Talk:Common cold/Archive 3

Taking sides

The first sentence of this overstates the situation: we don't really know what the most common method of viral transmission is. From the same government agency as the next citation, this names the common cold as being solely "Airborne droplets from the nose and throat" and specifically says the "droplets in the air may be breathed in directly by another person" as the method of transmission, not just the indirect methods we're naming. The fact that inhalation of droplets is a known, non-trivial source of infection is in sources all over the place:

• "A cold can be spread through: direct contact – for example, if you sneeze or cough, tiny droplets of fluid containing the cold virus are launched into the air and can be breathed in by others." [1]
• "Transmission of the infection: This is caused by inhalation of airborne respiratory droplets from people infected with the virus." [2]
• "These droplets may also be inhaled" [3]
• "Flu and common cold are mostly spread through transfer of virus-containing droplets by inhalation or hand-to-hand contact." ISBN 9780120885794 p 164

We really have very little basis for saying that airborne transmission is atypical. Some well-designed studies (e.g., PMID 3039011) indicate that airborne transmission may be the most common mechanism of transmission among adults, which means that this sentence may actually be backwards (at least for 80% of humans; fomites are probably most important for young children).

The source being cited here is about what the most effective treatment is, not about the routes of transmission. Being a systematic review about X does not make the source ideal for information about Y. The better sources tend to say little more than it's known to be both, and we don't know which is more important. I think we should follow them by listing what's known to happen without trying to reconcile the conflicting claims about which is more important. WhatamIdoing (talk) 20:48, 23 December 2011 (UTC)

This 2009 book chapter of transmission specifically agrees with the other review editors, Ronald Eccles, Olaf Weber, (2009). Common cold (Online-Ausg. ed.). Basel: Birkhäuser. ISBN 9783764398941. {{cite book}}: |last= has generic name (help)CS1 maint: extra punctuation (link) CS1 maint: multiple names: authors list (link) and I will add it. " Aerosol transmission has been studied in the experimental setting and may provide another, albeit less common method for transmission of rhinovirus infection." The above sources are typically not peer reviewed an frequently not up to date thus I am hesitant to use them to contradict these review articles. Still going over the literature. Hope to use nearly exclusively high quality sources as wish to bring this to GA.Doc James (talk · contribs · email) 01:32, 24 December 2011 (UTC)

This is BTW written by the foremost experts on the common cold from around the world. I just bought myself a copy :-) Doc James (talk · contribs · email) 08:26, 24 December 2011 (UTC)

Contradicated

The review above Pg.24 states that those with a poor immune system (ie those who are malnourished) have greater morbidity. Not that they become asymtomatic carriers...

*Counterintuitively, people with stronger immune systems are more likely to develop symptomatic colds. This is because the symptoms of a cold are directly due to the strong immune response to the virus, not the virus itself. People with less active immune systems—about a quarter of adults—get infected with the viruses, but the relatively weak immunological response produces no significant or identifiable symptoms. These people are asymptomatic carriers and can unknowingly spread the virus to other people. Because strong immune responses cause cold symptoms, "boosting" the immune system increases cold symptoms.

Doc James (talk · contribs · email) 13:28, 25 December 2011 (UTC)

Does the source explain what they mean by "greater morbidity"? That could mean "more likely to have mild symptoms upon infection" (which I've never seen claimed in any source) or "more likely to develop complications like pneumonia", which I believe is widely agreed upon. Either of those could technically be described as "greater morbidity", but the latter seems more likely to me, and it does not contradict the claim given above. WhatamIdoing (talk) 20:04, 26 December 2011 (UTC)

No, I just checked. First of all, it's a 354-page-long "book", not a "review". Second, all it says on that page is this:

"Although common cold viruses are responsible for a lot of morbidity and mortality, especially in developing countries where malnutrition may weaken the host response to infection, the common cold syndrome is usually understood as a self-limiting mild illness, and complications of common cold infections are usually described by other terms such as sinusitis, otitis media, laryngitis, tonsillitis, pharyngitis, etc."

In context, this is about complications (like dying). It says nothing at all about which people develop symptoms and which infected people don't. Page 130 (for example) similarly associates immunosuppression with a greater risk of complications, not with a greater risk of having symptoms in the first place. WhatamIdoing (talk) 20:15, 26 December 2011 (UTC)

The NYTs is not a suitable source. I have not seen the issue of a "strong immune system" yet corroborated by a reliable source. Yes it is a textbook on the common cold rather than a review.Doc James (talk · contribs · email) 03:28, 27 December 2011 (UTC)

Who cares whether the NYT is a suitable source? Nobody's citing the NYT. The citation is to a properly published book. And your source isn't a textbook; it's just a book. WhatamIdoing (talk) 01:10, 28 December 2011 (UTC)

