HealthCanal: Got Nosebleeds? Saline Could Work As Well As Drugs For Preventing Them

Squirting a simple saline solution into the nose twice a day could alleviate chronic nosebleeds just as effectively as spraying with any one of three different medications, reports a study published online in the Journal of the American Medical Association (JAMA) on Sept. 6.

“This research highlights that there could be a benefit even in the simplest of interventions,” says corresponding author Kevin Whitehead, M.D., F.A.H.A., associate professor of internal medicine at the University of Utah School of Medicine and director of the Utah HHT Clinical Center. “No drug proved to be any better than the saline placebo, but the majority of patients improved over the course of treatment – even those using saline.”

Whitehead’s collaborators included investigators from several other study sites across the U.S. including senior author James Gossage, M.D., director of the Pulmonary Vascular Disease Program at Augusta University and Scott E. Olitsky, M.D., an Opthalmologist at Children’s Mercy.

While nosebleeds are an occasional nuisance for most of us, they are an unpleasant fact of life for those with hemorrhagic telangiectasia (HHT). One bloody nose per week is not uncommon, and some with the condition have more than two a day. Doctors have tried prescribing drugs off-label to treat what can be a debilitating problem, but with mixed results. The NOSE (North American Study of Epistaxis in HHT) phase 2 clinical trial was designed to determine how three of these medications – bevacizumab, estriol, and tranexamic acid – stacked up against one another.

The idea that simple hydration from any nasal spray, even saline, could prevent nosebleeds certainly makes sense, says Whitehead. People are at higher risk for nosebleeds when their nose dries out, for instance when they’re in an arid climate for extended periods of time. Further, the most dreaded but proven remedy – surgically sealing shut the nose – effectively keeps the nasal cavity permanently moist.

Yet the investigators cannot completely rule out the possibility that symptoms may have improved because of a placebo effect: that participants reported better outcomes because they expected to see an improvement. What’s more, it could be that some of the drugs would work better if taken at a higher dose, or if applied as a gel or polymer that adheres better to the inside of the nasal cavity.

Nevertheless, the results from this clinical trial were enough to convince Whitehead, Gossage, and their colleagues, to routinely recommend saline nasal spray to their patients with HHT. “We stress the importance of hydration,” says Whitehead. “We tell them that something as simple as a morning and night saline spray could offer them some benefit.”

Nosebleeds caused by HHT are not fundamentally different from common nosebleeds, but scientists have yet to test whether saline could work just as well for anyone.

The work was supported by Cure HHT and was published as “Effect of Topical Intranasal Therapy on Epistaxis Frequency in Patients with Hereditary Hemorrhagic Telangiectasia: A Randomized Clinical Trial” in JAMA on Sept. 6, 2016

Read the full article via HealthCanal.

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