Non-steroidal anti-inflammatory drugs for the common cold

Kim Sy, Cho HM, Hwang Y-w, Moon YS, Chang Y-J

Published Online:

October 5, 2011

The common cold is the most common and widespread illness known to humans. Non-steroidal anti-inflammatory drugs (NSAIDs) are drugs with analgesic (pain reducing), antipyretic (fever reducing) and, in higher doses, anti-inflammatory effects. NSAIDs have been widely used for over a century for the treatment of pain and fever associated with the common cold. This review found nine studies (including 1069 participants) that compared various NSAIDs either with each other or with an inactive substance that has no treatment value (placebo). Our findings suggest that NSAIDs may improve most analgesia-related symptoms caused by the common cold, but there is no clear evidence that NSAIDs are effective in improving coughs and runny noses caused by the common cold.

Abstract (click to read)

Background:

Although non-steroidal anti-inflammatory drugs (NSAIDs) have been widely used for the treatment of pain and fever associated with the common cold, there is no systematic review to assess the effects of NSAIDs in people with the common cold.

Objectives:

To determine the effects of NSAIDs versus placebo and other treatments on the signs and symptoms of the common cold.
To determine any adverse effects of NSAIDs in patients treated with NSAIDs for the common cold.

Search strategy:

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 1) which contains the Cochrane Acute Respiratory Infections Group's Specialised Register, MEDLINE (January 1966 to March week 4, 2011), EMBASE (January 1980 to April 2011), CINAHL (January 1982 to April 2011), ProQuest Digital Dissertations (January 1938 to April 2011), KoreaMed (January 1958 to April 2011) and KMbase (January 1949 to April 2011).

Selection criteria:

Randomised controlled trials (RCTs) studying treatment of the common cold with NSAIDs in adults or children.

Data collection and analysis:

Four review authors (SYK, YSM, YJC, YWH) extracted data. We subdivided trials into placebo-controlled RCTs and head-to-head comparison of NSAIDs RCTs. We extracted and summarised data on global efficacies of analgesic effects (such as reduction of headache and myalgia), non-analgesic effects (such as reduction of nasal symptoms, cough, sputum and sneezing) and side effects. We expressed dichotomous outcomes as risk ratios (RR) with 95% confidence intervals (CI) and continuous data as mean difference (MD) or standardised mean differences (SMD). Data were pooled using the fixed- and random-effects model.

Main results:

We included nine RCTs, with 1069 participants, describing 37 comparisons: six were NSAIDs versus placebo and three were NSAIDs versus NSAIDs. The overall risk of bias in included studies was mixed. In a pooled analysis, NSAIDs did not significantly reduce the total symptom score (SMD -0.40; 95% CI -1.03 to 0.24, three studies, random-effects model), or duration of colds (MD -0.23; 95% CI -1.75 to 1.29, two studies, random-effects model). Malaise showed a borderline benefit (SMD -0.29; 95% CI -0.6 to 0.03, two studies, random-effects model), throat irritation did not improve (SMD -0.01; 95% CI -0.33 to 0.30, two studies, random-effects model) and chills showed mixed results (SMD -0.02; 95% CI -0.34 to 0.30, two studies, random-effects model). For respiratory symptoms, cough (SMD -0.05; 95% CI -0.66 to 0.56, two studies, random-effect model)?, two studies, random-effects model) and nasal discharge scores did not improve but the sneezing score (SMD -0.44; 95% CI -0.75 to -0.12, two studies, random-effects model) significantly improved. However, for outcomes related to the analgesic effects of NSAIDs (headache, ear pain, and muscle and joint pain) such treatment produced significant benefits. The risk of adverse effects was not high with NSAIDs (RR 2.94, 95% CI 0.51 to 17.03, two studies, random-effects model) and it is difficult to conclude that such drugs are not different from placebo.

Authors' conclusions:

NSAIDs are somewhat effective in relieving discomfort caused by a cold but there is no clear evidence of their effect in easing respiratory symptoms. The balance of benefit and harms needs to be considered when using NSAIDs for colds.

This record should be cited as:

Kim Sy, Cho HM, Hwang Y-w, Moon YS, Chang Y-J. Non-steroidal anti-inflammatory drugs for the common cold. Cochrane Database of Systematic Reviews 2009, Issue 3. Art. No.: CD006362. DOI: 10.1002/14651858.CD006362.pub2

Assessed as up to date:

April 6, 2011

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Primary Review Group:

Acute Respiratory Infections Group

PEARLS - Practical Evidence About Real Life Situations (click to read)

Clinical question:

How effective are non-steroidal anti-inflammatory drugs (NSAIDs) for the common cold?

Bottom line:

In a pooled analysis, compared to placebo, NSAIDs did not significantly reduce the total symptom score or duration of colds. However, for outcomes related to the analgesic effects of NSAIDs (headache, ear pain, and muscle and joint pain) NSAIDs produced significant benefits, as well as a borderline benefit for malaise, but throat irritation was not improved. NSAIDs showed mixed results for chills. For respiratory symptoms, cough and nasal discharge scores were not improved, but the sneezing score was significantly improved. There was no evidence of increased frequency of adverse effects in the NSAID treatment groups.

Caveat:

The overall quality of studies was mixed, largely due to missing information regarding randomisation procedures. Only 2 studies were assessed as being of high quality.

Context:

The common cold is the most common and widespread illness known to humans. NSAIDs are drugs with analgesic, antipyretic, and in higher doses, anti-inflammatory effects. NSAIDs have been widely used for over a century for the treatment of pain and fever associated with the common cold.

Cochrane Systematic Review:

Kim SY et al. Non-steroidal anti-inflammatory drugs for the common cold. Cochrane Reviews 2009, Issue 3. Article No. CD006362. DOI: 10.1002/14651858.CD006362.pub2. This review contains 9 studies involving 1064 participants.

Authored by:

Brian R McAvoy

Cochrane Primary Health Care Field

Health topics:

Ear, nose, & throat > Nose & sinus > Common cold & cough

Infectious disease > Respiratory infections > Common cold & cough

Lungs & airways > Respiratory infections > Common cold & cough

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Non-steroidal anti-inflammatory drugs for the common cold

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