Nasal decongestants for the common cold

The common cold is a major and recurrent cause of morbidity, affecting children and adults two or more times each year. Nasal congestion is its commonest symptom and many therapies are marketed for its relief. There is no meta-analysis of controlled clinical trials on the effects of nasal decongestants in the common cold.

To assess the efficacy of nasal decongestants at reducing the symptom of nasal congestion in adults and children with the common cold and to identify possible adverse effects associated with their use.

In updating this review in 2004, the following databases were searched: the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 1, 2004) which contains the Cochrane Acute Respiratory Infections Group's specialised register; MEDLINE (January 1996 to February week 1 2004); EMBASE (1996 to February week 7 2004); and Current Contents (February 2004). We handsearched review citations from other references and contacted known principal investigators and pharmaceutical companies.

Randomised controlled trials with placebo of single-active oral and topical nasal decongestants in adults and children suffering from common cold.

Data were independently extracted by two reviewers (DT and GJL). All outcomes variables were continuous. Subjective outcomes were normalised to a common scale and a weighted mean difference (WMD) was calculated. We calculated a standardised mean difference (SMD) for the objective outcomes.

Five studies involving 286 adults were included, none in children. There was a significant 13% decrease in subjective symptoms after decongestants were compared with placebo. This was supported by a significant decrease in nasal airways resistance. Repeated doses of nasal decongestant were not significantly better than placebo at relieving symptoms of nasal congestion.

A single dose of nasal decongestant in the common cold is moderately effective for the short term relief of congestion in adults, while there is no evidence available to show benefit after repeated use over several days. There is insufficient data on the use of these medications in children and therefore they are not recommended for use in young children with the common cold.