Nasal Rinses for COVID-19: Evidence-Based Recommendation

Safety Profile

• The European Respiratory Society classifies nasal saline irrigation as a safe, inexpensive, and easy-to-use intervention with potential minor side effects including Eustachian tube dysfunction symptoms or throat irritation with gargling, but these are uncommon 1

Guideline Context and Limitations

• The European Respiratory Society does not address nasal irrigation in their COVID-19 treatment guidelines, highlighting the need for further research 2
• The American College of Rheumatology also does not address nasal irrigation in their guidelines, but suggests other adjunctive measures may be considered 3
• The use of povidone-iodine nasal spray as a potential adjunctive measure has been suggested based on theoretical mechanisms rather than clinical trial data, as noted by the Autoimmunity Reviews 5

Clinical Decision Framework

• The Rhinology society suggests that nasal saline irrigation should be offered as an adjunctive strategy when patients seek additional preventive or therapeutic measures beyond standard care, particularly for those who can tolerate the procedure and are at high risk of exposure 1
• The European Respiratory Journal notes that nasal saline irrigation can be considered when cost and accessibility are concerns, as it is an inexpensive intervention 2
• The Arthritis and Rheumatology society recommends that nasal saline irrigation can be safely added to standard treatment protocols for mild-to-moderate symptoms and outpatient management 3