I have not found other sources that support that a "stronger immune system" leads to more severe symptoms. Better sources say the opposite. WRT Eccles the editor of the book on the common cold (each chapter is written by an expert in this disease and most have many peer reviewed publications in this area). The author of Achoo is a popular science writer and the text does not contain inline citations. Are there other sources that confirm this? I am not happy with Achoo as a reliable source for medical information even though it does look like a good read. Doc James (talk · contribs · email) 09:24, 28 December 2011 (UTC)

BTW I agree with half of it, that the immune system causes symptoms from the rhinovirus infection. Its just the "people with stronger immune systems" bit.--Doc James (talk · contribs · email) 10:05, 28 December 2011 (UTC)

Ahchoo! names its sources in the endnotes. Have you read that source?

And have you actually found a source that says people with lower-than-average (NB: not necessarily low enough to be properly immunocompromised) immune activity have either the same or more symptoms when infected compared to people with higher-than-average immune activity? I've never seen such a source myself, and none of the ones you've proposed so far say anything like that—but we do have a source here that says a quarter of provably infected people develop no symptoms, and that those people have lower-than-average immune system activity. WhatamIdoing (talk) 23:38, 2 January 2012 (UTC)

Google has limited my further viewing of Ahchoo after so many pages and I was unable to find the ref in question. What I have found is that 1)people as they get older elderly get more symptomic colds as their immune system weakens 2) those who are immunocompromized and very young get worse colds. 3) As people are exposed to more colds and their immune system gets better they get less of them. Finally I am not sure what "lower-than-average immune system" means. Would be happy to look at the ref in question. Doc James (talk · contribs · email) 23:43, 2 January 2012 (UTC)

The typical way to run such a study is to compare the top quarter to the bottom quarter. I'm sure we can agree that the bottom quartile of adults are not all immunocompromised—but, yet, one quarter of actively infected adults produce no apparent symptoms.

I'm not convinced that you're reading your sources correctly. It's widely accepted that the common cold is most prevalent among children, and that the incidence decreases with age:

• "The incidence of the common cold decreases with age."
• "The incidence of acute or temporary conditions, such as infections or the common cold, decreases with age, although those that do occur can be more debilitating and require more care." (ISBN 9781556428166 p. 113)
• "The incidence of the common cold syndrome decreases with age." (ISBN 9780781762274 p. 474)
• "The annual number of colds decreases with age, to 2 to 3 colds each year by adulthood." (ISBN 9781416001591 p. 487)
• "As they get older, both men and women catch fewer colds. After the age of sixty, most people have only about one cold in a year." (ISBN 9780761419136 p. 12)
• "As people age they get fewer colds, partly because of immunity and partly because contact with children decreases." (ISBN 9780674012820 p. 153)

Also, I wonder if your sources really do identify immunosenescence as a proven factor in this supposed increase, rather than speculation, given that the opposite outcome is reported by other sources:

• "Infections occur less frequently and with milder symptoms with increasing age." (ISBN 9781582557243 p. 541)

The fact that they get fewer infections and have milder symptoms suggests that if immunosenescence is a factor at all, it does not produce more symptomatic infections. Elderly people do have a greater rate of complications, but that's not the same thing as a greater rate of getting infected in the first place. WhatamIdoing (talk) 02:03, 3 January 2012 (UTC)

Have send you a copy of the text in question

• This ref also agrees http://books.google.ca/books?id=P7OZt24014kC&pg=PA208

I guess another problem with these studies is as the elderly more commonly get LRTIs from rhinovirus do you than say they do not have a cold as they are too sick.Doc James (talk · contribs · email) 02:42, 3 January 2012 (UTC)

I believe that once you've got pneumonia, you get removed from the list of people with the "common cold syndrome".

The refs you provided here say that more complications happen in elderly and/or frail people (which is undisputed), and the one (in e-mail) notes a relative increase in infections compared to non-elderly adults, not compared to children, who definitely have the highest rate. I thought its statement about this being "often attributed to the waning of immunity with age" is both accurate and weak: people do often say that a weak immune system makes you more likely to get infected (just like they often say that going outside with wet hair magically causes the spontaneous generation of a rhinovirus infection), but there's zero actual evidence for this, and there is evidence to the contrary. WhatamIdoing (talk) 04:41, 3 January 2012 (UTC)

Yes I think we all agree it is most common in children. Much pneumonia starts out as a common cold especially in the elderly. The evidence around the immune system and symptoms I agree is weak all around. Do you have the ref from the Achoo book?Doc James (talk · contribs · email) 04:48, 3 January 2012 (UTC)

The only bit I am able to see is " “If we get our white blood cells to work better, we're going to have a stronger immune response and more exaggerated symptoms.” So, what is normally the upshot of the body's natural response to a cold virus?" from pg 45

http://books.google.ca/books?id=-aAL-JyxoikC&pg=PT45 Doc James (talk · contribs · email) 05:31, 3 January 2012 (UTC)

Few little suggestions

(1) It would be good to clarify which organ(s) are primarily affected by colds. The seems to be contradiction between the Diagnosis section and the first and second paragraphs of the lead.

