Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

The common cold in adults: Diagnosis and clinical features

Daniel J Sexton, MD
Micah T McClain, MD
Section Editors
Martin S Hirsch, MD
Mark D Aronson, MD
Deputy Editor
Howard Libman, MD, FACP


The common cold is a benign self-limited syndrome representing a group of diseases caused by members of several families of viruses. It is the most frequent acute illness in the United States and throughout the industrialized world [1]. The term "common cold" refers to a mild upper respiratory viral illness. The common cold is a separate and distinctly different entity than influenza, pharyngitis, acute bronchitis, acute bacterial rhinosinusitis, allergic rhinitis, and pertussis.

The common cold is associated with an enormous economic burden as assessed by lost productivity and expenditures for treatment [2]. A United States telephone survey conducted between 2000 and 2001 indicates that about 500 million noninfluenza viral respiratory infections occur yearly, resulting in estimated direct costs of USD $17 billion and indirect costs of $22.5 billion annually [3].

The average incidence of the common cold is five to seven episodes per year in preschool children, and two to three per year by adulthood [4]. Annual absences from school and work in the United States due to colds caused 26 and 23 million lost days, respectively [2]. Colds account for 40 percent of all time lost from jobs among employed people [1]. It is no surprise then, that tens of millions of research dollars have been spent on ways to prevent and shorten the course of the common cold. (See "The common cold in children: Clinical features and diagnosis" and "The common cold in children: Management and prevention".)

The epidemiology and clinical manifestations of the common cold are discussed here. Treatment and prevention of colds are discussed separately. (See "The common cold in adults: Treatment and prevention".)


Over 200 subtypes of viruses have been associated with the common cold. New viruses, such as the human metapneumovirus and bocaviruses, have been identified using polymerase chain reaction (PCR) and pan-viral DNA microarrays (Virochip) technology, and it is anticipated that additional viruses that also cause the common cold are yet to be identified.

