Steroids for the common cold

Review question

We reviewed the evidence for using steroid medications to improve symptoms in patients who have a common cold.

Background

Common colds are experienced by over half a billion patients annually in the USA alone and result in significant loss of productivity. Although there are a number of medications used to help improve the symptoms of the common cold, none have good evidence of benefit. Steroids (corticosteroids) have been shown to help relieve symptoms in other types of upper respiratory tract infections by reducing the inflammation of the lining of the nose and throat, which means they might also improve the symptoms of the common cold.

Study characteristics

Our evidence is current to May 2015. We found three trials in total. Two trials recruited adults from the general population or from among hospital staff in Finland. These trials (total 253 adults) compared intranasal steroid sprays, which allow steroids to be puffed into the nostrils, to sprays containing placebo only. We found a third trial, which recruited 100 children referred to outpatient clinics in an Iranian paediatric hospital. This trial compared intranasal steroid spray to no spray and gave oral antibiotics to all participants.

Key results and quality of the evidence

Neither of the two trials comparing steroid spray to placebo spray in adults showed a benefit of steroids across a range of different measures. The trial comparing steroid spray to no spray in children did find some evidence of benefit but we rated the quality of the evidence from this trial as very poor and the results were unclear. We could not combine the results of the trials to assess this question further. There were no reports of adverse events.

Conclusion

The available evidence suggests that we should not use intranasal steroids for the common cold. However, as we found only three small trials, we cannot be sure that there is no effect without performing larger, well-designed trials.

Authors' conclusions: 

Current evidence does not support the use of intranasal corticosteroids for symptomatic relief from the common cold. However, there were only three trials, one of which was very poor quality, and there was limited statistical power overall. Further large, randomised, double-blind, placebo-controlled trials in adults and children are required to answer this question.

Read the full abstract...
Background: 

The common cold is a frequent illness, which, although benign and self limiting, results in many consultations to primary care and considerable loss of school or work days. Current symptomatic treatments have limited benefit. Corticosteroids are an effective treatment in other upper respiratory tract infections and their anti-inflammatory effects may also be beneficial in the common cold. This updated review has included one additional study.

Objectives: 

To compare corticosteroids versus usual care for the common cold on measures of symptom resolution and improvement in children and adults.

Search strategy: 

We searched Cochrane Central Register of Controlled Trials (CENTRAL 2015, Issue 4), which includes the Acute Respiratory Infections (ARI) Group's Specialised Register, the Database of Reviews of Effects (DARE) (2015, Issue 2), NHS Health Economics Database (2015, Issue 2), MEDLINE (1948 to May week 3, 2015) and EMBASE (January 2010 to May 2015).

Selection criteria: 

Randomised, double-blind, controlled trials comparing corticosteroids to placebo or to standard clinical management.

Data collection and analysis: 

Two review authors independently extracted data and assessed trial quality. We were unable to perform meta-analysis and instead present a narrative description of the available evidence.

Main results: 

We included three trials (353 participants). Two trials compared intranasal corticosteroids to placebo and one trial compared intranasal corticosteroids to usual care; no trials studied oral corticosteroids. In the two placebo-controlled trials, no benefit of intranasal corticosteroids was demonstrated for duration or severity of symptoms. The risk of bias overall was low or unclear in these two trials. In a trial of 54 participants, the mean number of symptomatic days was 10.3 in the placebo group, compared to 10.7 in those using intranasal corticosteroids (P value = 0.72). A second trial of 199 participants reported no significant differences in the duration of symptoms. The single-blind trial in children aged two to 14 years, who were also receiving oral antibiotics, had inadequate reporting of outcome measures regarding symptom resolution. The overall risk of bias was high for this trial. Mean symptom severity scores were significantly lower in the group receiving intranasal steroids in addition to oral amoxicillin. One placebo-controlled trial reported the presence of rhinovirus in nasal aspirates and found no differences. Only one of the three trials reported on adverse events; no differences were found. Two trials reported secondary bacterial infections (one case of sinusitis, one case of acute otitis media; both in the corticosteroid groups). A lack of comparable outcome measures meant that we were unable to combine the data.

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