If you have a COVID-19 infection, common respiratory symptoms include significant nasal congestion, a persistent runny nose, and uncomfortable sinus pressure. The SARS-CoV-2 virus initiates infection in the upper respiratory tract, leading to inflammation and mucus production. Treating this discomfort with a nasal spray is a common approach, but it requires distinguishing between the different types of sprays available to ensure safety and effectiveness during an active viral illness.
Saline and Simple Moisturizing Sprays
The safest and most recommended option for managing COVID-19 nasal symptoms is a simple saline or moisturizing nasal spray. These products contain a sterile solution of sodium chloride, which may be isotonic (0.9% salt concentration) or hypertonic (higher salt concentration). The primary mechanism is gentle physical relief, hydrating dry nasal passages and promoting better function of the cilia, the tiny hairs that clear mucus.
Using a saline spray helps to thin the thick mucus produced during the inflammatory response, making it easier to expel. Hypertonic saline may also draw excess fluid out of swollen nasal tissues, helping to temporarily reduce inflammation. Because these sprays do not contain pharmaceutical drugs, they can be used frequently throughout the day without risk of dependency or drug interactions.
Over-the-Counter Decongestant Sprays
Over-the-counter decongestant sprays, which contain vasoconstrictors like oxymetazoline or phenylephrine, offer rapid relief from severe congestion. These sprays work by targeting receptors on the blood vessels within the nasal lining, causing them to constrict. This immediate reduction in blood flow quickly decreases swelling in the nasal tissues, opening the airways for easier breathing within minutes.
These sprays should not be used for more than three to five consecutive days. Prolonged use creates a dependency where the nasal blood vessels become unresponsive and swell dramatically once the medication wears off, a condition known as rhinitis medicamentosa, or rebound congestion. This rebound effect often results in worse congestion than the original COVID-19 symptoms. Furthermore, because these are systemic agents, they can potentially affect individuals with pre-existing conditions by causing a temporary increase in heart rate or blood pressure.
Corticosteroid Nasal Sprays
Corticosteroid nasal sprays, such as fluticasone or triamcinolone, are primarily used to manage chronic inflammation, often associated with allergies, but they can also be useful for COVID-19-related inflammation. Unlike decongestants, these sprays do not provide immediate relief. Instead, they work over several days to reduce the underlying inflammatory response in the nasal passages, alleviating symptoms like congestion and runny nose.
A common concern during a viral infection is whether using a steroid will compromise the immune system. However, the medicine delivered by a nasal spray is highly localized, meaning only a minimal amount is absorbed into the bloodstream, unlike oral or injected systemic steroids. Studies suggest that regular users may experience a lower risk of severe COVID-19 outcomes, possibly because the sprays can downregulate the ACE2 receptor, the primary cellular entry point for the SARS-CoV-2 virus. Those who are immunocompromised or taking other steroid medications should consult a healthcare provider before starting a new corticosteroid spray during an acute infection.
Nasal Rinses Targeting Viral Load
A separate category involves rinses or sprays promoted for their ability to reduce the viral load in the nasal cavity. These products often contain ingredients like povidone-iodine (PVP-I) or xylitol, based on the hypothesis that the nose is the primary site of viral replication and shedding. Povidone-iodine is an antiseptic that has shown efficacy in laboratory settings for rapidly inactivating the SARS-CoV-2 virus, potentially reducing infectivity and transmission.
Xylitol, a sugar alcohol, is thought to work by an anti-adhesive mechanism, making it more difficult for the virus to attach to the nasal lining cells. Clinical data on the use of these specific rinses for COVID-19 is still developing, with some small studies suggesting a benefit in accelerating viral clearance and reducing symptom severity. These specialized rinses are not standard over-the-counter treatments and should be used cautiously, often requiring specific dilution instructions to ensure safety and effectiveness.