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Common cold - Management
How do I assess a person with the common cold?
- Confirm clinical features are consistent with the common cold. Key signs and symptoms are general malaise, sore throat, nasal discharge (rhinorrhoea), sneezing, and hoarse voice (caused by laryngitis). Fever is more common in children and is usually mild (< 39°C). The onset of symptoms is usually relatively rapid. For further details, see Diagnosis.
- Factors which may complicate management of the common cold include smoking, diabetes, asthma, and immunosuppression. These may worsen symptoms of the cold and may prompt more careful monitoring or follow-up. Pregnant women may be managed in the usual way, but they should avoid using any drugs other than paracetamol.
- It is important to eliminate the possibility that a serious illness is present. Look for the following 'red flags':
- Upper airway distress may be a result of obstruction and is characterized by stridor, drooling, or an inability to swallow. It may indicate peritonsillar or retropharyngeal abscesses, or epiglottitis.
- Lower airway distress is characterized by laboured breathing (moderate or severe dyspnoea) and may be a sign of pneumonia, an acute exacerbation of asthma or chronic obstructive pulmonary disease, or the presence of a foreign body. Assess thoroughly and consider referral if necessary (e.g. if severe pneumonia or respiratory spasm is present).
- Severe headache may be an early sign of meningitis or a serious vascular disorder, such as subarachnoid haemorrhage. It may be described as the 'worst ever' and be accompanied by a rigid neck, altered mental state, and focal neurological symptoms. The decision to refer will depend on the suspected diagnosis.
- Serious illnesses (such as meningitis, septicaemia, or pneumonia) are difficult to diagnose in very young children; lower the threshold for suspicion accordingly.
- For further information, see Differential diagnosis.
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