Over 80 percent of uncomplicated colds have reversible sinus abnormalities demonstrable on computed tomography, but only 0.5 to 2.0 percent of colds are complicated by clinically overt bacterial sinus infection. Fever, purulent nasal drainage, cough productive of purulent sputum, increasing symptoms or malaise after one week, or localized pain suggests possible superinfection. Transillumination of the sinuses, particularly when performed properly in patients without preexisting chronic sinus disease, is a useful procedure. Otitis media complicates approximately two percent of colds in adults and five percent of colds in children. Respiratory viral infections, particularly rhinovirus colds, are associated with up to 85 percent of asthma exacerbations in adolescents and 40 to 60 percent in adults.
Treatment is symptomatic and is based on the use of individual remedies to treat specific symptoms.
Saline nose drops may be helpful for obstructing secretions, particularly in young children, and warm saline gargles reduce sore throat. Topical decongestants such as phenylephrine and the longer-acting oxymetazoline provide prompt relief of nasal obstruction but may be associated with rebound congestion and possibly throat irritation. Oral decongestants such as pseudoephedrine also provide partial relief of nasal obstruction but may cause anxiousness and insomnia in some patients. It is uncertain whether topical or oral vasoconstrictors alter the risks of bacterial complications. First-generation oral antihistamines, such as chlorpheniramine and clemastine, reduce sneezing and, to a lesser extent, rhinorrhea, probably because of their anticholinergic effects, but are often associated with excess sedation.