We state the nose in both places... --Doc James (talk · contribs · email) 04:38, 3 January 2012 (UTC)

Well, yes, but on first reading this article, it struck me as odd that the first sentence says, "The common cold ... primarily affects the nose", while the fourth sentence says, paraphrasing, "the common cold primarily affects the nose, the throat, and the sinuses." I realise those sentences aren't literally factually contradictory – they just sound weird together. Adrian J. Hunter^{(talk•contribs)} 10:15, 4 January 2012 (UTC)

Thanks for catching that. The syntax was changed which changed its meaning. Have corrected--Doc James (talk · contribs · email) 16:58, 4 January 2012 (UTC)

(2) The Antibiotics and antivirals sections states, "[Antibiotics] cause overall harm; however, they are still frequently prescribed." Some clarification of this surprising statement would be helpful. Why do so many doctors still prescribe antibiotics? Is the "overall harm" to the patient, or only to society as a whole due to resistance?

Overall harm is to both the individual due to side affects and to society due to increased resistance. Will add something as to why doctors prescribe them. Part of the reason is because patients demand them. --Doc James (talk · contribs · email) 04:38, 3 January 2012 (UTC)

Ah, that is exactly what I'd hoped for. Adrian J. Hunter^{(talk•contribs)} 10:15, 4 January 2012 (UTC)

(3) The Epidemiology section gives figures for the incidence of colds, but does not provide scope for those figures. I'd have thought infection rates would vary tremendously between countries based on population density, climate, culture etc. The Lancet article cites "Johnston S, Holgate S. Epidemiology of viral respiratory infections. In: Myint S, Taylor-Robinson D, eds. Viral and other infections of the human respiratory tract. London: Chapman & Hall, 1996: 1–38"

The numbers are not well known as the common cold is a poorly studied condition relative to how prevalent it is.--Doc James (talk · contribs · email) 04:38, 3 January 2012 (UTC)

Adrian J. Hunter^{(talk•contribs)} 03:55, 3 January 2012 (UTC)

On the last point, it pretty much seems to be universal except in very isolated populations. The primary difference is seasonality (in North America and Europe, colds peak shortly after the school year starts each fall, whereas in tropical climates, they tend to peak during the rainy season) rather than the number of colds per year. WhatamIdoing (talk) 04:44, 3 January 2012 (UTC)

Ok, that's interesting, and sounds like a worthwhile way to flesh out the epidemiology section. Thanks Doc James and WhatamIdoing for the quick responses! Adrian J. Hunter^{(talk•contribs)} 10:15, 4 January 2012 (UTC)

Per these edits

[4] I have removed this text "People may also feel a "frog" in their throat or trouble breathing from the mucus." which is not supported by the text in question. And this ref "Zinc for the common cold - Health News - NHS Choices". nhs.uk. 2012 [last update]. Retrieved 24 February 2012. In this review, there was a high level of heterogeneity between the studies that were pooled to determine the effect of zinc on the duration of cold symptoms. This may suggest that it was inappropriate to pool them. It certainly makes this particular finding less conclusive. {{cite web}}: Check date values in: |year= (help) is not of sufficient per WP:MEDRS. Doc James (talk · contribs · email) 11:52, 25 February 2012 (UTC)

• Also restored this " Much of the benefit from treatment is however attributed to the placebo effect." as I am not sure why it was removed. Doc James (talk · contribs · email) 11:53, 25 February 2012 (UTC)
• As Zinc is typically seen as an alternative medicine it is best discussed there.Doc James (talk · contribs · email) 11:55, 25 February 2012 (UTC)

I have added that the NHS has questioned these conclusions. Hope that addresses your concerns.. Doc James (talk · contribs · email) 12:00, 25 February 2012 (UTC)

I reworded the sentence about the zinc study per my original rewording of it, as I believe this reflects the sources better. I don't know why you think the NHS is not a reliable source though, as the article in question is certainly "medical guidelines or position statements from nationally or internationally recognised expert bodies" per WP:MEDRS.--Pontificalibus (talk) 12:49, 25 February 2012 (UTC)

I have added it in the content with the NHS ref. Just removed the statement that it is from a "recent meta analysis" which as we always use the best sources is not needed.Doc James (talk · contribs · email) 07:15, 26 February 2012 (UTC)

Review

AFP this month JFW | T@lk 09:52, 15 July 2012 (UTC)

Thanks will take a look.Doc James (talk · contribs · email) (if I write on your talk page please reply on mine) 11:41, 15 July 2012 (UTC)

