Can a Nasal Spray Help Keep You From Getting Sick?
Three simple options to know about during cold and flu season
By Cammy Benton, MD | Benton Integrative Medicine
What if one of the easiest ways to help protect yourself from viruses starts with your nose?
When we breathe, viruses can enter through our nose and infect the cells inside. That's why researchers are studying nasal sprays as another way to help protect us from getting sick.
Three options are getting attention: saline (salt water), iodine nasal spray, and azelastine (Astepro).
Let's look at what the research shows.
1. Saline Nasal Spray: Simple Salt Water
Saline helps wash mucus, dust, and other particles out of your nose. It's inexpensive, easy to find, and generally safe for regular use.
In a large study involving nearly 14,000 adults, people assigned to use saline nasal spray had fewer days of respiratory illness than those receiving usual care.
Usual care: about 22 sick days over one year
Saline spray: about 18 sick days
That's about 4 fewer sick days per year!
Another study found that children using saltwater nose drops after getting sick recovered about two days sooner.
My take: Saline is a reasonable first choice for keeping your nose moist and comfortable, especially when traveling or spending time in dry air. It may also help reduce the burden of respiratory illness.
We still don't know whether using it right before a flight or crowded event actually prevents infection.
2. Iodine Nasal Spray: A Germ-Fighting Option
Iodine has been used to kill germs for many years.
A special form called povidone-iodine can kill certain viruses in laboratory studies.
A 2025 study followed 260 adults who already had colds. Researchers compared a 0.5% iodine nasal spray with saline.
People using iodine generally reported less severe symptoms. However, the study's main result was not statistically significant. Some smaller groups, especially people who started treatment within 24 hours, appeared to benefit more.
My take: Iodine nasal sprays are interesting, especially for early illness, but we don't yet have strong proof that they prevent infections during travel or crowded events.
Only products specifically made for nasal use should be considered. Regular Betadine skin antiseptic should never be sprayed into the nose. Iodine nasal products also need extra caution in people with thyroid disease, during pregnancy, and with repeated use.
3. Azelastine (Astepro): The Surprising Allergy Spray
This one really caught my attention!
Azelastine is an antihistamine nasal spray that has been used for allergies for decades.
But researchers are finding that it may also help prevent some viral infections.
In a 2025 study of 450 adults:
COVID-19 infections:
Azelastine: 2.2%
Placebo: 6.7%
That's about a 67% lower relative risk of COVID-19!
Common cold infections caused by rhinovirus:
Azelastine: 1.8%
Placebo: 6.3%
Researchers have also found that azelastine may help lower the amount of COVID-19 virus in the nose after infection.
My take: Of these three options, azelastine has the most direct clinical trial evidence for preventing COVID-19. However, the study was relatively small, and we need larger studies to confirm the results.
The study used a 0.1% spray three times daily for eight weeks. That's different from the over-the-counter Astepro Allergy 0.15% product and its labeled directions.
Azelastine is not FDA-approved for preventing viral infections.
Which Nasal Spray Should You Choose?
Nasal spray | What the research suggests |
Saline | May reduce sick days and help with cold symptoms |
Povidone-iodine | Kills viruses in the lab; possible benefits early in a cold |
Azelastine | Promising human evidence for COVID-19 prevention and fewer rhinovirus infections |
These sprays have not been directly compared with each other in one prevention study, so we cannot say which works best.
When Might Nasal Sprays Be Helpful?
I especially think about nasal care during times when we're around more people and more germs:
Before and after airplane travel
During cold and flu season
When attending crowded events
When working in schools, medical offices, or busy buildings
When someone in the household is sick
For most people, plain saline is a practical option to consider during these situations. It can help keep nasal passages moist and clear mucus.
For people interested in azelastine or iodine nasal sprays specifically for virus prevention, I recommend discussing the evidence and safety with their healthcare provider first.
We do not yet have a proven nasal spray routine for flights, crowds, or workplace exposure. These sprays should be considered possible added tools, not replacements for clean indoor air, handwashing, staying home when sick, or a well-fitting mask in higher-risk settings.
A Final Thought
As an integrative physician, I love finding simple, affordable ways to support our health.
Sometimes the most exciting discoveries come from things we've used for years.
Nasal sprays may become another helpful tool for preventing respiratory infections. The research is promising, especially for azelastine, but there is still more to learn.
The goal isn't to live in fear of germs. It's to understand our options and make informed choices to protect our health.
Dr. Cammy Benton
Benton Integrative Medicine
Research References
This article is for education and does not replace personal medical advice. Nasal sprays are not FDA-approved for viral prevention, and results from early studies should not be considered guarantees of protection.
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