METHODS: A total of 249 parents of symptomatic children and 257 symptomatic adults who sought medical advice in the spring of 1997 from 1 of 3 primary care clinics in the Minneapolis-St. Paul, Minnesota, area were surveyed by telephone 48 to 96 hours after contact with the medical system.
RESULTS: Of the adults seeking care for a child or themselves, 44% believed viruses alone cause the common cold; an additional 42% believed both viruses and bacteria play a role. Most thought rest (97%) and nonprescription medications (63%) were helpful for colds, which was consistent with published reports. Contrary to medical reports, however, most felt vitamin C (67%) and the inhalation of steam (70%) reduced cold symptoms, and 44% believed antibiotics help colds (c2=19.57; P=.0002). But 85% believed colds could resolve on their own.
CONCLUSIONS: Those adults seeking medical care for uncomplicated colds are misinformed about the primary cause of the common cold, the use of prescription medications for treating cold symptoms, and the effectiveness of some palliative care techniques. Care providers should address these perceptions rather than enabling overuse of antibiotics.
Most people (87%) treat their colds at home.1 Still, colds account for 22 million physician visits and 250 million restricted activity days per year.2 Despite extensive documentation of viral etiology,3,4 antibiotic use is prevalent in medical management of uncomplicated colds.5,6 Factors such as low environmental temperature and dampness neither facilitate getting a cold nor affect its severity;7 stress and less diverse social connections increase the frequency and severity8-10 of colds.
Cold management is limited to symptom relief. Folklore, anecdotes, and unsubstantiated beliefs persist regarding effective treatments. There is no role for antibiotic medications in managing uncomplicated colds5,6,11 or preventing secondary bacterial infections12; the therapeutic effect of vitamin C in preventing or alleviating symptoms has been inconsistently demonstrated.13-15 Some nonprescription medications relieve cold symptoms in older children and adults.16,17 In particular, aspirin and nonsteroidal drugs reduce headache and sore throat pain.2 Aspirin use in symptomatic children is contraindicated because of an association with Reye’s syndrome.18,19 Antihistamines reduce sneezing and nasal drainage;5,20 decongestants reduce nasal secretions.5,21 Coughing can be controlled with codeine.4 Inhaling moist warm heat22-24 and taking zinc25-27 do not alter the course of a cold.
In an unspecified patient sample, 31% of adults with uncomplicated colds thought antibiotics were helpful; 37% did not know.28 A survey of adult patients with uncomplicated colds residing in rural, suburban, or urban areas of the United Kingdom revealed that 87% believed antibiotics reduce symptoms.29 In a convenience sample of ethnically diverse healthy and ill adults with various conditions,30 61% believed antibiotics help reduce cold symptoms; at least 50% reported that vitamin C and over-the-counter medications were helpful.
Since the early 1970s, the medical literature has been replete with articles on colds and their management.31-35 It is unclear how this attention has influenced the knowledge and beliefs of those seeking medical care for uncomplicated colds. Previous studies focused on a few treatment options.28-30 Knowledge and beliefs may differ on the basis of a person’s ethnicity or socioeconomic status. The purpose of our study was to identify knowledge and beliefs about colds among generally healthy suburban people seeking medical care for their children or themselves during the early stages of an uncomplicated cold.
The medical staff and administrators of 3 independent suburban primary care clinics collaborated on our study. Each clinic identified consecutive patients who called the nurse triage line, the Urgent Care walk-in clinic, or the departments of family practice, internal medicine, or pediatrics because of cold symptoms. Approximately 80 parents of symptomatic children and 80 symptomatic adults at each site were selected from mid-March through mid-April 1997. Eligible adults had a primary complaint of respiratory symptoms, such as runny nose, cough, fever, or sore throat. Patients were excluded if they reported ear pain, asthma, or moderate to severe sore throat; if symptom duration exceeded 14 days in adults or 10 days in children; or if the patient was in poor general health. We included a total of 506 people (249 parents of symptomatic children and 257 symptomatic adults). The response rate was 90% for parents of symptomatic children and 94% for symptomatic adults.
Data Collection and Analysis
Trained interviewers conducted the telephone survey 48 to 96 hours after the respondent contacted the medical system. By that time, patients were more comfortable and better able to complete the survey. To assure eligibility, the script included the following statement: “We are talking with people who recently called or visited their clinic for care of cold symptoms or upper respiratory infections…” All questions included a reference to the cold or related symptoms.