Nasal Corticosteroids Show Little Promise for Common Cold

Nasal corticosteroid sprays do not seem to be viable treatments for the common cold.

Half a billion Americans develop colds each year. These viral upper respiratory infections create virus-induced inflammation (eg, vasodilation and increased vascular permeability) leading to sneezing, rhinorrhea, and nasal congestion.

Intranasal corticosteroids are efficacious for other upper respiratory infections and may reduce the common cold’s airway inflammation. However, scant research has been conducted on their use in treating common cold symptoms.

A team of researchers published an intervention review on corticosteroids as common cold treatment in a recent issue of the Cochrane Collaboration.

The study authors eliminated any study using experimentally induced infection with proactive intervention and when another respiratory infection was identified, such as influenza.

Subsequently, they were able to locate only 3 studies that looked at steroid use in colds.

Two trials were placebo-controlled, and the third compared children diagnosed with sinusitis with and without steroid treatment, although both groups received amoxicillin.

The 3 available trials were significantly different, making meta-analysis impossible.

Intranasal corticosteroids did not reduce time until symptom resolution in either placebo-controlled trial, while sore throat was prolonged in the corticosteroid group in one placebo-controlled trial.

The only trial that reported adverse effects found the rates comparable regardless of receipt of corticosteroids.

The study authors interpreted this to mean that patients who use corticosteroids for other reasons need not discontinue them when they catch a cold.

The non-placebo trial found a mean reduction in symptom severity scores, but its research methods were fundamentally flawed, according to the researchers.

The study authors concluded that corticosteroids have no added efficacy or risk in the setting of a common cold.

They suggested that patients continue otherwise indicated corticosteroids during a cold, although the impact of viral load and spread of infection are unknown.

Large placebo-controlled trials are necessary to confirm the impact of corticosteroids on duration of symptoms, school and work productivity, and the shedding of active virus.