Non-steroidal anti-inflammatory drugs for the common cold

Soo Young Kim, Yoon-Jung Chang, Hye Min Cho, Ye-Won Hwang, Yoo Sun Moon, Soo Young Kim, Yoon-Jung Chang, Hye Min Cho, Ye-Won Hwang, Yoo Sun Moon

Abstract

Background: Non-steroidal anti-inflammatory drugs (NSAIDs) have been widely used for the treatment of pain and fever associated with the common cold.

Objectives: To determine the effects of NSAIDs versus placebo (and other treatments) on signs and symptoms of the common cold, and to determine any adverse effects of NSAIDs in people with the common cold.

Search methods: We searched CENTRAL (2015, Issue 4, April), (January 1966 to April week 3, 2015), EMBASE (January 1980 to April 2015), CINAHL (January 1982 to April 2015) and ProQuest Digital Dissertations (January 1938 to April 2015).

Selection criteria: Randomised controlled trials (RCTs) of NSAIDS in adults or children with the common cold.

Data collection and analysis: Four review authors extracted data. We subdivided trials into placebo-controlled RCTs and head-to-head comparisons of NSAIDs. We extracted and summarised data on global 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 differences (MD) or standardised mean differences (SMD). We pooled data using the fixed-effect and random-effects models.

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 the 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). For respiratory symptoms, cough did not improve (SMD -0.05, 95% CI -0.66 to 0.56, two studies, random-effects model) but the sneezing score significantly improved (SMD -0.44, 95% CI -0.75 to -0.12, two studies, random-effects model). For outcomes related to the analgesic effects of NSAIDs (headache, ear pain, and muscle and joint pain) the 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) but it is difficult to conclude that such drugs are no different from placebo. The quality of the evidence may be estimated as 'moderate' because of imprecision. The major limitations of this review are that the results of the studies are quite diverse and the number of studies for one result is quite small.

Authors' conclusions: NSAIDs are somewhat effective in relieving the 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.

Conflict of interest statement

Soo Young Kim: none known. Yoon‐Jung Chang: none known. Hye Min Cho: none known. Ye‐Won Hwang: none known. Yoo Sun Moon: none known.

Figures

1
1
'Risk of bias' graph: review authors' judgements about each methodological quality item presented as percentages across all included studies
2
2
'Risk of bias' summary: review authors' judgements about each methodological quality item for each included study
1.1. Analysis
1.1. Analysis
Comparison 1 NSAIDs versus placebo, global effect, Outcome 1 Sum of overall symptom score (random‐effects model).
1.2. Analysis
1.2. Analysis
Comparison 1 NSAIDs versus placebo, global effect, Outcome 2 Moderate to marked severity.
1.3. Analysis
1.3. Analysis
Comparison 1 NSAIDs versus placebo, global effect, Outcome 3 Duration of colds (random‐effects model).
1.4. Analysis
1.4. Analysis
Comparison 1 NSAIDs versus placebo, global effect, Outcome 4 Duration of restriction of daily activities.
2.1. Analysis
2.1. Analysis
Comparison 2 NSAIDs versus placebo, analgesic effect, Outcome 1 Throat irritation score (fixed‐effect model).
2.2. Analysis
2.2. Analysis
Comparison 2 NSAIDs versus placebo, analgesic effect, Outcome 2 Headache score (random‐effects model).
2.3. Analysis
2.3. Analysis
Comparison 2 NSAIDs versus placebo, analgesic effect, Outcome 3 Score of pain in muscles/joints score (fixed‐effect model).
2.4. Analysis
2.4. Analysis
Comparison 2 NSAIDs versus placebo, analgesic effect, Outcome 4 Malaise score (fixed‐effect model).
2.5. Analysis
2.5. Analysis
Comparison 2 NSAIDs versus placebo, analgesic effect, Outcome 5 Chilliness score (random‐effects model).
2.6. Analysis
2.6. Analysis
Comparison 2 NSAIDs versus placebo, analgesic effect, Outcome 6 Nose irritation score.
2.7. Analysis
2.7. Analysis
Comparison 2 NSAIDs versus placebo, analgesic effect, Outcome 7 Score of pain on swallowing.
2.8. Analysis
2.8. Analysis
Comparison 2 NSAIDs versus placebo, analgesic effect, Outcome 8 Eye itching score.
2.9. Analysis
2.9. Analysis
Comparison 2 NSAIDs versus placebo, analgesic effect, Outcome 9 Earache score.
3.1. Analysis
3.1. Analysis
Comparison 3 NSAIDs versus placebo, non‐analgesic effect, Outcome 1 Cough score (random‐effects model).
3.2. Analysis
3.2. Analysis
Comparison 3 NSAIDs versus placebo, non‐analgesic effect, Outcome 2 Sneezing score (fixed‐effect model).
3.3. Analysis
3.3. Analysis
Comparison 3 NSAIDs versus placebo, non‐analgesic effect, Outcome 3 Total number of sneezes.
3.4. Analysis
3.4. Analysis
Comparison 3 NSAIDs versus placebo, non‐analgesic effect, Outcome 4 Rhinorrhoea score (fixed‐effect model).
3.5. Analysis
3.5. Analysis
Comparison 3 NSAIDs versus placebo, non‐analgesic effect, Outcome 5 Nasal obstruction score (fixed‐effect model).
3.6. Analysis
3.6. Analysis
Comparison 3 NSAIDs versus placebo, non‐analgesic effect, Outcome 6 Nasal obstruction score > 5.
3.7. Analysis
3.7. Analysis
Comparison 3 NSAIDs versus placebo, non‐analgesic effect, Outcome 7 Total number of nose blows.
3.8. Analysis
3.8. Analysis
Comparison 3 NSAIDs versus placebo, non‐analgesic effect, Outcome 8 Total mucus weight.
3.9. Analysis
3.9. Analysis
Comparison 3 NSAIDs versus placebo, non‐analgesic effect, Outcome 9 Total tissue number count.
3.10. Analysis
3.10. Analysis
Comparison 3 NSAIDs versus placebo, non‐analgesic effect, Outcome 10 Score of dryness in the nose.
3.11. Analysis
3.11. Analysis
Comparison 3 NSAIDs versus placebo, non‐analgesic effect, Outcome 11 Score of reduced sense of smell.
3.12. Analysis
3.12. Analysis
Comparison 3 NSAIDs versus placebo, non‐analgesic effect, Outcome 12 Hoarseness score.
3.13. Analysis
3.13. Analysis
Comparison 3 NSAIDs versus placebo, non‐analgesic effect, Outcome 13 Fatigue score.
4.1. Analysis
4.1. Analysis
Comparison 4 NSAIDs versus placebo, adverse effects, Outcome 1 Overall side effects (random‐effects model).
4.2. Analysis
4.2. Analysis
Comparison 4 NSAIDs versus placebo, adverse effects, Outcome 2 GI complaint (fixed‐effect model).
4.3. Analysis
4.3. Analysis
Comparison 4 NSAIDs versus placebo, adverse effects, Outcome 3 Lethargy/drowsiness (fixed‐effect model).
4.4. Analysis
4.4. Analysis
Comparison 4 NSAIDs versus placebo, adverse effects, Outcome 4 Feeling hyperactive.
4.5. Analysis
4.5. Analysis
Comparison 4 NSAIDs versus placebo, adverse effects, Outcome 5 Feeling more awake.
4.6. Analysis
4.6. Analysis
Comparison 4 NSAIDs versus placebo, adverse effects, Outcome 6 Flushed face.
4.7. Analysis
4.7. Analysis
Comparison 4 NSAIDs versus placebo, adverse effects, Outcome 7 Difficulty sleeping.
4.8. Analysis
4.8. Analysis
Comparison 4 NSAIDs versus placebo, adverse effects, Outcome 8 Light‐headedness.
4.9. Analysis
4.9. Analysis
Comparison 4 NSAIDs versus placebo, adverse effects, Outcome 9 Dry mouth.
5.1. Analysis
5.1. Analysis
Comparison 5 Head to head comparison, global effect, Outcome 1 Global improvement rating, marked improvement (fixed‐effect model).
5.2. Analysis
5.2. Analysis
Comparison 5 Head to head comparison, global effect, Outcome 2 Global improvement rating, moderate to marked improvement (fixed‐effect model).

