Hypertonic saline nasal drops: A remedy for pediatric URTIs?

Use of hypertonic saline nasal drops can shorten the duration of a upper respiratory tract infections (URTI) in children by two days, according to the results of ELVIS-Kids randomized controlled trial presented at the ongoing European Respiratory Society (ERS) Congress being held in Vienna, Austria.1,2 Transmission of infection in the household contacts was also reduced.

The study enrolled 301 children, aged up to 6 years, within 48 hours of development of URTI. They were otherwise healthy. 150 children in the intervention group were administered hypertonic saline nasal drops (2.6%) by the parents in the dose of 3 drops per nostril, at least 4 times in a day until they recovered, while 151 children in the control group received the usual care for colds. A daily diary was maintained with a record of side effects, symptoms and compliance as assessed by the Canadian Acute Respiratory Illness and Flu Scale (CARIF). Nasal mid-turbinate swabs were collected daily for 5 days to test for viruses using a respiratory PCR panel; 17 URTI viruses were identified. The aim was to study the impact of the nasal drops on the duration of URTI.

The median duration of symptoms decreased by 2 days in children who used the hypertonic saline nasal drops for 5 days (median). Children in the nasal drops group had the symptoms for an average of six days (interquartile range [IQR], 5-9 days), whereas children in the usual care group remained symptomatic for 8 days (IQR, 5-11 days).

The saline nasal drops reduced the duration of symptoms in cases where virus was detected (hypertonic saline drops n =102, median 6 days; UC n=101, median 8 days), but not where virus was not detected. The most frequently isolated virus was Rhinovirus, detected in 73%. Children who received the drops also had significantly fewer episodes of wheeze; 5% vs 19%, respectively.

The spread of infection among household contacts of children who received hypertonic saline nasal drops was also reduced compared to the usual care group. There were 66 infections (41%) among household members in the hypertonic saline nasal drops group vs 92 (58%) in the usual care group.

“Eighty-two per cent of parents said the nose drops helped the child get better quickly and 81% said they would use nose drops in the future.”2

The side effects were rare and included sneezing, runny nose and pain. These were mild in nature. No serious adverse effects were observed.

The authors also explained the mechanism by which the hypertonic salt nasal drops exert their beneficial effect. They said, “Salt is made up of sodium and chloride. Chloride is used by the cells lining the nose and windpipes to produce hypochlorous acid within cells, which they use to defend against virus infection. By giving extra chloride to the lining cells this helps the cells produce more hypochlorous acid, which helps suppress viral replication, reducing the length of the virus infection, and therefore the duration of symptoms.”2

These findings demonstrate the benefits of hypertonic saline nasal drops in children with URTIs as well as in their family members as  a simple and cost-effective intervention. Faster recovery of children translates to fewer infections among their household contact with “clear implications for how quickly a household feels better and can return to their usual activities like school and work etc.”2

References

1.   S Cunningham, et al. Abstract OA1985. A randomised controlled trial of hypertonic saline nose drops as a treatment in children with the common cold (ELVIS-Kids trial). Available at: https://ers.app.box.com/s/2m4iity3v3z128m59bk6cn12xuz51dpr. Dated Sept. 8, 2024. Accessed on Sept. 9, 2024.

2.   ERS News. Available at: https://www.ersnet.org/news-and-features/news/saline-nasal-drops-reduce-the-duration-of-the-common-cold-in-young-children-by-two-days/ Dated Sept. 7, 2024. Accessed on Sept. 9, 2024.