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Feb 25, 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Kirkpatrick GL. The common cold. Prim Care 1996; 23:657.
  2. Turner RB. Epidemiology, pathogenesis, and treatment of the common cold. Ann Allergy Asthma Immunol 1997; 78:531.
  3. Fendrick AM, Monto AS, Nightengale B, Sarnes M. The economic burden of non-influenza-related viral respiratory tract infection in the United States. Arch Intern Med 2003; 163:487.
  4. Monto AS. Studies of the community and family: acute respiratory illness and infection. Epidemiol Rev 1994; 16:351.
  5. Heikkinen T, Järvinen A. The common cold. Lancet 2003; 361:51.
  6. Eccles R. Understanding the symptoms of the common cold and influenza. Lancet Infect Dis 2005; 5:718.
  7. JACKSON GG, DOWLING HF. Transmission of the common cold to volunteers under controlled conditions. IV. Specific immunity to the common cold. J Clin Invest 1959; 38:762.
  8. Palmenberg AC, Spiro D, Kuzmickas R, et al. Sequencing and analyses of all known human rhinovirus genomes reveal structure and evolution. Science 2009; 324:55.
  9. Sung RY, Murray HG, Chan RC, et al. Seasonal patterns of respiratory syncytial virus infection in Hong Kong: a preliminary report. J Infect Dis 1987; 156:527.
  10. Turner RB, Hendley JO. Virucidal hand treatments for prevention of rhinovirus infection. J Antimicrob Chemother 2005; 56:805.
  11. Gwaltney JM Jr, Moskalski PB, Hendley JO. Interruption of experimental rhinovirus transmission. J Infect Dis 1980; 142:811.
  12. Hall CB, Douglas RG Jr. Modes of transmission of respiratory syncytial virus. J Pediatr 1981; 99:100.
  13. Lindsley WG, Blachere FM, Davis KA, et al. Distribution of airborne influenza virus and respiratory syncytial virus in an urgent care medical clinic. Clin Infect Dis 2010; 50:693.
  14. Tellier R. Review of aerosol transmission of influenza A virus. Emerg Infect Dis 2006; 12:1657.
  15. Gwaltney JM Jr, Hendley JO. Transmission of experimental rhinovirus infection by contaminated surfaces. Am J Epidemiol 1982; 116:828.
  16. Winther B, McCue K, Ashe K, et al. Rhinovirus contamination of surfaces in homes of adults with natural colds: transfer of virus to fingertips during normal daily activities. J Med Virol 2011; 83:906.
  17. Hall CB, Douglas RG Jr, Geiman JM. Possible transmission by fomites of respiratory syncytial virus. J Infect Dis 1980; 141:98.
  18. Larson EL, Lin SX, Gomez-Pichardo C, Della-Latta P. Effect of antibacterial home cleaning and handwashing products on infectious disease symptoms: a randomized, double-blind trial. Ann Intern Med 2004; 140:321.
  19. Zitter JN, Mazonson PD, Miller DP, et al. Aircraft cabin air recirculation and symptoms of the common cold. JAMA 2002; 288:483.
  20. Hendley JO, Gwaltney JM Jr. Viral titers in nasal lining fluid compared to viral titers in nasal washes during experimental rhinovirus infection. J Clin Virol 2004; 30:326.
  21. Douglas RG Jr, Cate TR, Gerone PJ, Couch RB. Quantitative rhinovirus shedding patterns in volunteers. Am Rev Respir Dis 1966; 94:159.
  22. Cohen S, Tyrrell DA, Smith AP. Psychological stress and susceptibility to the common cold. N Engl J Med 1991; 325:606.
  23. Nieman DC. Exercise, upper respiratory tract infection, and the immune system. Med Sci Sports Exerc 1994; 26:128.
  24. Cohen S, Doyle WJ, Alper CM, et al. Sleep habits and susceptibility to the common cold. Arch Intern Med 2009; 169:62.
  25. Warshauer DM, Dick EC, Mandel AD, et al. Rhinovirus infections in an isolated antarctic station. Transmission of the viruses and susceptibility of the population. Am J Epidemiol 1989; 129:319.
  26. Tyrrell DA, Cohen S, Schlarb JE. Signs and symptoms in common colds. Epidemiol Infect 1993; 111:143.
  27. Mainous AG 3rd, Hueston WJ, Eberlein C. Colour of respiratory discharge and antibiotic use. Lancet 1997; 350:1077.
  28. Havas TE, Motbey JA, Gullane PJ. Prevalence of incidental abnormalities on computed tomographic scans of the paranasal sinuses. Arch Otolaryngol Head Neck Surg 1988; 114:856.
  29. Bolger WE, Butzin CA, Parsons DS. Paranasal sinus bony anatomic variations and mucosal abnormalities: CT analysis for endoscopic sinus surgery. Laryngoscope 1991; 101:56.
  30. Gwaltney JM Jr, Phillips CD, Miller RD, Riker DK. Computed tomographic study of the common cold. N Engl J Med 1994; 330:25.
  31. Kaiser L, Lew D, Hirschel B, et al. Effects of antibiotic treatment in the subset of common-cold patients who have bacteria in nasopharyngeal secretions. Lancet 1996; 347:1507.
  32. Cherry JD. Epidemic pertussis in 2012--the resurgence of a vaccine-preventable disease. N Engl J Med 2012; 367:785.
  33. Wendt CH, Hertz MI. Respiratory syncytial virus and parainfluenza virus infections in the immunocompromised host. Semin Respir Infect 1995; 10:224.
  34. Han LL, Alexander JP, Anderson LJ. Respiratory syncytial virus pneumonia among the elderly: an assessment of disease burden. J Infect Dis 1999; 179:25.
  35. Mlinaric-Galinovic G, Falsey AR, Walsh EE. Respiratory syncytial virus infection in the elderly. Eur J Clin Microbiol Infect Dis 1996; 15:777.
  36. Teichtahl H, Buckmaster N, Pertnikovs E. The incidence of respiratory tract infection in adults requiring hospitalization for asthma. Chest 1997; 112:591.
  37. Kistler A, Avila PC, Rouskin S, et al. Pan-viral screening of respiratory tract infections in adults with and without asthma reveals unexpected human coronavirus and human rhinovirus diversity. J Infect Dis 2007; 196:817.
  38. Gern JE, Galagan DM, Jarjour NN, et al. Detection of rhinovirus RNA in lower airway cells during experimentally induced infection. Am J Respir Crit Care Med 1997; 155:1159.
  39. Kelly JT, Busse WW. Host immune responses to rhinovirus: mechanisms in asthma. J Allergy Clin Immunol 2008; 122:671.
  40. DeMore JP, Weisshaar EH, Vrtis RF, et al. Similar colds in subjects with allergic asthma and nonatopic subjects after inoculation with rhinovirus-16. J Allergy Clin Immunol 2009; 124:245.
  41. Folkerts G, Nijkamp FP. Virus-induced airway hyperresponsiveness. Role of inflammatory cells and mediators. Am J Respir Crit Care Med 1995; 151:1666.
  42. Rovers MM, Schilder AG, Zielhuis GA, Rosenfeld RM. Otitis media. Lancet 2004; 363:465.
  43. McBride TP, Doyle WJ, Hayden FG, Gwaltney JM Jr. Alterations of the eustachian tube, middle ear, and nose in rhinovirus infection. Arch Otolaryngol Head Neck Surg 1989; 115:1054.
  44. Heikkinen T, Thint M, Chonmaitree T. Prevalence of various respiratory viruses in the middle ear during acute otitis media. N Engl J Med 1999; 340:260.