Preventive and therapeutic role of nasal irrigation in management of acute respiratory disease during COVID-19 pandemic and beyond

It has long been known, that nasal saline irrigation is a safe and effective method, which is routinely prescribed by otorhinolaryngologists to prevent and to treat a wide range of pathologies. There are a lot of publications on different irrigation techniques and methods. This literature review discusses the key parameters of nasal irrigation, including tonicity, pH, and the additional components, and explains how they affect the effectiveness of the procedure. The vast majority of available publications did not found any possible changes in the effectiveness of solutions with different pH close to neutral meaning. Whereas, the volume of the irrigated solution, increases the efficiency of the irrigation in direct proportion. Thus, the largest distribution area of the solute is noted when washing with a large volume of liquid. Nasal saline irrigation is an effective treatment option for patients with several acute and chronic diseases and for postoperative care after rhinosurgery. Moreover, nasal irrigation might be used as an effective non-specific method for prevention of acute upper respiratory tract infections. Irrigation of the nasal cavity reduces the mucus viscosity and promotes its faster elimination, along with pathogens fixed in it. Additionally, irrigation with isotonic saline solutions increases the hydration of the underlying water base, which enhances the frequency of ciliary beat and reduces the concentration of local inflammatory mediators. COVID-19 pandemic situation due to lack of any specific antiviral drugs dictates the necessity of an effective non-specific preventive option, which could be introduced worldwide. The so-called full volume lavage of the nasal cavity allows for better cleaning of the nasal cavity and effective moisturizing of the mucous membrane. It is the timely cleansing and moisturizing that are most important for maintaining the normal activity of the local protective mechanisms of the upper respiratory tract.

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