Nasal spray use shortens length of respiratory tract-related illnesses
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Key takeaways:
- In addition to shortening the length of illness, use of nasal spray meant fewer workdays lost.
- Adults assigned to a nasal spray or behavioral intervention vs. usual care used fewer antibiotics.
Adults assigned to use a gel-based nasal spray or a saline spray experienced fewer days of illness from respiratory illnesses over 6 months vs. those assigned to usual care, according to results published in The Lancet Respiratory Medicine.
“Considering that adherence was only modest (we would anticipate with better adherence more impact) these findings show remarkable impact for some of our most vulnerable patients — reducing illness duration, severity and impact on daily life in addition to reducing antibiotic use,” Paul Little, FMedSci, professor of primary care research at the Primary Care Research Center at University of Southampton, told Healio. “Clinicians can confidently support using these sprays preventatively.”
In a randomized, controlled, open-label, parallel-group trial, Little and colleagues evaluated 11,612 adults in the U.K. with either a comorbidity/factor that raised their risk for adverse outcomes due to respiratory illness or a minimum of three self-reported respiratory tract infections in a year prior to the COVID-19 pandemic to find out how two nasal sprays and a behavioral intervention vs. usual care impact respiratory illness length via a 6-month survey.
Comorbidities or risk factors included, “immune compromise due to serious illness or medication; heart disease; asthma or lung disease; diabetes; mild hepatic impairment; stroke or severe neurological problem; obesity; or age [greater than or equal to] 65 years,” according to researchers.
Within the total cohort, 2,935 adults (mean age, 61.5 years; 53.9% women; 97.1% white) received gel-based spray (Vicks First Defense, Proctor and Gamble) and 2,967 (mean age, 61.4 years; 55.2% women; 97.5% white) received saline spray (Sterinase, Earol), both of which individuals could use up to six times a day after they experienced the first sign of infection or had potential infection exposure.
The behavioral intervention took the form of a website that promoted physical activity and stress management and was assigned to 2,727 adults (mean age, 61.7 years; 54% women; 97.2% white). The remaining 2,983 adults (mean age, 61.6 years; 53.2% women; 97.3% white) received usual care, or brief advice about managing illness.
After 6 months, researchers found significantly fewer total days of illness due to respiratory tract illnesses such as colds, influenza or sinus/ear infections among those assigned to gel-based nasal spray vs. usual care (mean, 6.5 days vs. 8.2 days; adjusted incidence rate ratio [aIRR] = 0.82; 99% CI, 0.76-0.9; P < .0001). A similar result was observed between those assigned to saline nasal spray and those assigned to usual care (mean, 6.4 days vs. 8.2 days; aIRR = 0.81; 99% CI, 0.74-0.88; P < .0001).
“We were a little surprised to find that saline was as effective as Vicks First Defense, and this is probably because saline has antiviral properties (ie, not simply acting as a washout mechanism),” Little told Healio.
There was no significant difference in the total number of days of illness when placing those assigned to the behavioral intervention against those assigned to usual care (mean, 7.4 days vs. 8.2 days; aIRR = 0.97; 99% CI, 0.89-1.06).
Those assigned gel-based nasal spray also had fewer days with moderately bad symptoms vs. those assigned usual care (mean, 2.4 days vs. 3 days; aIRR = 0.82; 95% CI, 0.73-0.91; P < .0001). This pattern held true for those assigned saline spray vs. usual care (2.3 days vs. 3 days; aIRR = 0.82; 95% CI, 0.74-0.92; P < .0001) and those assigned behavioral intervention vs. usual care (2.6 days vs. 3 days; aIRR = 0.89; 95% CI, 0.8-0.99; P = .04).
In terms of antibiotic use, researchers observed a significantly reduced number of courses among those assigned to gel-based nasal spray vs. usual care (aIRR = 0.65; 95% CI, 0.5-0.84; P = .001). Fewer antibiotic courses were also found for those assigned to saline nasal spray vs. usual care (aIRR = 0.69; 95% CI, 0.45-0.88; P = .003) and those assigned to the behavioral intervention vs. usual care (aIRR = 0.74; 95% CI, 0.57-0.94; P = .02).
In the usual care group, the mean number of days of work lost was 1.6, whereas in the gel-based spray group, the mean number was 1.2 days (aIRR = 0.81; 95% CI, 0.67-0.98; P = .03) and in the saline spray group, it was 1 day (aIRR = 0.72; 95% CI, 0.59-0.87; P = .001).
A greater proportion of adults advised to use gel-based nasal spray vs. the three other types of care experienced headaches (7.8% vs. saline spray, 4.5% vs. behavioral intervention, 4.5% vs. usual care, 4.8%).
“[In future studies,] we need to better engage patients in adhering to using the sprays and determine the impact of different regimes (eg, additive effects of the two sprays we used, dosing effects),” Little told Healio.