Saline nasal irrigation for acute upper respiratory tract infections

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. 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.