Nasal saline in upper respiratory tract infections (URTI)
- saline can be delivered to the nose as a large‐volume wash using reservoir pots and tubing, or in a small volume via spray devices that deliver a fine mist or jet of saline into the nose
- usual concentration is 'normal saline', which approximates an iso‐osmolar fluid
- hypertonic saline is sometimes used to deliver a stronger concentration of fluid to the nasal cavity and sinuses
- saline irrigation of the nose is believed to alleviate URTI symptoms by clearing excess mucus, reducing congestion and improving breathing
- is thought to improve mucociliary clearance by increasing the ciliary beat frequency
- in addition to relieving sinonasal symptoms, saline irrigation may remove infectious material from the sinuses and reduce cough associated with postnasal drip
A systematic review concluded that (1):
- limited data from five randomised controlled trials (RCTs) suggest that saline nasal irrigation may have some benefit in patients with acute upper respiratory tract infections (URTIs)
- nasal irrigation with saline is a safe treatment that may be mildly beneficial to some patients
- note that some participants experienced minor discomfort, no serious side effects were identified
Follow-up of Immune defence trial found Vick’s First-Defence (VFD) spray (2 sprays per nostril 6 times a day) and saline nasal spray (same dosing) both reduced illness days (mean 18 days for both vs 22 days usual care) and a website promoting self-care reduced incident infections (2):
- immune defence trial documented short term impacts on RTIs for nasal sprays, and a stress-management and physical activity website
- 12-month follow-up of a randomized open-label trial found that both nasal sprays (gel-based and saline) and a behavioral intervention reduced the severity and duration of RTIs compared to usual care
- showed that all interventions reduced symptom severity and work-days lost, both spray groups reported lower intention to consult and fewer falls, and there were fewer antibiotic courses and practice visits with saline
- among those with recurrent illness saline had the most impact on both recurrence and symptom days (respectively 0.93 (0.87,0.99), 0.70 (0.60,0.82))
- headache were higher for VFD and lower for saline (7.8%, 3.4% respectively; 4.7% usual care)
- study authors concluded:
- widely available, inexpensive sprays and a website promoting self-care reduce the incidence, duration and/ or severity of RTIs and impact work-days lost and healthcare use
Reference:
- King D, Mitchell B, Williams CP, Spurling GK. Saline nasal irrigation for acute upper respiratory tract infections. Cochrane Database Syst Rev. 2015 Apr 20;2015(4):CD006821.
- Little P et al. 12-month follow-up of a randomized open-label trial found that both nasal sprays (gel-based and saline) and a behavioral intervention reduced the severity and duration of respiratory tract infections (RTIs) compared to usual care. BJGP October 24th 2025.