The common cold presents perhaps one of the greatest sources of medical misconceptions and consequently the sometimes serious nature of this infectious disease and the possibility that successful treatments may have blockbuster potential can easily be overlooked. Contrary to popular thinking, the common cold cannot be effectively treated by many of the products commonly used by cold sufferers - in fact, some products such as repetitive doses of aspirin can increase viral shedding while only slightly improving symptoms; bacterial complications occur in only 2% of patients however, antibiotics are prescribed for more than 60% of common colds seen by doctors in the US; the common cold is not a minor inconvenience - in fact, colds account for a large number of lost school or work days, represent the most common cause of doctor visits and, perhaps most importantly, account for around 30% of emergency room admissions for acute severe asthma. With no current FDA-approved antiviral treatment for the common cold, Americans turn to over-the-counter cough and cold remedies to ease their symptoms, spending an estimated $3-5 billion each year, and as a result, some analysts have predicted that the first effective ethical treatment of the common cold may well be a blockbuster. A second common respiratory tract infection is respiratory syncytial virus (RSV). This virus is the most common cause of lower respiratory tract infections in children worldwide. Virtually all children contract it by the age of three presenting the leading cause of pneumonia and bronchiolitis in infants, and possibly a key contributor to the pathogenesis of asthma and chronic obstructive pulmonary disease. Disease severity varies widely and aggressive treatment of severe infection could present significant long-term advantages. Like RSV and the common cold, influenza is very common affecting about 10% to 20% of US each year. As a result an average of about 20,000 people per year will die and 114,000 per year have to be admitted to the hospital. Anyone can get the flu and serious problems from flu can happen at any age although the elderly, people with chronic medical conditions, and very young children are more likely to get complications from flu. Together therefore, respiratory tract viruses are particularly significant causes of illness and death in children and in the elderly. Vaccines offer the possibility of decreasing the severity and complications of viral respiratory disease, but development has been delayed by numerous factors. First, there are more than 200 serologically distinct RNA and DNA virus species and strains which cause an essentially similar spectrum of disease. Some re-infect at high efficiency despite little antigenic variation, while others exhibit extensive coat protein variability. A number of promising vaccines are in clinical trial, and it is likely that vaccines against RSV and parainfluenza will be licensed within the next 5-10 years. This field represents a lucrative yet unmet market and therefore deserves greater pharmaceutical attention.

Entry date October, 2002

Adapted from Olszewska et al, Br Med Bull 2002;62:99-111

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