1. What is a cold?

No one has ever caught a cold in their lifetime. On average, adults get 2-3 colds a year and children average 6-8 colds a year. Common cold is acute upper respiratory tract infection caused by various pathogens including viruses, and it is a very common disease that affects social life and daily life.

2. The occurrence of cold

The first time a cold develops, symptoms begin to develop 12-72 hours after the virus spreads from the outside and others. It is not yet fully known what causes the symptoms. It is believed that after the virus invades, symptoms may develop through damage to respiratory epithelial cells, various chemical mediators, and the autonomic nervous system.

In most people with colds, no damage to the nasal mucosa is found. The exception is severe damage to respiratory epithelial cells caused by influenza or adenoviruses.

3. The progress of cold

Most of the time, it heals naturally, but secondary bacterial infections can result from increased normal flora of the upper respiratory tract, changes to other germs, decreased removal of secretions, closure of the sinus openings and the exit of the ear canal.

4. Kind of cold

Cold-like symptoms include acute pharyngitis, acute laryngitis, flu (influenza), acute bronchitis, and acute sinusitis, with some overlapping.

The nasal cavity is divided into two sides by the nasal septum into the inside of the nose and becomes the first gateway to transport air to the lungs. As air passes through the nasal passages, the temperature and humidity become the same as the body. The oral cavity allows you to chew and talk.

The pharynx is a common part of the airy respiratory system and the digestive system where food passes to the esophagus, and is divided into the nasopharynx, the upper part of the study dog, and the oropharyngeal part, the back of the tongue. This is where lymphatic tissue, including the tonsils, is located, causing pain when swallowing saliva or food when inflamed.

The larynx is the part from the entrance to the esophagus to the vocal cords that cannot be observed with the naked eye. Inflammation here can cause a sore throat and can cause breathing problems in infants.

Causes

It wasn’t until the 1950’s that the cause of the cold was a virus, and about ¾-¾ of the cold was the virus. About 5-10% is caused by a bacterium called group A streptococcus and may not be able to determine the cause.

1. Virus

The most common causes of viruses are rhinoviruses, followed by coronaviruses, respiratory fusion viruses, influenza viruses, and parainfluenza viruses. In addition, adenoviruses, enteroviruses, rubella viruses, and measles viruses are rare but cause.

More than 100 different types of rhinoviruses are known. For this reason, you will catch a cold often and will catch it again even if the cold is over. Unlike hepatitis and influenza vaccines, there is no vaccine to prevent colds caused by rhinoviruses.

1) Virus

It is an independent organism that can cause disease in humans. Unlike bacteria, it can’t live on its own and can only grow in living cells. It is smaller than bacteria and varies in size and shape, but consists of a protein shell and a site containing a gene called nucleic acid.

2) Avian Influenza (AI)

Avian influenza is the cause of the flu in chickens, ducks, wild poultry, and swine, not humans. Currently, bird flu has spread in eight countries: Korea, Japan, Vietnam, Thailand, China, Indonesia, Laos and Cambodia.

In 1997, Hong Kong experienced the first death of a non-avian human patient in Hong Kong.

SARS (Severe Acute Respiratory Syndrome)

In the early stages of infection, symptoms range from fever, myalgia, malaise, chills, dry cough, and severe breathing difficulties. The first patient occurred in 2002 in China, and the infection was confirmed in Taiwan and Singapore. The cause is a new variant of coronavirus, which causes viral pneumonia and high mortality. There is no proven cure yet.

2. Bacteria

Some of the causes of colds are caused by bacteria, with group A streptococcus being the most common cause of P. aeruginosa.

Bacteria are one of the most primitive creatures, the smallest living organisms consisting of one cell, one micrometer (μm, one thousandth of a millimeter), one tenth the size of a human white blood cell. The structure consists of the cytoplasm inside, the chromosomes (genes) within the cytoplasm, and the cell membrane and cell walls that surround them. Unlike human cells, there is no mitochondria involved in intracellular metabolism and the composition of ribosomes is different.

3. Frequency of colds and other causes

1) Season and Climate

In temperate climates with distinct four seasons, colds are common in winter. In case of rhinoviruses, the number of patients increases rapidly in spring and autumn. Unlike common sense, exposure to cold temperatures does not seem to cause more colds. On the contrary, it is estimated that living in the winter mainly increases the chances of contact with people who have already caught a cold, and it may be caused by changes in humidity depending on the season.

The flu usually occurs in winter from October to April, and spreads well between people, causing a sudden epidemic due to its high contagion and onset.
In the tropics, it is said that there are many colds during the rainy season.