Onset

This "The incubation period for a cold is usually around two to three days before symptoms start," referenced to ADAM is the same as "Symptoms typically peak two to three days after infection onset" referenced to a textbook on the subject. The textbook IMO is a better quality reference. And I have seen issues with ADAM in the past. Doc James (talk · contribs · email) (if I write on your page reply on mine) 16:13, 4 August 2012 (UTC)

Those sentences do not mean the same thing. The first says that the earliest symptoms appear two or three days after the virus first invades and infects the host. The second says that the symptoms start to get better ("peak" means "at their worst") after two or three days.

we need to know what's actually going on here. Offhand, I suspect that the first is true (infection of the first cells to appearance of first symptoms is likely to be two or three days) and that the second is wrong, and should actually say that the symptoms peak two or three days after they first appear, which is four to six days after the first cells were invaded. WhatamIdoing (talk) 00:39, 5 August 2012 (UTC)

"Infection onset" is the time one first contact the infection. Symptoms may begin with 16 hours of contact. [5] Doc James (talk · contribs · email) (if I write on your page reply on mine) 17:20, 9 August 2012 (UTC)

That source says that the time to the first symptom is 16 to 72 hours. Since the first symptom is taking up to three days to appear, and since we all know from our own experience that cold symptoms do not suddenly appear at full strength, but start with mild symptoms that get worse before they get better, it is not logically possible for the symptoms which begin up to 72 hours after the virus infects the person to also peak within 72 hours of that same moment. It is much more likely that the virus gets inside you on Monday, that your symptoms start on Wednesday, and that the symptoms are at their worst ("peak") on Friday. WhatamIdoing (talk) 00:41, 11 August 2012 (UTC)

Yes the sources seem to contradict each other. I will try to figure it out. I might be misinterpreting what "infection onset" means. If infection on set means the start of the symptoms or encountering the virus. I assumed the latter. Doc James (talk · contribs · email) (if I write on your page reply on mine) 01:13, 11 August 2012 (UTC)

This ref [6] states onset of symptoms is 1-2 days after infection and peak is 2-4 days after infection. Thus what we haveDoc James (talk · contribs · email) (if I write on your page reply on mine) 20:02, 11 August 2012 (UTC)

"Catching a cold"

In the subsection "Weather" of section "Cause" the common folk theory about "catching a cold" is discussed. I think the findings of the following article should be mentioned:

R. Gordon Douglas, Jr., Keith M. Lindgren, and Robert B. Couch, N. Engl. J. Med. 279:742-747 (1968).

http://www.nejm.org/doi/full/10.1056/NEJM196810032791404

In this study, the test subjects were infected with rhinovirus while some of them were exposed to cold. The study "demonstrated no effect of exposure to cold on host resistance to rhinovirus infection and illness that could account for the commonly held belief that exposure to cold influences or causes common colds."

130.233.174.38 (talk) 16:36, 4 August 2012 (UTC)

We typically try to use references from the last 10 years. Anything newer? Doc James (talk · contribs · email) (if I write on your page reply on mine) 22:51, 4 August 2012 (UTC)

Differentiating signs and symptoms

Could someone please edit this article to reflect the difference between signs (changes in the body that are visible and or measurable, eg. fever, spots, runny nose, redness, blood count abnormalities, radiographic abnormalities) and symptoms (effects of an illness that are perceived by the patient and not apparent to an observer eg. pain, numbness, lassitude, blurred vision) In the lede there is reference to symptoms and then goes on to mention 'runny nose', 'fever' and 'sputum colour', all of which are signs. There are several similar clarifications needed further on in the article. Uner 'management' - 'symptomatic' there is reference to a 'runny nose' being a symptom. It is more precis to call it a sign. Thank you. I'd be happy if you respond here.Richard Avery (talk) 13:47, 25 August 2012 (UTC)

Yes technically. But in common usage symptoms is often used to also mean signs (or short for signs and symptoms). Thus do not see this as a huge issue.Doc James (talk · contribs · email) (if I write on your page reply on mine) 15:36, 25 August 2012 (UTC)

Technically, a runny nose is a symptom if the patient reports it (e.g., over the phone) and a sign if someone else sees it. What value do you see in trying to draw a bright line between the two in this article? WhatamIdoing (talk) 18:34, 25 August 2012 (UTC)

Broad-spectrum viral / infection identification?

Is there any broad spectrum medical testing method currently available for all viruses of every known type to be identified? How do you tell the difference between a rhinovirus, a flu virus, and mononucleosis? Severity of symptoms is a vague classification method that is almost useless for clearly and exactly identifying the true cause.

With all the talk of research into sophisticated biochips and all that, it seems like it should be possible to do a single low-cost blood test that identifies everything currently in the blood, including concentration levels of all active antibodies, to determine what a person is currently infected with.

