Nasal washing is important

Siblings Drs. Doloreich Dumaluan (left) and Theodore Dumaluan on fighting against COVID-19. Photo: Allen Doydora/DYRD

The coronavirus disease 2019 (COVID-19) pandemic has ignited interest in viral transmission and prevention owing to the extent of it and significan morbidity and mortality associated with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

Nature Medicine said the cells in the eye and some other organs also contain the viral-entry proteins. The study also predicts how a key entry protein is regulated with other immune system genes and reveals potential targets for the development of treatments to reduce transmission.

The COVID-19 affects the lungs and airways. In the worst cases, the virus causes pneumonia that can ultimately lead to death. The virus is thought to be spread through respiratory droplets produced when an infected person coughs or sneezes, and appears to be easily transmitted within affected areas. 

Just like our teeth, our nasal needs cleaning.

Last Saturday's "The Doctor is In" (with Dr. Doloreich Dumaluan as the main resource person), the topic was about nasal washing. 

Sinus rinsing, using a saline solution of salt and water, can be beneficial for those with allergies and sinus and nasal diseases. 

It moisturizes the nose while flushing out allergens and mucus, says Theodore "Doyet" Dumaluan, M.D., an eye, ear, nose and throat (EENT) surgeon. 

He said all infections of the body result from failure of innate immune system.

The primary defense against respiratory infection is in the nose in the way of mucus clearance. 

Dumaluan recommends spray washing (not nasal irrigation) "because it is very convenient and gentle, easy to apply on daily basis, adaptable to all ages and generally safe."

But with the rise of the novel coronavirus, nasal washing is recommended. 

Here' an article from Theodore Dumaluan, EENT about  Novel Nasal Wash for Airborne Particles: a home remedy solution I lifted from his Facebook page" Nasal Care": 

Nasal washing, in its practical sense, would mean sanitation. That is, lessening the number of contaminants lodged in the nasal cavity. Since it started as an ancient Hindu practice in preparation for meditation, a significant amount of liquid was used to pass into the nasal cavity to cleanse it.  Neti pot, a tea pot shaped vessel, was popularized in the early 70’s. It delivers saline solution into the nasal cavity by gravity; that is, positioning the tilted head below the pot while pressing the spout into the nostril. 

Since then, with the basic principles in place, nasal washing evolved with the use of squirt bottles and mist sprays (and even automated irrigation-aspiration device). 

A study was done to prove the efficacy of saline nasal lavage for long term use (1 year) with unfavorable outcome, showing lower incidence of infection AFTER discontinuing. 

The recommendation then was not to use saline nasal irrigation on a regular basis, only when there is infection. One possible reason for the risk of infection is the retention of fluids in the sinuses, when not properly drained, which favors pathogenic eruption as normal saline has no antiseptic potential.

Saline nasal (lavage)wash is basically good, but not for long term. We unknowingly inhale airborne particles (dust, pollen, virus, bacteria etc.) from the environment most of the time, on a daily basis, that would trigger allergic reactions to acute and chronic infection. These micro-particles are initially trapped in the mucus layer covering the nasal epithelium. Our innate immune system has limited capacity, depending on the load and virulence of the pathogen, among others.

How do we balance the issues of long-term wash, daily airborne-particle load, and pathogenic virulence which maybe carried?

In washing, what you cannot do with small volume, you can compensate with technique. Mist sprays cannot mechanically displace contaminated mucus but can deliver enough liquid coating to lessen viscosity and make it more displaceable. If we coat it with layers of saline, good mucus clearance is attained easing down particle load, without possibility of fluid retention in the sinuses that predisposes to infection.

Apparently, saline is not enough.  How do we address pathogenicity?

 Povidone-Iodine (PVI) is a very potent antiseptic, which is widely available and has been around for ages. It is the only antiseptic which increases biocidal potency, at contact time of 15 seconds, when diluted. Free Iodine, the active component, is released when 10% PVI is diluted, with the highest free Iodine at 0.1% dilution (4.88 ppm) where it is tasteless, odorless and colorless. 

At the same dilution, studies have shown that it is non-toxic to the ciliary lining of the nasal mucosal epithelium.  The free Iodine is involved in blocking viral attachment to cellular receptors and inhibits viral release and spread from infected cells. PVI is useful to prevent infection and limit spread of human and avian influenza viruses. 

Virgin coconut oil (VCO) is generally recommended and safe (GRAS) oil for oral intake and local application. It has antiulcerogenic activity, thus a good mucosal conditioner, minimizing the mild irritating effect of hyperyonic saline. Its monolaurin compounds reduce viral infectivity of enveloped RNA and DNA viruses. Though local application may trigger irritation and mild allergic reaction, it is not common.

Delivering the saline wash thru pump mist spray minimizes fluid retention; VCO promotes nasal mucosal epithelium function, and together with the free iodine from PVI, biocidal activity is potentiated without ciliotoxicity. This Saline-Iodine-VCO (SIV) emulsion wash is a novel home remedy solution made with boiled/sterile water.

 

Thus, SIV emulsion is a safe nasal wash solution for daily hygiene, with minimal tolerable irritation, delivered with pump nasal spray bottle and can be applied 2-3x a day.

Homemade saline solution requires the following:

1. 4 cups of distilled or boiled (for at least 20minutes) water. Cooled later.

2. 1 tsp iodized salt

3. An airtight storage container with a lid, such as 350ml bottle 

To make saline solution (stock): 

 A. Wash hands thoroughly

 B. Sterilize container and mixing utensil using dishwasher or boiling them in water

 C. Pour 300-350 of the cooled sterile water into 350 ml sterilized bottle

 D. Add and mix 1 tsp of iodized salt into the bottle.

To make SIV emulsion wash with 30 ml saline in spray bottle:

A. Add 3-5 drops of 10% PVI (Betadine) then

B. Add 2 ml VCO

To apply, shake the spray bottle thoroughly to emulsify the oil before using.  Position spray tip 2-3mm in the nasal opening. Apply 3 rounds of 5 puffs per nostril, sniffing in every puff and blow out gently after every round. Wash nose 3x a day. Refill with stock saline when consumed then add PVI and VCO.

(See technique at  "Nasal Care" Facebook page)

https://www.facebook.com/107202160845042/videos/507688963266732/

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