References

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Gehanno 2003 {published data only}
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Gruber 1977 {published data only}
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Kandoth 1984 {published data only}
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Katsu 1977 {published data only}
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Katsu 1982 {published data only}
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Katsu 1983 {published data only}
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Kierszenbaum 1991 {published data only}
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Lopes 1991 {published data only}
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Martinez Gallardo 1994 {published data only}
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Matsumoto 1984 {published data only}
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Moore 2002 {published data only}
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Nagaoka 1985 {published data only}
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Nagaoka 1986b {published data only}
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Nouri 1984 {published data only}
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Nouri 1993 {published data only}
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Pagella 2001 {published data only}
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Passali 1997 {published data only}
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Reiner 1983 {published data only}
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Ruperto 2011 {published data only}
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Russo 2013 {published data only}
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Salmon 1993 {published data only}
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Salzberg 1993 {published data only}
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Sanchez 1999 {published data only}
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Schachtel 2002 {published data only}
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References to other published versions of this review Kim 2007
    1. Kim SY, Chang YJ, Cho HM, Hwang YW, Moon YS. Non‐steroidal anti‐inflammatory drugs for the common cold. Cochrane Database of Systematic Reviews 2007, Issue 1. [DOI: 10.1002/14651858.CD006362]
Kim 2009
    1. Kim Sy, Chang Y‐J, Cho HM, Hwang Y‐w, Moon YS. Non‐steroidal anti‐inflammatory drugs for the common cold. Cochrane Database of Systematic Reviews 2009, Issue 3. [DOI: 10.1002/14651858.CD006362.pub2]
Kim 2011
    1. Kim Sy, Chang Y‐J, Cho HM, Hwang Y‐w, Moon YS. Non‐steroidal anti‐inflammatory drugs for the common cold. Cochrane Database of Systematic Reviews 2011, Issue 10. [DOI: 10.1002/14651858.CD006362.pub2]
Kim 2013
    1. Kim SY, Chang YJ, Cho HM, Hwang YW, Moon YS. Non‐steroidal anti‐inflammatory drugs for the common cold. Cochrane Database of Systematic Reviews 2013, Issue 6. [DOI: 10.1002/14651858.CD006362.pub3]

Source: PubMed

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