快樂小藥師 Im pharmacist nichts glücklich

 News Author: Laurie Barclay, MD
CME Author: Désirée Lie, MD, MSEd
July 20, 2009 — Nonsteroidal anti-inflammatory drugs (NSAIDs) are recommended for relieving discomfort or pain caused by the common cold, according to the results of a review reported online in the July 8 issue of the Cochrane Database of Systematic Reviews.

"Although...NSAIDs have been widely used for the treatment of pain and fever associated with the common cold, there is no systematic review to assess the effects of NSAIDs in patients with the common cold," write Soo Young Kim, from Kangdong Sacred Heart Hospital in Seoul, South Korea, and colleagues. "There is some evidence that cold symptoms might be the result of inflammatory mediators such as kinins and prostaglandins, which can be blocked by NSAIDs, rather than the result of the direct cytopathic effects of viruses."

The goals of this systematic review were to evaluate the effects of NSAIDs vs placebo and other treatments on the signs and symptoms of the common cold and to identify any adverse effects of NSAIDs in patients receiving them for relief of common cold symptoms.

The reviewers searched the Cochrane Central Register of Controlled Trials (The Cochrane Library 2009, issue 1), which includes the Acute Respiratory Infections Group's Specialized Register, MEDLINE from January 1966 to March 2009, EMBASE from January 1980 to March 2009, CINAHL from January 1982 to March 2009, ProQuest Digital Dissertations from January 1938 to March 2009, KoreaMed from January 1958 to March 2009, and KMbase from January 1949 to March 2009.

Criteria for inclusion in the review were randomized controlled trials (RCTs) of NSAIDs for treatment of the common cold in adults or children. Trials were subdivided into those comparing NSAIDs vs placebo and those comparing specific NSAIDs vs other NSAIDs. Four of the review authors extracted and summarized data regarding global efficacies of NSAIDs. These included analgesic effects on headache and myalgia; nonanalgesic effects on nasal symptoms, cough, sputum, and sneezing; and adverse effects.

Selection criteria were met by 9 RCTs involving a total of 37 comparisons in a total of 1064 patients with the common cold. Of these, 6 compared NSAIDs vs placebo, and 3 compared specific NSAIDs vs other NSAIDs. Treatment with NSAIDs did not significantly reduce the total symptom score, or duration of colds, according to the results of a pooled analysis.

However, NSAID treatment was associated with significant benefits for outcomes related to analgesic effects on headache, ear pain, and muscle and joint pain. Although throat irritation was not relieved, there was a borderline benefit for malaise and mixed results for chills.

With respiratory tract symptoms, the sneezing score significantly improved, but there was no improvement in scores for cough and nasal discharge. The NSAID treatment groups had no apparent evidence of increased frequency of adverse effects.

"The authors recommend NSAIDs for relieving discomfort or pain caused by the common cold," the review authors write. "Further research is needed to investigate the effect of NSAIDs in relieving respiratory symptoms such as cough and nasal discharge."

Limitations of this review include mixed methodologic quality of the included studies, largely because of missing information regarding randomization procedures. In addition, the review did not address the comparison of acetaminophen vs NSAIDs.

"We were unable to exclude the theory that NSAIDs are effective in reducing cough based upon the data included in this review," the authors conclude. “A large trial to study NSAIDs in colds may make this relationship clearer."

The review authors have disclosed no relevant financial relationships.

Cochrane Database Syst Rev. Published online July 8, 2009.

Acute upper respiratory tract infection manifesting as the common cold is the most common illness in humans affecting all age groups. Several studies have proposed that NSAIDs can alleviate symptoms of the common cold, but their effects on different symptoms are uncertain.

This is a systematic review of RCTs to examine the efficacy of NSAIDs in patients with the common cold.

