ABSTRACT Background: Common cold is the most frequent illness managed in general practice. Data regarding prevalence of th

Babak Amra

Hamid Sohrab-Pour

Mohammad Golshan

Shahin Shirani

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1   Common Cold Symptoms and Associated Risk Factors 
Tanaffos 2006; 5(3): 13-17 
Tanaffos (2006) 5(3), 13-17 
2006 NRITLD, National Research Institute of Tuberculosis and Lung Disease, Iran  
 
 
Prevalence of the Common Cold Symptoms and 
Associated Risk Factors in a Large Population Study 
 
 
Babak Amra 
1
, Hamid  Sohrab-pour 
2
, Shahin Shirani 
3
, Mohammad Golshan
1
 
1 Department of Pulmonary Medicine, Isfahan University of Medical Sciences and Health Services, 2 Department of Pulmonary Medicine, 
Labbafinejad Hospital, Shaheed Beheshti University of Medical Sciences and Health Services, 3 Department of Internal Medicine, Isfahan 
University of Medical Sciences and Health Services, ISFAHAN-IRAN. 
 
ABSTRACT 
Background: Common cold is the most frequent illness managed in general practice. Data regarding prevalence of the 
common cold in communities is confounded by the close similarity between allergy and/or asthma related symptoms and 
common cold. 
The purpose of this study was to elucidate possible correlations between self-reported common cold episodes and 
asthma/allergy related symptoms and some evident risk factors. 
Materials and Methods: As a part of  an ISSAC study in Isfahan , Iran, a randomly selected population of 11666 students 
aged 6 to 18 years(mean ± SD =12.96±2.99) were studied. The children or parents completed in a questionnaire with both 
ISSAC, and other supplementary questions regarding the common cold and allergy.   
Results: 11666 pupils (88.9% ) completed  the study . 
Those pupils reporting more than 3 to five episodes of the common cold exhibited a significantly more asthma and/or allergy 
related symptoms.   
Conclusion: Persian people with more than 3 to 5 episodes of cold like symptoms per year should be evaluated for allergic 
conditions. (Tanaffos 2006; 5(3): 13-17) 
Key words: Common cold, Allergy, Asthma, ISSAC (International Study of Asthma and Allergies in Childhood) 
 
 
INTRODUCTION 
The common cold is the most commonly 
encountered infectious syndrome of human beings 
(1), and the most frequent illness managed in general 
practice (2). However, this illness is not well defined 
and most major textbooks do not provide a definition 
for the condition (3).  
Despite a long search for a cure, only potential 
 
Correspondence to: Amra B 
Address: Department of Pulmonary Medicine, Isfahan University of Medical 
Sciences and Health Services, PO.Box:81655-755, ISFAHAN, IRAN 
Email address: amra@med.mui.ac.ir 
Received: 10 March 2006 
Accepted: 6 December 2006  
 
treatments for the symptoms have been established 
(4). Colds afflict most adults two to three times a 
year and children five to seven times a year, and the 
resulting hours of absenteeism from work or school 
have enormous economic bearings (5). Of the several 
viruses that cause the disease, the role of rhinoviruses 
is most prominent (6). About a quarter of all colds 
are still without proven causes (7).  
A confusing burden to epidemiologic studies 
concerning the common cold, is the great similarity 
between the common cold and allergic rhinitis 
ORIGINAL RESEARCH ARTICLE 
14   Common Cold Symptoms and Associated Risk Factors 
Tanaffos 2006; 5(3): 13-17 
symptoms, which makes questionnaire based studies 
to be of limited reliability (8).   
The purpose of this study was to provide 
epidemiologic information concerning self reported 
common cold symptoms in a large pediatric 
population in Isfahan. The cold frequencies and 
symptom patterns were compared in subjects 
suffering from asthma and those without asthma 
symptoms to see if these differences can differentiate 
true colds from symptoms of allergy.  
 
