Nasal saline treatment for acute upper airway infection symptoms

Acute upper respiratory tract infections (URTIs) are infections of the upper airways that can cause symptoms for up to four weeks. Acute URTIs include colds, influenza and infections of the throat, nose or sinuses. The symptoms are often treated with painkillers and decongestants. Sometimes antibiotics are prescribed, although most acute URTIs are caused by viruses. Nasal saline sprays or irrigation have been used to treat symptoms of chronic airway infections, and sometimes for acute infections.

This review is limited by the differences in the characteristics of the included studies, including study populations and outcome measures. However, it found little research to support the use of nasal saline for acute URTIs. Included studies showed limited benefit for symptoms relief with nasal saline irrigation in adults. Nasal saline is safe and may reduce time off work but may cause minor adverse effects such as dry nose or irritation in less than half of users.

Future studies are needed to establish the use of nasal saline irrigation as a way of reducing acute URTI symptoms safely while keeping people at work and reducing antibiotic use.

Authors' conclusions: 

Included trials were too small and had too high a risk of bias to be confident about the possible benefits of nasal saline irrigation in acute URTIs. Future trials should involve much larger numbers of participants and be rigorously designed and controlled.

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Background: 

Acute upper respiratory tract infections (URTIs), including the common cold and rhinosinusitis, are common afflictions that cause discomfort and debilitation, and contribute significantly to workplace absenteeism. Treatment is generally by antipyretic and mucolytic drugs, and often antibiotics, even though most infections are viral. Nasal irrigation with saline is often employed as an adjunct treatment for chronic or allergic sinusitis, but little is known about its effect on acute URTIs.

Objectives: 

To evaluate the efficacy of saline nasal irrigation in treating the symptoms of acute URTIs.

Search strategy: 

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2009, issue 2) which contains the Acute Respiratory Infections (ARI) Group's Specialised Register, MEDLINE (1966 to May 2009), EMBASE (1974 to May 2009), CINAHL (1982 to May 2009), AMED (1985 to 2009) and LILACS (May 2009).

Selection criteria: 

Randomised controlled trials (RCTs) comparing topical nasal saline treatment to other interventions in adults and children with clinically diagnosed acute URTIs.

Data collection and analysis: 

Two review authors (DK, GS) independently assessed trial quality and extracted data. All data were analysed using Cochrane Review Manager software.

Main results: 

Three RCTs (618 participants) were included. Most results showed no difference between nasal saline treatment and control. However, there was limited evidence of benefit with nasal saline irrigation in adults. One study showed a mean difference of 0.3 day (out of eight days) for symptom resolution, but this was not significant. Nasal saline irrigation was associated with less time off work in one study. Minor discomfort was not uncommon and 40% of babies did not tolerate nasal saline drops.