• Included were RCTs comparing NSAIDs alone or in combination with other medications vs placebo or other treatments that examined their effect on cold symptoms.
• Excluded were participants with allergic rhinitis, concurrent lower or chronic respiratory tract infection or other chronic disease, an elevated temperature of more than 38°C, sinusitis, or exudative pharyngitis.
• The investigators searched the Cochrane Central Register of Controlled Trials, which contains the Acute Respiratory Infection Group's Specialized Register, MEDLINE, EMBASE, CINAHL, ProQuest Digital Dissertations, KoreaMed, and KMBase, for English-language and non–English-language studies.
• 3 review authors independently screened results, and 1 collated the studies.
• The Cochrane Collaboration risk of bias tool was used to independently assess quality.
• The case definition of cold was recent onset of symptoms of runny and/or stuffy nose, sneezing, with or without symptoms of headache and cough.
• Primary outcomes were efficacy of NSAIDs for analgesic and nonanalgesic symptoms of the common cold.
• Secondary outcomes were adverse effects.
• Heterogeneity among trials was assessed.
• Publication bias was not examined.
• 55 studies were identified, but only 9 fulfilled the inclusion criteria.
• The studies were diverse in dose and type of NSAIDs and duration of therapy, making quantitative analysis difficult.
• The 9 included studies were all double blinded and involved 1064 patients with colds.
• 891 patients had community-acquired colds, and in 3 studies, 178 were experimentally infected by inoculation with cold viruses.
• 3 studies were performed in the United States, 4 in Japan, and 1 each in Belgium and Denmark.
• Trials took place in 154 settings in hospitals, clinics, and outpatient departments.
• 6 trials compared NSAIDs vs a placebo, and 4 compared one NSAID vs another NSAID.
• 5 studies used ibuprofen, 2 used aspirin, and 2 used loxoprofen.
• Ketoprofen, fenoprofen, fentiazac, and naproxen were used in 1 study.
• 3 studies used a general symptom score, and 5 used a symptom severity score.
• A total of 37 outcomes (56.7% from 1 study) were identified, and 8 studies assessed effectiveness, whereas 5 assessed adverse effects.
• For analgesic outcomes including cumulative pain scores and headaches, NSAIDs were associated with significant benefits.
• The cumulative earache score was significantly reduced in the ibuprofen group vs the placebo group in 1 study.
• Daily throat irritation scores showed no significant benefit, whereas malaise showed a borderline benefit.
• No significant benefits were seen for duration of illness, number of days with limited activities, and total symptom score.
• Results for cumulative chills score were mixed, with 1 trial reporting a significant decrease and another reporting a significant increase.
• Cumulative cough and sneezing scores were not improved.
• No differences were seen for NSAIDs in cumulative rhinorrhea scores, total nose blows, nasal dryness, reduced sense of smell, hoarseness, and fatigue.
• Of 5 trials that examined adverse effects, only 1 on ibuprofen showed more frequent adverse effects in the ibuprofen group (9.5% vs 1.1% in the placebo group; P < .05).
• Other trials did not show differences in adverse effects including gastrointestinal tract effects, rash, and edema.

• Use of NSAIDs for the common cold is associated with a reduction in pain and earache symptoms.

Use of NSAIDs for the common cold is not associated with the relief of nonanalgesic cold symptoms, and only ibuprofen is associated with more adverse effects vs placebo. 

接下來就是考試時間啦

Questions answered incorrectly will be highlighted.

Which of the following symptoms of the common cold is least likely to be relieved by the use of NSAIDs?

Cumulative pain

Headache

Throat irritation

Earache

Which of the following outcomes associated with the common cold is most likely to be improved by use of NSAIDs?

Nasal dryness

Limited activities

Malaise

Hoarseness

答案寫好了嗎？

Which of the following symptoms of the common cold is least likely to be relieved by the use of NSAIDs?

Answer: Throat irritation
In this systematic review examining 9 RCTs, for analgesic outcomes including cumulative pain scores and headaches, NSAIDs were associated with significant benefits. The cumulative earache score was also significantly reduced in the ibuprofen group vs the placebo group in 1 study. Daily throat irritation scores showed no significant benefit, whereas malaise showed a borderline benefit.

Which of the following outcomes associated with the common cold is most likely to be improved by use of NSAIDs?

Answer: Malaise
In this systematic review examining 9 RCTs, malaise showed a borderline benefit with NSAID use for the common cold. No significant benefits were seen for duration of illness, number of days with limited activities, and total symptom scores. Results for the cumulative chills score were mixed, with 1 trial reporting a significant decrease and another reporting a significant increase. Cumulative cough and sneezing scores were not improved. No differences were seen for NSAIDs in cumulative rhinorrhea scores, total nose blows, nasal dryness, reduced sense of smell, hoarseness, and fatigue.