2) Age

When will you catch a cold often? The frequency is highest in children under five years of life. Growing through a number of illnesses, accidents, and growing up, adults are less likely to catch a cold.

3) Environment

It is more likely to occur if there are children in the home because it is spread well at home by infected children in pre-kindergarten or school. No one can say it first, but you may have experienced a lot of colds in a row.
Do you know why your parents told you to wash your hands and feet first when you came back from school?

4) Other causes

It is said that smoking causes a cold, and the stress that everyone has to some degree can cause it. Quitting smoking not only helps prevent cancer and cardiovascular disease, but also helps prevent colds.

Symptoms

1. Cold

1) Symptoms

The main symptoms are runny nose, stuffy nose, sneezing, sore throat, cough. It is mainly limited to the upper airways, including the nose, pharynx and throat. Fever is more common in infants and children than in adults

A day or two after the onset of sore throat, malaise and fever, runny nose, stuffy nose and cough develop. You can also feel sore throat, dryness and foreign body.
After symptoms begin, they can peak up to 2-3 days, then disappear after about a week.

In some patients, symptoms may last up to two weeks. If the cold damages the throat, especially in the dry season, the cough, sputum, and larynx of the larynx may last for more than three weeks. In smokers, the cough is more severe and lasts longer. If you have rhinitis, the postnasal drip syndrome may persist, and you may have symptoms similar to sinusitis and asthma.

Depending on age, the causative virus is somewhat different, but in children, viral pneumonia, laryngeal croup, bronchiolitis, parainfluenza virus, and respiratory syncytial virus only cause colds in adults.

2) Complications

Blockages of the ear canal can cause fullness of the ears, headaches when the sinus openings are closed, and burning in the eye area (burning pain or burning). Adenoviruses may also be associated with conjunctivitis (pharyngeal conjunctivitis).
About 2% of adults with colds develop symptoms of otitis media (fever, pain, redness of the tympanic membrane, and exudates), which are more common in children.
Chronic diseases such as asthma, chronic obstructive pulmonary disease, and heart failure can cause acute exacerbation and worsen respiratory distress.

3) Chronic cough

If you have a cough that lasts more than three weeks (or eight weeks), it is called a chronic cough and chest radiography should be done to check for lung abnormalities.
If this happens repeatedly, tests may be required for the cause of a chronic cough, such as asthma, postnasal drip syndrome and reflux esophageal disease.

(1) Asthma

Chronic inflammatory airway (air passage through breathing) disease, characterized by wheezing (rough breathing) or coughing, shortness of breath, and cough due to limited airflow due to repetitive and reversible airway hypersensitivity Treatment with sex steroids.

(2) Postnasal drop syndrome

One of the causes of chronic cough is a sore throat, cough, throat irritation, runny nose, and severe coughing when lying down.It is caused by rhinitis, sinusitis, upper respiratory tract infection, and environmental irritation.

2. Acute laryngitis

It is a symptom of the flu (influenza) rather than a cold and complains of fever, sore throat, hoarseness, and difficulty swallowing food.

In young children, it can cause dyspnea called croup and death from upper airway obstruction.

3. Acute Pharyngitis

Although it is part of the common cold, pharyngitis may be the main symptom and mild pain and fever, malaise, headache, chills and severe sore throat make it difficult to swallow saliva or food and radiate pain in the ear.

In case of virus and group A streptococcus, symptoms are difficult to distinguish. Group A streptococcus is mild to severe cold, severe sore throat, dysphagia, high fever over 39`C, headache, abdominal pain, nausea and Vomiting, redness of the throat, tonsil exudate, cervical lymphadenitis and swelling appear.

Complications can include sinusitis, otitis media, laryngitis, bronchitis, and pneumonia. Systemic complications can include rash, toxic shock syndrome, meningitis, encephalitis, and myocarditis.

4. Acute Bronchitis

Unlike a cold, a cough is one of the symptoms, cough and purulent sputum are the main symptoms, and fever is rare in adults. It may be bronchitis if it lasts several weeks and the cough and phlegm persist even after the cold has healed. In bronchitis, pain and burning in the front chest appear.

The flu also has different mechanisms, but it causes bronchitis. Smoking and air pollution can make symptoms worse. Repeated bronchitis is known to cause bronchial damage and asthma.

5. Influenza

Systemic symptoms such as fever, muscle pain, fatigue, anorexia and headaches above 40 degrees are more common than respiratory symptoms such as cough, sputum, sore throat, runny nose and stuffy nose. It occurs mainly in winter and is highly epidemic, lasting 5-10 days.