MATERIALS AND METHODS 
As a part of an international study of asthma and 
allergies in childhood (ISAAC) during a two-year 
period from Oct.1998 to Dec. 2000 a randomly 
selected population of 11666 students aged 6 to 18 
years (mean ± SD= 12.96±2.99) including 6166 girls 
(52.9%) and 5500 boys (47.1%) were studied. Details 
of randomization, population selection, 
questionnaires and pulmonary evaluations, have been 
previously published (9-10). Briefly, 300 elementary, 
junior high school, and high school classes were 
randomly selected, and 10 interns of Isfahan Medical 
School completed a standard questionnaire 
supplemented by many questions concerning cold 
habits of the population, their household conditions, 
family history of asthma allergies, and similar 
conditions of frequent and/or prolonged colds. Post 
exercise spirometric measurements were conducted 
in subjects with any history of frequent and/or 
prolonged colds and also those with asthma related 
symptoms. 
Definitions: 
The common cold is any benign and self limiting 
illness presenting with nasal stuffiness and discharge, 
combined with any of the following symptoms; 
sneezing, sore throat, and cough(4).  
Rhinitis is chronic or recurrent sneezing and/or 
runny or congested nose (11).   
Allergic rhinitis in this study is any history of 
physician-diagnosed allergic rhinitis.  
Asthma in the studied children is any history of 
repeating dyspneal attacks associated with wheezy 
breathing. 
Family history of asthma is a history of physician-
diagnosed asthma. 
Histories of pulmonary infection, allergy, etc. in 
subjects or family members are physician-diagnosed 
conditions.  
Data analysis: 
The information recorded in a data base was 
analyzed using frequency tables to determine the 
frequency of yearly colds and cold or allergy-related 
symptoms. Student t-test was used to correlate 
various findings.Logistic regression analysis was 
used to evaluate correlation between cold-related 
symptoms and various risk factors. 
 
RESULTS 
Of the initially invited 13127 subjects 11666 
pupils (88.9%) were able to complete the study. Male 
to female ratio was 47.53%. Twenty-eight of the 
fathers were smokers, while less than 1% of mothers 
were smokers. Anthropometric characteristics of the 
population are summarized in table 1. 
 
Table 1.   Population database 
 
 Male (%) Female (%) Total (%) 
Total population  
 
Smoking father  
Smoking mother 
Parental education 
    Less than high school  
    High school or above 
Family size 
   Small family (2 siblings or less) 
   Large family (3 siblings or more) 
5500 (47.15) 
 
1622 (29.5) 
53 (1.0) 
 
2956 (54.4) 
2480 (45.6) 
 
2536 (46.3) 
2941 (53.7) 
6166(52.85) 
 
1682(27.3) 
70 (1.1) 
 
3587 (58.5) 
2540 (41.5) 
 
2411 (39.3) 
3725 (60.7) 
11666(100) 
 
3304 (28.3) 
123 (1.1) 
 
6543 (56.6) 
5020 (43.4) 
 
4947 ( 42.6) 
6666 (57.4) 
 
Overall, those pupils with frequently repeated 
colds especially if associated with prolonged course 
or complicated by persistent cough showed 
statistically significant correlation with asthma-
related symptoms including dyspneal attacks and 
wheezy breathing.  Frequency of cold episodes 
and/or allergy related symptoms in different genders 
of the studied population are reported in table 2.  
Logistic regression analysis showed that the 
existence of some environmental or reported co-
morbidities significantly increases the chance of 
frequent colds. Associations between the reported 
common cold-like conditions with various risk 
factors are listed in table 3. 
Amra B, et al.    15 
Tanaffos 2006; 5(3): 13-17 
  
Table 2. Frequency of cold or allergy related symptoms in different genders of the studied population.  
 
Cold or allergy related symptoms  Male (%) Female (%) Total (%) 
 
p value 
History of diagnosed asthma  80 (1.5) 49 (0.8) 129 ( 1.1) 0.000 
History of diagnosed allergy 111 (2) 247 (4) 358 (3.1) 0.000 
History of dyspnea associated with wheezy breathing  862 (15.7) 779 (12.6) 1641(14.1) 0.000 
History of parent’s asthma 1527 (27.8) 1675 ( 27.2) 3202 (27.5) 0.23 
Frequent chest infections diagnosed by family physician 112 (2) 93 (1.5) 205 (1.8) 0.02 
Prolonged cough in most colds  1025 (18.7) 1503 (24.4) 2528 (21.7) 0.000 
More than 2 colds in last 6 months 1167 (21.2) 1586 (25.7) 2753 (23.6) 0.000 
More than 4 colds in last 12 months 1060 (19.3) 1459 (23.7) 2519 (21.6) 0.000 
Colds usually lasting more than 5 days 1438 (26.2) 2236 (36.3) 3674 (31.5) 0.000 
Colds usually followed by persistent cough 785 (19.7) 798 (18.8) 1583 (19.2) 0.15 
 
Table 3.  Association of reported common cold like conditions with various risk factors  
 
