alarm. The warning signs listed above are not handled remotely; they call for urgent care.
This material is for information only and does not replace medical advice.
Consult with a doctor about The common cold
Discuss your symptoms and possible next steps with a doctor online.
Online doctors for The common cold
Discuss your symptoms and possible next steps for The common cold with a doctor online.