-- DMahalko (talk) 11:54, 8 October 2012 (UTC)

Malingering

Not sure how to edit the section on economic impact, but the estimate of 20 billion dollars per year and 40% of lost work days is for people reporting to have a common cold, a number of these are in fact malingering, so if there were no common cold they would simply choose another malingering reason to stay off (eg back pain, migraine, diarrhea and vomiting etc). — Preceding unsigned comment added by 77.103.213.208 (talk) 12:58, 16 December 2012 (UTC)

To add this claim, you will need to find a reliable source reporting it. - SummerPhD (talk) 22:03, 16 December 2012 (UTC)

Typo

Not sure how to edit the article since it is protected, but one instane of "in adults" should be eliminated from the following sentence under Management - Symptomatic: In adults there is insufficient evidence to support the use of cough medications in adultsJixani (talk) 19:51, 24 December 2012 (UTC)

Thanks will do. Doc James (talk · contribs · email) (if I write on your page reply on mine) 20:37, 24 December 2012 (UTC)

Change spelling of "air born" to "airborne"

In the Pathophysiology section, there is a misspelling: "air born" should be changed to "airborne". The mistaken sentence would then read:

The respiratory syncytial virus (RSV) on the other hand is contracted by both direct contact and airborne droplets.

The word "airborne" is used correctly elsewhere in the article. Of course, "air born" would mean created or birthed in the air; "airborne" means carried in the air.

Many thanks and welcome to Wikipedia. Doc James (talk · contribs · email) (if I write on your page reply on mine) 13:15, 4 January 2013 (UTC)

Zinc: Treatment affecting duration of infection: contradiction?

The article currently says:

There are currently no medications or herbal remedies which have been conclusively demonstrated to shorten the duration of infection.

Then later says:

Studies suggested that zinc, if taken within 24 hours of the onset of symptoms, reduces the duration and severity of the common cold in healthy people.

Does anyone else see a contradiction here? pgr94 (talk) 18:41, 23 January 2013 (UTC)

Suggestive evidence means (to me at least) that it has not been conclusively demonstrated, so I see no problem on my end. Maybe there would be a better way to phrase it, however. Biosthmors (talk) 20:37, 23 January 2013 (UTC)

I've had a closer look at the source. It is a Cochrane systematic review which is usually quite a reliable source. Thirteen trials were included. The Author's Conclusion says "Zinc administered within 24 hours of onset of symptoms reduces the duration and severity of the common cold in healthy people." Seems a little stronger than just "suggests"; I'd say that is fairly categoric. Is there any reason to doubt this conclusion? pgr94 (talk) 15:14, 25 January 2013 (UTC)

For duration of symptoms "There was a significant difference between the zinc and control group for the proportion of participants symptomatic after seven days of treatment (OR 0.45; 95% CI 0.2 to 1.00) (P = 0.05)" The P just hit statistical significance in 966 participants. It does look promising agree. Doc James (talk · contribs · email) (if I write on your page reply on mine) 15:39, 25 January 2013 (UTC)

That a Cochrane review has concluded that zinc really is effective for treating the common cold is an incredibly significant (and little known!) piece of information that surely merits inclusion in the lead. (The apparent contradiction Pgr94 identified could have been avoided using {{As of}}.) Adrian J. Hunter^{(talk•contribs)} 22:34, 25 January 2013 (UTC)

And we state these conclusions. The Cochrane review also states "Of the 18 trials conducted since 1984, 11 trials have shown zinc may be useful in the treatment of the common cold and seven have shown no benefit. Most trials showing beneficial effects have been criticised for failing to mask treatment adequately due to the occurrence of side effects, while trials showing no benefit have been criticised for using formulations that reduced the bioavailability of zinc." "There was no significant difference between the intervention and control group for the proportion of participants symptomatic after day three of treatment " "There was no significant difference between the intervention and control group for proportion of participants symptomatic after day five of treatment" "There was a significant difference between the intervention and control group for proportion of participants symptomatic after day seven of treatment" Doc James (talk · contribs · email) (if I write on your page reply on mine) 13:00, 26 January 2013 (UTC)

And we also have the NHS commenting on Cochrane specifically " In this review, there was a high level of heterogeneity between the studies that were pooled to determine the effect of zinc on the duration of cold symptoms. This may suggest that it was inappropriate to pool them. It certainly makes this particular finding less conclusive. The researchers note that the high level of heterogeneity is likely to be due to the different zinc preparations used in the studies, the study populations that were combined (adults and children) and how long cold symptoms had existed before supplementation began.