Respiratory complications are very high and secondary to about 10% of elderly, pregnant and chronic cardiopulmonary diseases. Bacterial pneumonia or primary viral pneumonia develops, some of which cause death. In addition, it can cause croup, aggravation of chronic lung disease, and acute bronchitis.

Diagnoses

Experience shows that a cold can often be self-diagnosed without a doctor’s diagnosis. There is still no more effective and better way to diagnose symptoms.

1. Clinical symptoms

As already introduced, the symptoms are limited to the upper respiratory tract. If the runny nose is the main symptom, it is confused with allergic rhinitis, but the difference is that it often recurs and lasts long.

Above all, it is important to detect complications such as secondary bacterial sinusitis and otitis media. In sinusitis, there is tenderness, such as nasal congestion, purulent runny nose, fever, general weakness and pain in the sinus and pressing of the face.

2. Physical examination

Most of the time it is normal to see a doctor, but there may be redness, swelling, and discharge from the throat. In conjunctivitis, the conjunctival vessels become thick and the eyes look red. Severe inflammation and exudate of the pharynx may be suspected of group A streptococcus, adenovirus, herpes simplex virus, ulcerative pharyngeal pharyngitis (Vincent`s angina), infectious mononucleosis, and diphtheria. For acute sore throats, it is necessary to distinguish them from viral sore throats to determine whether antibiotics can be treated. Tonsil exudate, painful lymphadenitis, skin rashes, conjunctivitis, etc. may be helpful but not very accurate. Exudate is rare when there is a viral cold or flu.

Vincent`s angina An infection of the pharynx and oral cavity caused by some bacteria. It is called ulcerromembranous pharyngitis because it has an ulcer attached to the surface of the stomach membrane on one side of the tonsil.

3. Culture test

There are no other symptoms specific to each cause virus or germ, so a culture test should be done to determine the cause.

Most cases of acute pharyngitis are viruses, but 5-15% are caused by group A streptococcus and are not available for all patients with acute pharyngitis because of the significance of throat culture in determining antibiotic treatment.

4. Rapid Antigen Assay and Anti-Chain Antibody Value

In case of group A streptococcus, the rapid antigen test on the cell wall of the streptococcus along with the cultivation of the throat may be helpful, but the test cannot be said to be negative and the culture should be repeated. Complications such as acute rheumatic fever and glomerulonephritis may occur later, which may be necessary for rapid diagnosis, but are not widely used, but are tested for the anti-chain bacterium antibody (Antistreptolysin O). Not suitable for diagnosis

5. Other

Chest radiographs during chronic coughing, a nasal speculum for sinusitis, sinus radiographs, sinus computed tomography, and iron technique.

Treatments

1. Cold

Most are natural healing. Instead of killing the virus, the doctor treats the symptoms that appear, and buys over-the-counter drugs at a pharmacy without a prescription, or receives a prescription after a doctor’s consultation.

Young children under 2 years of age require careful supervision if they are prescribed and taken after seeing a doctor. In the long term, you should consult your doctor. If you have had allergies in the past, such as rash, itching, hives, asthma, fever, liver, kidneys, heart, diabetes, high blood pressure, glaucoma, difficulty urinating, expectant mothers, pregnant women or nursing mothers, you should inform your doctor.

1) Environment

Do not let the room humidity dry, but need plenty of water, rest and nutrition.

2) Cough

For usual healthy adults, most cough suppressants are safe. Drugs acting on the cough center include non-narcotics (eg dextromethorphan, diphenhydramine) and narcotic (eg codein), which is not recommended for use by children.

In addition, drugs that inhibit cough in the central and peripheral cough with levo-cloperastine have recently been developed and marketed drugs such as levodropizine.

Although beta2 agonists and expectorants are commonly used as bronchodilators, they are less effective. Drugs containing the first-generation antihistamine / non-mucosal constrictor combination sold in the past have some effects, and second-generation antihistamines are less effective for coughing. There are some reports that NSAIDs and expectorants are also effective in coughing.

3) Runny nose and stuffy nose

Antihistamines are effective for runny nose, sneezing and coughing. First-generation antihistamines (e.g. chlorpheniramine maleate, brompheniramine, doxylamine succinate, clemastine fumarate, etc.) used in the past are very effective for runny nose but have severe drowsiness. It is better to avoid In addition, dizziness, sputum sticking, dry mouth, discomfort, contraindications to glaucoma, enlarged prostate gland, asthma.

Less drowsy second-generation antihistamines (e.g. cetirizine, azelastine, epinastine, fexofenadine, ebastine, etc.) have less effect on cold symptoms than first generation, but they are longer and safer for glaucoma and prostatic hyperplasia.

