The Pharmaceutical Journal
Vol 268 No 7181 p51
19 January 2002

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Why 2002 started with a common cold

For a large number of people in the United Kingdom, the new year began with a cold. Clare Bellingham finds out more

It seems that the cold and 'flu season has arrived. Approximately eight million people across the United Kingdom are currently suffering from a cold and it is likely that a large proportion of them will turn to a pharmacist for treatment. The incidence of influenza, on the other hand, remains low.

"There are a lot of colds around at the moment," according to Professor Ron Eccles, director of the Common Cold Research Centre, University of Cardiff. "The levels have been increased since New Year. We could have expected this to happen to some extent because of the cold spell at New Year after an unseasonably warm autumn. However, there are more colds around compared with last year," he said.

Although Professor Eccles suspects that we are at the peak of this particular outbreak, he said that this was impossible to predict with certainty. "If the weather warms up then the virus levels will fall but if it becomes colder, the virus levels will increase and the number of colds could increase." But why do more colds occur during the winter compared with the summer? People spend more time indoors which might help virus spread, levels in winter of ultraviolet light which kills viruses are lower, colder air can cool the nose allowing faster virus replication, and the increased stress of Christmas might suppress the immune system.

The current cold outbreak appears to involve a virus that causes more coughs and sore throats and fewer nasal symptoms, Professor Eccles said. He recommends using the Beechams Cold and 'Flu scale, which monitors frequency of illness (see Panel). The scale can be found at www.coldsandflu.co.uk.

Although the risk of catching a cold seems to be high. According to the Public Health Laboratory Service this week, levels of influenza across the UK remain low.

Meanwhile, research published in the BMJ (2002;324:89) has found a decline in the annual rate of deaths from influenza over the past 30 years. This could be due to immunisation and to a reduction in the number of new viral strains. The research also identified that, of 1,265 annual excess winter deaths per million over the past 10 years, 2.4 per cent were due to influenza, either directly or indirectly.

Treating colds

Pharmacists are well informed on cold remedies and there is an increasing trend for patients to contact pharmacists first when they catch a cold, said Professor Eccles.

It would certainly appear that this is the case. The Birmingham research unit of the Royal College of General Practitioners has not registered an increase in the number of consultations with GPs for colds in recent weeks, despite the apparent high numbers of cases registered by the Beecham scale. The unit records numbers of consultations in 78 GP practices. The numbers of consultations for colds in these practices over the past three weeks were 160, 210 and 213, respectively.

Treating colds

So what remedies should pharmacists be recommending? There is no cure for the common cold, but symptom relief can be offered. According to Professor Eccles, the most effective remedies for colds are analgesics. Paracetamol, ibuprofen and aspirin are equally effective. "Analgesics relieve fever, chills, sore throats, headaches and sinus pain," he said. After analgesics, he recommended topical decongestants over oral formulations and said that although the efficacy of cough syrups "was not great" that the vehicle they are in can be useful. "Steam inhalation provides a lot of relief of sore throat and sinus pain, especially if menthol or eucalyptus is added." He also recommended use of a daily dose of 2g vitamin C for its antioxidant effect during a cold.

Antibiotics

The Department of Health launched a campaign this month to raise awareness that antibiotics will not cure colds, coughs and sore throats. Dr Pat Troop, the deputy chief medical officer, said: "Although most people realise that antibiotics do not work for colds, the fact that they do not work for the majority of coughs and sore throats is less well known. This campaign will help people understand why they are not being prescribed antibiotics for these illnesses."

The campaign's leaflet advises patients to get advice about paracetamol or a cold remedy from a pharmacist, and to see a GP only if the cough lasts longer than three weeks, if the patient becomes short of breath, develops chest pain, or if the person already has a chest complaint.

Using an information leaflet to explain why antibiotics are not usually needed for acute bronchitis has been shown by new research to be a safe strategy which reduces antibiotic use (BMJ 2002;324:91). However, research published in December suggested that falls in antibiotic prescribing might be linked to increases in deaths from pneumonia (PJ, 8 December 2001, p808).

Pharmacists, as patients' first contact point, can provide treatments and advice, and help to identify at-risk patients who might need an antibiotic.