Results of logistic regression analysis Respiratory conditions and associated risk factors 
p value OR(CI) 
More than two colds in last 6 months   
      Female gender  0.000 1.31(1.16-1.47) 
      Age more than 11 years 0.028 1.22(1.02-1.45) 
      History of physician diagnosed allergy  0.001 2.01(1.16-3.85) 
      History of dyspneal attacks with wheezy breathing 0.000 1.57(1.36-1.83) 
      More than two siblings  0.023 0.86(0.76-0.98) 
      Colds lasting more than 5 days 0.000 2.11 (1.88-2.37) 
      Colds with persistent  cough 0.049 1.11( 1.01- 1.27) 
       Parental smoking  NS  
       Pets in the household  0.02 1.60(1.03-2.78) 
      Cockroaches in the household 0.002 1.19(1.07-1.34) 
       Family history of frequent colds  0.05 1.21(1.08-2.01) 
More than three colds in last 12 months   
      Female gender  0.000 1.24(1.11-1.38) 
      Age more than 11 years NS  
      History of physician diagnosed allergy  NS  
      History of dyspneal attacks with wheezy breathing 0.02 1.21(1.04-1.41) 
      More than two siblings  0.049 0.89(0.78-0.97) 
      Colds lasting more than 5 days 0.000 2.05 (1.83 -2.29) 
      Colds with persistent  cough 0.008 1.12( 1.00- 1.41) 
       Parental smoking  NS  
       Pets in the household 0.05 1.72(1.01-2.97) 
      Cockroaches in the household 0.002 1.18(1.07-1.31) 
       Family history of frequent colds  NS  
More than five colds in last 12 months   
      Female gender  0.031 1.34(1.04-1.55) 
      Age more than 11 years NS  
      History of physician diagnosed allergy  NS  
      History of dyspneal attacks with wheezy breathing 0.005 1.31(1.08-1.56) 
      More than two siblings  0.015 0.82(0.70-0.96) 
      Colds lasting more than 5 days 0.000 2.05(1.78-2.37) 
      Colds with persistent  cough 0.020 1.23(1.04-1.46) 
       Parental smoking  NS  
       Pets in the household  0.02 2.01(1.11-3.66) 
      Cockroaches in the household 0.051 1.23(1.10-1.42) 
       Family history of frequent colds  NS  
16   Common Cold Symptoms and Associated Risk Factors 
Tanaffos 2006; 5(3): 13-17 
DISCUSSION 
In most instances, the clinical diagnosis of the 
common cold is simple and can be made reliably by 
adult patients, themselves (12). However, diagnosis 
is sometimes problematic in infants and young 
children who are not capable of expressing their 
symptoms, or in patients suffering from intermittent 
recurrences of allergic rhinitis (4). The symptoms of 
sneezing, nasal congestion and, running nose are 
common in both allergic rhinitis and the common 
cold, so misinterpretation of allergic symptoms, as a 
common cold is not uncommon.  
In this study frequent colds, occurring in more 
than two occasions in the last 6 months or recurring 
more than 3 to five times a year were strongly 
associated with previous histories of dyspneal attacks 
associated with wheezy breathing, a finding which 
seriously points to the possibility of misinterpretation 
of asthma attacks by the subjects, parents and/or 
family physicians.  
Further association of the frequent colds with 
cockroaches and/or pets in the house hold, might 
enforce the possible allergic origin for at least many 
of the recurring cold like episodes. Under-diagnosis 
of allergic conditions including asthma have been 
frequently stressed in many epidemiologic studies 
both in developing (9-10) and industrialized (13) 
countries. Interestingly, allergic conditions had been 
diagnosed more in boys while morbidity conditions 
due to wrong attribution to simple colds especially 
those reported in the last four rows of table 2 are 
more common in girls. This paradox can be 
attributed to the physician’s belief, that asthma might 
be more common in boys (14). 
Although, viral infections have been associated 
with asthma exacerbations, the role of respiratory 
viral infection in the development of asthma remains 
unclear (15, 16). A number of factors play crucial 
roles, including the type of virus, the severity           
of  the  disease,  the  time  of  the  infection, and most  
 