Nasal drops containing anticholinergic agents (eg, ipratropium) used for watery runny nose (clear runny nose) during allergic rhinitis or vasomotor rhinitis are used for colds due to less systemic side effects but should be sprayed 3-4 times a day. Sneezing, nose may feel hot and dry. Topical nasal mucosa constrictor may cause rebound when used for 3-5 days or more, causing congestion of the nasal mucosa.

Oral nasal mucosa (e.g. ephedrine, pseudoephedrine, phenylephrine) lasts about 6 hours. Common side effects include palpitations and tremors, and high blood pressure and cardiovascular disease should be noted.

4) Fever, muscle pain, sore throat

Nonsteroidal anti-inflammatory drugs (NSAIDs) are effective for fever, headaches, and malaise and may reduce some coughs.
Aspirin and many NSAIDs can cause gastrointestinal bleeding and asthma in patients who are sensitive to aspirin, so in some patients it may be safe to take medications that contain acetaminophen as the main ingredient. Among nonsteroidal anti-inflammatory drugs, celecoxib (celecoxib), which is a COX-2 inhibitor, has low asthma attacks and gastrointestinal disorders, but the drug price is very expensive and the risk of cardiovascular side effects at high doses has been discussed.

5) Antibiotics

Although most people do not recommend taking antibiotics for the purpose of shortening or improving symptoms during the treatment of colds, acute rheumatic fever may develop acute rheumatic fever if they are caused by group A, not a virus, and should be treated with antibiotics. . You may be prescribed drugs to inject or take drugs of penicillin or macrolide (disrupting bacterial protein synthesis).

It is often mistaken for acute sinusitis caused by bacteria when there is a purulent runny nose, but it is difficult to distinguish it from bacterial sinusitis, which requires antibiotics within 1 week after the onset of cold symptoms. However, antibiotics are not recommended.

6) Other

In some studies, large amounts of vitamin C have reduced the symptoms of colds by 10-20% but are not actively recommended to treat the symptoms. The prevention of colds does not show a significant decrease in frequency.

Herbal medicines, such as Echinacea, have been reported in some studies to reduce the duration of colds and reduce the incidence of colds, but their effectiveness has not been proven. Similar cases for zinc are not recommended.

2. Acute sore throat and acute laryngitis

In acute sore throat, the use of antibiotics is the most important decision for treatment, but it is not possible to distinguish between viral and bacterial cases. Popular antibiotics include penicillin, cephalosporin, and macrolides. Other symptoms are the same as symptomatic with a cold, and it is important to rest the vocal cords during acute laryngitis.

3. Acute Bronchitis

Most acute bronchitis also heals naturally. You must quit smoking, and you may be given antitussives to control cough, and in some cases, bronchodilators and antibiotics. Antibiotics may be given if you have a fever, severe bronchitis, and purulent sputum. Oral or inhaled steroids are sometimes used, but their effectiveness is not yet known.

4. Flu

The flu is similar to the treatment of a cold and is treated symptomatically. Anti-influenza medications (a type of antiviral agent, amantadine, rimantadine, zanamivir, oseltamivir), when used within 48 hours of onset, cause lesser symptoms, shorten the duration of symptoms, and reduce the incidence of secondary complications.

Preventions

1. Infection Prevention

Renovirus is spread by hand. It is transmitted through the mucous membranes of the nose or eye through the hands of a susceptible person. Infection can also be caused by airway powder that coughs or sneezes. Washing your hands after going out or on a regular basis, without touching your nose or eyes with your hands, and without contaminating your surroundings with nasal secretions can prevent the spread of infection between people.

2. Vaccination

More than 100 different types of rhinoviruses are known. For this reason, unlike the hepatitis and flu vaccines, there are no vaccines that can be prevented yet.

Influenza virus has several subtypes, and vaccines are made beforehand to predict the subtypes of the flu. Therefore, even if you get the flu shot, if you are infected by a subtype other than the expected subtype, you will not have a preventive effect.

People who are 65 years old or older, chronic cardiopulmonary disease, decreased immune function, diabetes, chronic kidney disease, cancer, chronic liver disease, pregnant women who are in early pregnancy, group inmates, etc. Immunization is recommended for health care workers, caregivers, nursing home workers, and families who care for high-risk families at home. If you are allergic to eggs or have had severe side effects after vaccination in the past, you should not take the vaccine for acute illness.

Some antiviral agents (eg amantadine, rimantadine, oseltamivir) have a protective effect as well as treatment.

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