More research will undoubtedly be published on this topic. Over time, this can be added to systematic reviews, such as this one. As the evidence grows, it will allow subgroup analyses that can answer outstanding questions about dose and who will benefit most. Until then, the body of evidence for zinc supplementation seems to be swinging in favour of its benefit, and the choice of whether to take supplements is an individual one. Many healthy people may not see the potential benefits of taking zinc as being worth the expense of supplements or the possible side effects, which can include nausea." [7] Doc James (talk · contribs · email) (if I write on your page reply on mine) 13:14, 26 January 2013 (UTC)

There are a number of other treatments that have tentative evidence of reducing duration of illness in adults includinng:pseudoephedrine, phenylephrine, inhaled ipratropium but I would call it only tentative. Doc James (talk · contribs · email) (if I write on your page reply on mine) 13:18, 26 January 2013 (UTC)

Criticism of the Cochrane meta-analysis

We should not fail to mention issues with the Cochrane study. A review of the Cochrane meta-analysis concludes: In light of the above, we are concerned that the potential threats of such biases in the review have not been considered carefully enough. We therefore feel that readers should be cautious in their interpretation of the evidence presented in [1] owing to the possible threat of reporting and publication biases on the results of their Cochrane review. Peters, J. L.; Moreno, S. G.; Phillips, B.; Sutton, A. J. (2012). "Are we sure about the evidence for zinc in prophylaxis of the common cold?". Expert Review of Respiratory Medicine. 6 (1): 15–16, author 16 17–16. doi:10.1586/ERS.11.84. PMID 22283573.

This criticism is in turn also criticized! Hemilä, H. (2012). "Zinc lozenges may shorten common cold duration". Expert Review of Respiratory Medicine. 6 (3): 253–254. doi:10.1586/ERS.12.30. PMID 22788939. The conclusion here is that an effect is likely but more trials are needed.

2012 Canadian meta-analysis

A Canadian meta-analysis published in 2012 also concluded zinc reduces the duration of symptoms. [8]

• 17 trials involving a total of 2121 participants
• Compared with patients given placebo, those receiving zinc had a shorter duration of cold symptoms (mean difference –1.65 days, 95% confidence interval [CI] –2.50 to –0.81);
• Zinc shortened the duration of cold symptoms in adults (mean difference –2.63, 95% CI –3.69 to –1.58)

Criticism:

• Meta-analysis authors themselves report trial heterogeneity: was high (I2 = 95%).
• (not MEDRS) http://www.forbes.com/sites/stevensalzberg/2012/05/08/zinc-versus-chicken-soup-round-two/

Does anybody want to summarise all these results & criticisms? pgr94 (talk) 11:14, 28 January 2013 (UTC)

I think we can continue to state that no treatment has been "conclusively demonstrate" yet. Doc James (talk · contribs · email) (if I write on your page reply on mine) 13:02, 28 January 2013 (UTC)

I think one could safely say that there is "strong support" for zinc shortening the length of infection, and if it's not at "conclusively demonstrate", it will be soon. The 95% CI of cold symptom duration is significantly reduced from placebo, it's not just barely better. I support changing the lede sentence in the management section to reflect that there is strong support for zinc; there's no need to keep the "conclusively demonstrate" wording, even though that may still be true. Pro crast in a tor (talk) 18:56, 28 January 2013 (UTC)

So what exact wording are you suggesting? Doc James (talk · contribs · email) (if I write on your page reply on mine) 16:37, 29 January 2013 (UTC)

Cold temperatures as a risk factor for catching colds

The cited source says this (emphasis mine):

Although not all studies agree, most of the available evidence from laboratory and clinical studies suggests that inhaled cold air, cooling of the body surface and cold stress induced by lowering the core body temperature cause pathophysiological responses such as vasoconstriction in the respiratory tract mucosa and suppression of immune responses, which are responsible for increased susceptibility to infections.

I do not believe that the current article accurately reflects the cited source. I edited it to better reflect what this source says and added another source to corroborate. This edit was reverted, with the comment "only one source" which is not at all accurate, and the added cite was deleted. Let's discuss this here on the talk page and try to reach a consensus. Mr. Swordfish (talk) 14:27, 15 February 2013 (UTC)

Sure the NYTs is not sufficient as a medical reference. The text "The role of body cooling as a risk factor for the common cold is controversial" is support by "Although not all studies agree" Doc James (talk · contribs · email) (if I write on your page reply on mine) 16:36, 15 February 2013 (UTC)

The NYT may not be sufficient as a medical reference, but the article it's based on is. Here's the link to that: http://fampra.oxfordjournals.org/content/22/6/608.full?sid=14da0c92-3402-483c-88f0-9cda381484b1

Anyway, I think this article can do better than just saying "it's controversial". A sentence or two weighing the evidence on both sides would be helpful. If "not all studies agree" then we should say that. If "most of the evidence from clinical studies" supports it being a risk factor, we should say that too. And perhaps the more neutral term "unsettled" would be a better choice than the loaded term "controversial". Mr. Swordfish (talk) 17:29, 15 February 2013 (UTC)

Which is a primary source and we should be using secondary sources per WP:MEDRS. The "controversy" bit means that some trials are supportive and others are not. Doc James (talk · contribs · email) (if I write on your page reply on mine) 17:33, 15 February 2013 (UTC)

We have this review [9] but it is a little old. Doc James (talk · contribs · email) (if I write on your page reply on mine) 17:34, 15 February 2013 (UTC)

Anyway have adjusted the wording. Doc James (talk · contribs · email) (if I write on your page reply on mine) 17:47, 15 February 2013 (UTC)

Thanks. I think the latest edit is an improvement.

