Physician Preferences and Prescribing Patterns for Hypertonic and Isotonic Saline Solutions in Upper Respiratory Symptom Management: A Multinational Clinical Practice Survey Across 13 Countries.

BACKGROUND: Managing respiratory symptoms in patients with comorbidities presents complex therapeutic challenges due to the risk of drug interactions and contraindications associated with conventional treatments, requiring careful consideration of treatment options. Recent interest in natural therapeutic alternatives, especially seawater-based nasal sprays, reflects evolving physician attitudes and unmet clinical needs. Despite widespread clinical application, multinational data on physician perspectives toward isotonic and hypertonic saline therapies remain limited, particularly in patients with chronic conditions. This study addresses this gap by evaluating physician preferences and prescribing patterns for saline-based nasal therapies across diverse healthcare systems.

METHODS: A cross-sectional survey of 398 physicians (specialists 167 (42%), general practice 183 (46%), family practice 48 (12%)) across 13 countries was carried out using online questionnaire methodology. Participants evaluated prescribing patterns and two seawater-based nasal sprays containing exclusively sodium chloride solutions (one isotonic 0.9% and one hypertonic 2.6% concentration) without additional pharmaceutical active ingredients.

RESULTS: Most physicians surveyed reported frequent concerns about prescribing conventional cough, cold, and allergy medications to patients with comorbidities, with 291 (73%) expressing caution regarding pseudoephedrine in cardiovascular or diabetic patients. Seawater-based nasal sprays were highly rated for safety and suitability, with 87-90% of respondents per country emphasizing their appropriateness for use in sensitive populations, including children and pregnant women. Notable international differences emerged, such as a strong preference for corticosteroids in Finland and a pronounced endorsement of nasal saline products in the United Arab Emirates.

CONCLUSIONS: These results demonstrate a clear physician consideration for nasal saline and clinically supported respiratory therapies in patients with comorbidities and highlight the necessity of adapting treatment recommendations to local clinical practices and healthcare environments, including saline solutions.