GPAtlas🧭 When to suspect
The common cold is an acute, self-limiting viral infection of the upper respiratory tract (acute viral rhinosinusitis). The great majority are caused by rhinoviruses (around 50–80%), with coronaviruses, RSV, parainfluenza, adenovirus and enteroviruses making up most of the rest. Because hundreds of viruses and serotypes circulate, lasting immunity is not acquired and colds recur throughout life.
Suspect a cold when there is a combination of nasal congestion, rhinorrhoea (clear at first, often turning thicker and discoloured), sneezing, sore throat and cough, with only mild systemic upset. Symptoms typically peak at day 2–3 and settle over 7–10 days, though an associated cough can linger for up to 3 weeks and occasionally longer. Adults average 2–4 colds a year; young children have considerably more (often 6–8 or more), reflecting immature immunity and close contact at nursery and school.
Diagnosis is clinical. The real primary-care skills are confident reassurance, antibiotic stewardship, and recognising the small number of patients in whom a serious illness is hiding behind cold-like symptoms.
| Feature | Common cold | Influenza |
|---|---|---|
| Onset | Gradual, over a day or two | Abrupt, often within hours |
| Fever | Absent or low-grade | Common and higher (often ≥ 38°C) |
| Headache / myalgia | Mild | Prominent, often severe |
| Nasal symptoms | Prominent (congestion, sneezing, rhinorrhoea) | Less prominent |
| Fatigue / function | Mild; usually able to carry on | Marked prostration; often bed-bound |
Where systemic features dominate, consider influenza, and consider COVID-19 where there is fever, cough or loss of taste or smell – testing and treatment follow current seasonal guidance.
Source: NICE NG120 · NICE NG84
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