I do think it would be appropriate to restate in this subsection that colds are caused by viruses, in contrast to the traditional folk theory which begins the subsection. I would suggest the following:

The traditional folk theory is that a cold can be "caught" by prolonged exposure to cold weather such as rain or winter conditions, which is how the disease got its name. While colds are caused by viruses and not cold temperatures, there is some controversy over the role of body cooling as a risk factor for the common cold; the majority of the evidence suggests that it may result in greater susceptibility to infection. This may occur due to cold induced changes in the respiratory system due, decreased immune response, and low humidity increasing viral transmission rates, perhaps due to dry air allowing small viral droplets to disperse farther and stay in the air longer. Additionally some of the viruses that cause the common colds are seasonal, occurring more frequently during cold or wet weather. This maybe due to people spending more time indoors, near an infected person: specifically children at school.

Comments? Mr. Swordfish (talk) 19:25, 15 February 2013 (UTC)

Sounds reasonable. Doc James (talk · contribs · email) (if I write on your page reply on mine) 19:42, 15 February 2013 (UTC)

Fluid intake

Question: why is it that there is a statement saying that there is no evidence that fluid intake can help recuperate the body? Also the article cited says that is for Acute Respiratory Infection, but don't you think that not all common cold cases constitute an acute respiratory infection? Is it not widely known that drinking enough liquid helps the body fight the virus or at least help with drainage? Ctorchia87 (talk) 09:27, 16 February 2013 (UTC)

Yes all colds are acute respiratory infections. Doc James (talk · contribs · email) (if I write on your page reply on mine) 00:49, 18 February 2013 (UTC)

So is that statement actually saying that there is no evidence that fluid intake has any effect on the well being of the body fighting a cold? Is your suggestion that the next time I get a cold that I drink a minimal amount of fluids because drinking fluids might not have any effect? Ctorchia87 (talk) 01:02, 18 February 2013 (UTC)

Feel free to read the reference in question. We state "drinking fluids to maintain hydration" however no one has studied this. Doc James (talk · contribs · email) (if I write on your page reply on mine) 01:10, 18 February 2013 (UTC)

Capitilization of cold

It would seem more professional with a capitalized c in cold. It would then read: Common Cold — Preceding unsigned comment added by 98.74.145.64 (talk) 01:27, 5 April 2013 (UTC)

In context we should (and do) refer to the "common cold" (as there is no reason to capitalize either word. As the title for the article, we use "Common cold". Wikipedia's style is to capitalize only the first word in titles unless there is a specific reason to capitalize other words (for example: Bless you and Bicycle helmet‎‎ but Marilyn Monroe and Star Wars). - SummerPhD (talk) 03:41, 5 April 2013 (UTC)

Prevention via probiotics

Has this study been considered?

Immunoprotective effects of oral intake of heat-killed Lactobacillus pentosus strain b240 in elderly adults: a randomised, double-blind, placebo-controlled trial.

"The accumulated incidence rate of the common cold was 47·3, 34·8 and 29·0 % for the placebo, low-dose b240 and high-dose b240 groups, respectively (P for trend = 0·012). Lower incidence rates were consistently observed throughout the experimental period in the b240 groups (log-rank test, P = 0·034). General health perception, as determined by the SF-36®, dose-dependently increased in the b240 groups (P for trend = 0·016). In conclusion, oral intake of b240 significantly reduced the incidence rate of the common cold in elderly adults, indicating that b240 might be useful in improving resistance against infection through mucosal immunity." http://www.ncbi.nlm.nih.gov/pubmed/22947249

--Vocasla (talk) 13:27, 6 April 2013 (UTC)

We try to use secondary sources rather than primary ones per WP:MEDRS. Doc James (talk · contribs · email) (if I write on your page reply on mine) 15:03, 6 April 2013 (UTC)

Would this be an acceptable secondary source?

