336 Therapy of Selected Diseases
Cough. Since coughing serves to expel ex-
‡ Common Cold
The common cold—colloquially the flu, ca-
tarrh, or grippe (strictly speaking the rarer
infection with influenza viruses)—is an acute
infectious inflammation of the upper respi-
ratory tract. Its symptoms—sneezing, run-
ning nose (due to rhinitis), hoarseness (lar-
yngitis), dif culty in swallowing and sore
throat (pharyngitis and tonsillitis), cough as-
sociated with first serous then mucous spu-
tum (tracheitis, bronchitis), sore muscles,
and general malaise—can be present individ-
ually or concurrently in varying combination
or sequence. The term stems from an old
popular belief that these complaints are
caused by exposure to chilling or dampness.
The causative pathogens are different viruses
(rhino-, adeno-, and parainfluenza viruses)
that may be transmitted by aerosol droplets
produced by coughing and sneezing.
Therapeutic measures. Causal treatment
with a virustatic is not possible at present.
Since cold symptoms abate spontaneously,
there is no compelling need to use drugs.
However, conventional remedies are in-
tended for symptomatic relief.
Rhinitis. Nasal discharge could be pre-
vented by parasympatholytics; however,
other atropine-like effects (p.108) would
have to be accepted. Parasympatholytics
are threfore hardly ever used, although a
corresponding action is probably exploited
in the case of H1-antihistaminics, an ingre-
dient of many cold remedies. Locally applied
(nasal drops), vasoconstricting α-sympatho-
mimetics decongest the nasal mucosa and
dry up secretions, clearing the nasal passage.
Long-term use may cause damage to nasal
mucous membranes (p. 94).
Sore throat, swallowing problems. De-
mulcent lozenges containing surface anes-
thetics such as lidocaine (caveat: benzocaine
and tetracaine contain an allergenic p-ami-
nophenyl group; p. 207) may provide short-
term relief; however, the risk of allergic re-
actions should be kept in mind.
Luellmann, Color Atlas of Pharmacology © 2005 Thieme
All rights reserved. Usage subject to terms and conditions of license.
cess tracheobronchial secretions, suppres-
sion of this physiological reflex is justified
only when coughing is dangerous (after sur-
gery) or unproductive because of absent se-
cretions. Codeine and noscapine (p. 210) sup-
press cough by a central action. A different,
though incompletely understood, mecha-
nism of action is evident in antitussives such
as clobutinol, which do not derive from opi-
um. The available clinical studies concerning
the benefits of antitussives in common colds
do not present a convincing picture.
Mucous airway obstruction. Expecto-
rants are meant to promote clearing of bron-
chial mucus by a liquefying action that
involves either cleavage of mucous substan-
ces (mucolytics) or stimulation of produc-
tion of watery mucus (e. g., hot beverages).
Whether mucolytics are indicated in the
common cold and whether expectorants
such as bromohexine or ambroxole effec-
tively lower viscosity of bronchial secretions
may be questioned. In clinical studies of
chronic obstructive bronchitis (but not com-
mon cold infections), N-acetylcysteine was
shown to have clinical effectiveness, as evi-
denced by a lowered incidence of exacerba-
tions during chronic intake.
Fever. Antipyretic analgesics (acetylsali-
cylic acid, acetaminophen, p.198) are indi-
cated only when there is high fever. Fever is
a natural response and useful in monitoring
the clinical course of an infection.
Muscle aches and pains, headache. Anti-
pyretic analgesics are effective in relieving
these symptoms.
 Common Cold 337

A. Drugs used in common cold

Soreness
Local use of Acetylsalicylic acid
α-sympathomimetics Headache
(nasal drops or spray)
Acetaminophen
Fever

Mucosal decongestion
Nose breathing facilitated
Caution: habituation Sniffles, runny nose
H1-Antihistamines
Caution: sedation
Common cold
Flu
Viral infection

Causal therapy
impossible

Surface anesthetics
Caution: Sore throat
risk of sensitization

CH3
Antitussive:
N

Cough
Codeine
H3CO O OH

O
Mucolytics
NH C CH3

HS CH2 C COOH Airway congestion

H
Acetylcysteine
Accumulation in airways
Br
of mucus, inadequate
Give expulsion by cough
warm fluids NH2
CH3
Elderberry Br CH2 N
tea
Bromhexine

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