importantly, the host predisposition. On the other 
hand, there is little doubt that a strong association 
exists between viral respiratory infections and 
induction of wheezing illnesses and asthma 
exacerbations. The underlying mechanisms, although 
not fully clarified, are likely to be multifactorial, 
involving inflammation of the bronchial mucosa, 
which interacts under certain circumstances with 
allergic inflammation. In addition, repetitive 
infections play an important role in perpetuating 
inflammation and airway hyperresponsiveness, 
especially in the presence of atopy, leading from 
childhood asthma to a more persistent asthma 
phenotype. But asthma as a predisposing factor to 
catch more viral infections has not been reported, so 
the more frequent cold episodes will be hard to be 
explained by asthma/ viral infection interactions. 
Furthermore, other symptoms including 
prolonged colds and colds going to the chest are 
strongly associated with frequent colds which further 
support the mentioned idea that more than three colds 
per year are highly suspicious for allergic conditions 
rather than viral infections. 
Lack of association between colds and parental 
smoking, might be a result of the fact that Persian 
women seldom smoke and most of the smoking 
fathers stressed that they do not smoke indoors.  
In conclusion, Persian people with more than 
three to four episodes of cold like symptoms per year 
have to be evaluated for possible allergic conditions.  
 
REFERENCES 
1. Wat D. The common cold: a review of the literature. Eur J 
Intern Med 2004; 15 (2): 79- 88.  
2. Kirkpatrick GL. The common cold. Prim Care 1996; 23 (4): 
657- 75.   
3. Treanor JJ, Hayden FG. Viral infections. In: Murray & Nadel 
Texbook of respiratory Medicine. Philadelphia PA, Saunders 
2000: 929-84. 
Amra B, et al.    17 
Tanaffos 2006; 5(3): 13-17 
4. Heikkinen T, Jarvinen A. The common cold. Lancet 2003; 
361 (9351): 51- 9.  
5. Turner RB. Epidemiology, pathogenesis, and treatment of the 
common cold. Ann Allergy Asthma Immunol 1997; 78 (6): 
531- 9. 
6. Arruda E, Pitkaranta A, Witek TJ Jr, Doyle CA, Hayden FG. 
Frequency and natural history of rhinovirus infections in 
adults during autumn. J Clin Microbiol 1997; 35 (11): 2864- 
8.  
7. Makela MJ, Puhakka T, Ruuskanen O, Leinonen M, Saikku 
P, Kimpimaki M, et al. Viruses and bacteria in the etiology 
of the common cold. J Clin Microbiol 1998; 36 (2): 539-42.  
8. Lack G. Allergic Rhinitis in children. Pharm J 1999; 262: 
649. 
9. Golshan M, Mohamad-Zadeh Z, Zahedi-Nejad N, Rostam-
Poor B. Prevalence of asthma and related symptoms in 
primary school children of Isfahan, Iran, in 1998. Asian Pac 
J Allergy Immunol 2001; 19 (3): 163- 70.  
10. Golshan M, Mohammad-Zadeh Z, Khanlar-Pour A, Iran-
Pour R. Prevalence of asthma and related symptoms in junior 
high school children in Isfahan, Iran. Monaldi Arch Chest 
Dis 2002; 57 (1): 19- 24.  
11. Sibbald B, Rink E. Epidemiology of seasonal and perennial 
rhinitis: clinical presentation and medical history. Thorax 
1991; 46 (12): 895- 901. 
12. Arruda E, Pitkaranta A, Witek TJ Jr, Doyle CA, Hayden FG. 
Frequency and natural history of rhinovirus infections in 
adults during autumn. J Clin Microbiol 1997; 35: 2864-68. 
13. van Schayck CP, van Der Heijden FM, van Den Boom G, 
Tirimanna PR, van Herwaarden CL. Underdiagnosis of 
asthma: is the doctor or the patient to blame? The DIMCA 
project. Thorax 2000; 55 (7): 562- 5.  
14. Mercer MJ, van der Linde GP, Joubert G. Rhinitis (allergic 
and nonallergic) in an atopic pediatric referral population in 
the grasslands of inland South Africa. Ann Allergy Asthma 
Immunol 2002; 89 (5): 503- 12.  
15. Velissariou IM, Papadopoulos NG. The role of respiratory 
viruses in the pathogenesis of pediatric asthma. Pediatr Ann 
2006; 35 (9): 637- 42.   
16. Stensballe LG, Kristensen K, Simoes EA, Jensen H, Nielsen 
J, Benn CS, et al. Atopic disposition, wheezing, and 
subsequent respiratory syncytial virus hospitalization in 
Danish children younger than 18 months: a nested case-
control study. Pediatrics 2006; 118 (5): e1360- 8.  
 
 


Prevalence of the Common Cold Symptoms and Associated Risk Factors in a Large Population Study

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Prevalence of the Common Cold Symptoms and Associated Risk Factors in a Large Population Study

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