The Effect of Probiotics on Prevention of Common Cold: A Meta-Analysis of Randomized Controlled Trial Studies

Conclusion:

In this meta-analysis, there was marginal effect of probiotics on the prevention of the common cold. The results implied that probiotics had a modest effect in common cold reduction. The balance of benefit and harms needs to be considered when using probiotics for common cold prevention.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3560336/

--Vocasla (talk) 11:16, 8 April 2013 (UTC)

Yes looks good. Doc James (talk · contribs · email) (if I write on your page reply on mine) 07:19, 7 May 2013 (UTC)

Wikiuser

In this edit [10] this sentence "which affects primarily the nose." to "which primarily affects the nose, the throat (pharyngitis), and the sinuses (sinusitis)" It is not also primarily affect the throat or the sinusus and thus this change makes the content incorrect. Reverted again. Doc James (talk · contribs · email) (if I write on your page reply on mine) 07:10, 7 May 2013 (UTC)

Alternative medicine section should be renamed

This section contains only one sentence about alternative medicine while the rest is about actual scientific case studies which are NOT alternative medicine but just medicine. I recommend renaming the section to Other approaches or merging it with the Antibiotics and antivirals paragraph and renaming it to Treatment attempts. Finally, I would also like to move the sentence about alternative medicine to then end of the paragraph in which is lies with a slight change:

• While there are many alternative treatments used for the common cold, there is insufficient scientific evidence to support the use of most.
• While there are many alternative treatments used for the common cold, there is no scientific evidence to support the use of them.

If there is scientific evidence for any form of alternative medicine then it is, by definition, no longer alternative medicine. Hamsterlopithecus (talk) 18:07, 6 June 2013 (UTC)

No it is not necessarily medicine if there is evidence. Additionally evidence is not so cut and dried. Doc James (talk · contribs · email) (if I write on your page reply on mine) 20:49, 6 June 2013 (UTC)

Obviously, I mean statistically significant evidence that has been reproduced by a few laboratories and in general accepted by the medical community. But the original point still stands: that alternative medicine is not an appropriate title for the section in question. Hamsterlopithecus (talk) 09:07, 7 June 2013 (UTC)

The use of garlic and echinasea would be alt med. Vitamins are also often deemed to be the same. Doc James (talk · contribs · email) (if I write on your page reply on mine) 09:10, 7 June 2013 (UTC)

Vitamins are ABSOLUTELY NOT alternative medicine. Is there any non-anecdotal evidence for the effectiveness of "garlic and echinasea"? If not, then why mention it? Unless we want to add an entire section about common placebo-based treatments for this. Hamsterlopithecus (talk) 09:50, 7 June 2013 (UTC)

The are included as both alt med and med depending on how they are used. See [11] as an example Doc James (talk · contribs · email) (if I write on your page reply on mine) 22:45, 7 June 2013 (UTC)

I'm familiar with the line of argument that says there is medicine, which is anything with evidence behind it, and then there is AltMed, which is anything without evidence. However, the far more common definition is that "medicine" means "mainstream", including things commonly done for which there is absolutely no good evidence in favor of it (like denying patients a small glass of water a couple of hours before surgery) and things commonly done for which there is solid evidence against it (refusing to let people eat after surgery until bowel sounds have returned). AltMed, by contrast, is whatever isn't mainstream, no matter how much evidence does or doesn't exist. WhatamIdoing (talk) 03:23, 10 June 2013 (UTC)

References from Eccles

This article mentions several references from various pages of Eccles which I presume to be a previous version of Eccles, Ronald; Weber, Olaf F. (1 January 2009). Common Cold. Springer. ISBN 978-3-7643-9912-2.. This book can be browsed or searched on google books and the relevant page numbers can be updated. Diptanshu^Talk 11:01, 5 October 2013 (UTC)

I have painstakingly merged the various references of Eccles using {{rp}} to mark the pages vide the edit [12]. Convertion of the page numbers remains pending. Diptanshu^Talk 11:39, 5 October 2013 (UTC)

I do not consider this an improvement and preferred it better before. Doc James (talk · contribs · email) (if I write on your page reply on mine) 12:18, 5 October 2013 (UTC)

Zinc

The previous content was more to the point and in simplier language. We can have the extra details in the sub article. Thus reverted. Doc James (talk · contribs · email) (if I write on your page reply on mine) 01:16, 25 October 2013 (UTC)

I extended the text on zinc. Let the longer desciption be on the separate page, and let this description be shorter. However, the Science paper in CMAJ that is cited in the old version of this wiki page is not valid as shown in a comment published in CMAJ. Wikipedia explicitly requires that the sources should be valid. Thus, presenting the Science (2012) paper without the document pointing out its errors, is misleading readers of thei wiki page.

Hhemila (talk) 08:41, 25 October 2013 (UTC)

You are quoting your own comment on the CMAJ paper.[13] This is not appropriate. You will need to get consensus for your proposed changes on the talk page first. Doc James (talk · contribs · email) (if I write on your page reply on mine) 12:34, 25 October 2013 (UTC)