Nasal Sprays Could Protect You From Serious COVID-19 Illness

Nasal steroid sprays may reduce the severity of COVID-19, according to a new study.

Researchers found that for people who regularly used a prescription corticosteroid like Beconase or Nasonex before getting sick with COVID-19, the risk of severe outcomes like hospitalization and death dropped by as much as 25%.

The study, which was published in August in The Journal of Allergy and Clinical Immunology: In Practice, is a retrospective report.

If the approach holds up in clinical studies, these steroids could be used to prevent serious COVID-19 outcomes and support the survival of the sickest patients, says Ronald Strauss, MS, MD, an allergist-immunologist and Director of the Cleveland Allergy and Asthma Center, and a lead author of the study.

“This would be something to add to the armamentarium besides the COVID vaccine. It’s certainly not recommended instead of it,” Strauss tells Verywell. “Depending on what the studies show, it might be something to send throughout the world in areas in Africa and other countries where the immunizations are not available to mitigate the severity of COVID-19.”

To understand the role of corticosteroids on COVID-19 outcomes, the researchers analyzed data from the Cleveland Clinic COVID-19 Research Registry on 72,147 adults who tested positive for COVID-19 between spring 2020 and spring 2021.  

Among these people, over 10,000 patients were using prescription nasal sprays before becoming infected with COVID-19. For this group, the risk of hospitalization decreased 22%, admissions to the intensive care unit fell 23%, and mortality dropped 24%.

The numbers support earlier lab-based studies which indicate that steroids may help prevent SARS-CoV-2—the virus that causes COVID-19—from entering cells in the nasal passageways.

How It Works

Using nasal steroids before and during COVID-19 infection might disrupt the virus’s ability to breach an important gateway: nasal passages. The nose has a large concentration of ACE2, a protein on certain human cells that serves as a dock for the virus, allowing it to infect and replicate. Because of this, the nasal passageway is a “major portal of entry” for the virus, the authors write.

“The theory was—and is now since we have these positive results—that if you can decrease ACE2 protein, that means there are fewer cells that can be infected with the virus, which would hopefully then lead to less severe COVID,” Strauss says.

The reported impact of nasal sprays on COVID-19 outcomes is promising, but a randomized clinical trial is necessary to definitely say that this approach is safe and effective for widespread use.

“It’s a potentially game-changing approach, but I think we probably want a bit more conclusive clinical trial data before we could say that definitely,” Aran Singanayagam, PhD, a professor of medicine at Imperial College London who is not affiliated with the study, tells Verywell.

Inhaled Steroids Could Have a Similar Effect

Inhaled corticosteroids work similarly to nasal sprays. This medication—often administered via devices like inhalers—can be used to treat pulmonary conditions like asthma and bronchitis.

Corticosteroids work by broadly suppressing inflammation where they are introduced. Inhaled steroids, for instance, sooth inflammation in the lungs. Some of the most severe outcomes of COVID-19, like respiratory failure, arise when the immune system kicks into high gear, triggering inflammation in organs like the lungs. Minimizing hyperinflammation can limit serious illness in infected patients.

Corticosteroids may also block the virus from infecting cells. Singanayagam’s team published a study earlier this year showing that steroid inhalers reduced the number of ACE2 receptors in animal models and human cells.

Researchers are working to better understand the different forms of ACE2 and how to engineer a steroid that can better target the virus.  

“We probably want a more targeted drug that retains some of the benefits of steroids but don’t broadly suppress the immune system,” Singanayagam says.

According to the National Institutes of Health, there is insufficient data to recommend the use of inhaled corticosteroids. Dexamethasone, which comes as an oral pill or solution, is the only corticosteroid currently recommended for use against COVID-19 in hospitalized patients.

Should You Start Using a Nasal Spray?

Nasal sprays are relatively inexpensive and easy to access, meaning they could become a key COVID-19 treatment option, especially in low- and middle-income countries where vaccination rates are low.

But don’t go running to the pharmacy for Flonase just yet, Singanayam says. The over-the-counter medications don’t have any contraindications, but clinical studies have yet to show that they are safe and effective as COVID-19 treatments.

The same holds true for inhaled steroids.

“You shouldn’t be on inhaled steroids if you don’t have asthma or COPD,” Singanayam adds.

If you already regularly take a nasal steroid, however, it’s likely that it can support your body in protecting against COVID-19.

“One of the definitive things we can say from our study is that if you’re on a nasal steroid, stay on it. It’s not going to make the COVID any worse and the essence of this study is that it can only help,” Strauss says.

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