What is the best moisturizing nasal spray for a patient on oxygen therapy?

Best Moisturizing Nasal Spray for Patients on Oxygen Therapy

Normal saline nasal spray is the best moisturizing nasal spray for patients on oxygen therapy, as it provides effective humidification without the risks associated with other options. 1

Understanding the Need for Nasal Moisturization in Oxygen Therapy

Patients receiving oxygen therapy commonly experience nasal dryness and discomfort due to:

• Continuous flow of dry oxygen through the nasal passages
• Reduced natural humidification of inspired air
• Potential for mucosal irritation and damage

Evidence-Based Recommendations

First-Line Option: Normal Saline Nasal Spray

Normal saline (0.9% sodium chloride) nasal spray is the optimal choice for several reasons:

• Safety profile: No significant adverse effects or drug interactions 2
• Effectiveness: Provides adequate moisture to nasal mucosa 2, 3
• Accessibility: Widely available over-the-counter and relatively inexpensive
• Guideline support: British Thoracic Society guidelines support the use of nebulized normal saline for patients with viscous secretions 1

When to Consider Humidification Systems

According to the British Thoracic Society guidelines 1:

• Humidification is not required for low-flow oxygen (mask or nasal cannulae) or short-term use of high-flow oxygen
• Consider humidification for patients requiring high-flow oxygen systems for more than 24 hours
• Consider humidification for patients who report upper airway discomfort due to dryness

Specific Clinical Scenarios

1. Short-term or low-flow oxygen therapy (≤4 L/min):

   • Normal saline nasal spray as needed
   • Routine humidification not required 4

2. Long-term or high-flow oxygen therapy (>24 hours):

   • Normal saline nasal spray plus consideration of large volume oxygen humidifier device
   • Especially beneficial if sputum retention is a clinical problem 1

3. Patients with tracheostomy or artificial airways:

   • Humidification is recommended 1
   • Can be managed without humidification for short periods (e.g., ambulance journeys)

Application Guidelines

• Apply 1-2 sprays of normal saline in each nostril every 2-4 hours as needed
• Increase frequency based on symptom severity and patient comfort
• Consider using before sleep and upon waking when dryness may be more pronounced

Alternatives to Avoid

1. Bubble bottles: Not recommended due to lack of evidence for clinical benefit and risk of infection 1

2. Oxymetazoline or other vasoconstrictors:

   • While effective for nasal congestion 5, these can cause:
   • Excessive dryness of nasal lining
   • Rebound congestion with prolonged use
   • Potential systemic effects including hypertension 1

3. Water: Should never be used as a nebulized solution as it may cause bronchoconstriction 1

Special Considerations

• COPD patients: Target SpO₂ of 88-92% to prevent hypercapnic respiratory failure 1, 6
• Patients with viscous secretions: Normal saline may help with expectoration 1
• Monitoring: Assess for nasal irritation, bleeding, or discomfort regularly

Clinical Pearl

After oxygen therapy is discontinued, patients may benefit from continued use of saline nasal spray for several days until nasal mucosa returns to normal hydration status.