A spray containing ipratropium bromide administered into the nose to treat common cold symptoms

The common cold is caused by a range of viruses and bacteria. It is the most common illness affecting humans. It causes a runny and stuffy nose, sore throat and sneezing. There is no proven cure for the cold and only symptom relief is available. The aim of this review was to investigate the use of a nasal spray containing ipratropium bromide (IB), which may improve cold symptoms. This review has found that IB may improve the runny nose but has no effect on nasal stuffiness.

We identified seven trials that included 2144 participants. There were more side effects with IB, such as dryness of the nose, mucus with streaks of blood and bleeding from the nose. Limitations in this review included two studies with missing participants and four studies with unclear blinding of the participants, personnel or outcome assessors. These limitations resulted in the majority of studies having an unclear risk of bias, which raises the concern of overestimation of the overall effect of IB. We concluded from this review that IB may be effective in improving the runny nose with some side effects that are well tolerated. There is a need for more high-quality studies to determine the effectiveness of IB in relieving common cold symptoms.

Authors' conclusions: 

For people with the common cold, the existing evidence, which has some limitations, suggests that IB is likely to be effective in ameliorating rhinorrhoea. IB had no effect on nasal congestion and its use was associated with more side effects compared to placebo or no treatment although these appeared to be well tolerated and self limiting. There is a need for larger, high-quality trials to determine the effectiveness of IB in relieving common cold symptoms.

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Background: 

The common cold is one of the most common illnesses in humans and constitutes an economic burden both in terms of productivity and expenditure for treatment. There is no proven cure for the common cold and symptomatic relief is the mainstay of treatment. The use of intranasal ipratropium bromide (IB) has been addressed in several studies and might prove an effective treatment for the common cold.

Objectives: 

To determine the effect of IB versus placebo or no treatment on severity of rhinorrhoea and nasal congestion in children and adults with the common cold. Subjective overall improvement was another primary outcome and side effects (for example, dry mucous membranes, epistaxis and systemic anticholinergic effects) were reported as a secondary outcome.

Search strategy: 

In this updated review we searched CENTRAL 2013, Issue 3, MEDLINE (1950 to March week 4, 2013), MEDLINE in-process and other non-indexed citations (8 April 2013), EMBASE (1974 to April 2013), AMED (1985 to April 2013), Biosis (1974 to February 2011) and LILACS (1985 to April 2013).

Selection criteria: 

Randomised controlled trials (RCTs) comparing IB to placebo or no treatment in children and adults with the common cold.

Data collection and analysis: 

Two review authors independently extracted data and assessed trial quality. We used a standardised form to extract relevant data and we contacted trial authors for additional information.

Main results: 

Seven trials with a total of 2144 participants were included. Four studies (1959 participants) addressed subjective change in severity of rhinorrhoea. All studies were consistent in reporting statistically significant changes in favour of IB. Nasal congestion was reported in four studies and was found to have no significant change between the two groups. Two studies found a positive response in the IB group for the global assessment of overall improvement. Side effects were more frequent in the IB group, odds ratio (OR) 2.09 (95% confidence interval (CI) 1.40 to 3.11). Commonly encountered side effects included nasal dryness, blood tinged mucus and epistaxis. The overall risk of bias in the included studies was moderate.

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