Nip Respiratory Illnesses in the Bud with Nasal Spray

Autumn is here - and with it the time of runny noses, scratchy throats and high sickness rates. Whether classic colds, flu or corona: viruses now find ideal conditions to spread. When the temperatures drop, we are drawn to heated indoor spaces where we sit closer together and viruses have an easy time of it.

In addition, viruses prefer cold and dry air; they remain active and infectious for longer. The dry heating air also causes our mucous membranes to lose moisture, weakening their natural protective barrier against pathogens. The immune system also works more slowly at this time of year - not least because of the reduced sunlight and the resulting lower vitamin D production.

Nitric Oxide Nasal Spray Kills Viruses Locally Before they can Spread in the Body

However, those who have not been able to escape the viruses may soon have the opportunity to contain the respiratory infection at an early stage and thus protect themselves and others. As part of the Europe-wide ECRAID-Prime study, the efficacy and safety of a new type of nasal spray that releases a small dose of nitric oxide (NO) is currently being investigated. This natural messenger substance has antimicrobial properties and can fight various pathogens, including viruses. The preparation, NONS for short, is designed to render viruses harmless in the upper respiratory tract before they can spread further in the body. A previous study* showed that NONS can reduce the viral load in the nose significantly faster than a placebo. A total of eight European countries are taking part in the platform study funded by the EU as part of Horizon 2021-2027. The Institute of General Medicine at the University Hospital of Würzburg (UKW) is conducting the study for Germany: ECRAID-Prime - Institute of General Medicine

At least One Respiratory and One Systemic Symptom

People aged 18 and over who have had symptoms of a respiratory infection for a maximum of three days can take part in the ECRAID-Prime study. This means that study participants should have both a respiratory symptom such as a cough, sore throat, runny nose or shortness of breath and a systemic symptom such as fever, headache or aching limbs, fatigue, loss of taste or loss of smell.

The study team is working closely with general practitioners in Würzburg and the surrounding area to recruit study participants. Other practices are also very welcome. However, people with respiratory tract infections can also contact the study team directly - by e-mail at ECRAID-Prime@ukw.de or by telephone on 0931/201-47818 or 0931/201-47802 (9 am to 5 pm).

Home Visit from the Study Team

"As we usually visit patients at home on the same day for study inclusion, study participants should live in Würzburg or the surrounding area," emphasises study doctor Nicolas Schwager. Randomisation takes place after informed consent has been obtained. This means that the study participants are randomly assigned to the test group with NONS (six times a day over seven days), the comparison group with saline nasal spray or a third group without specific application. In all groups, however, so-called "usual care" is permitted, i.e. the usual treatment with painkillers, steam baths or similar. All groups are also asked to keep a diary and regularly take nasal swabs, which are frozen and later collected by the study team.

"Our study participants so far have cooperated very well in all three groups, and even those without a nasal spray were highly motivated to support our research. Without this group, we would not have valid results," says Maike Ermster, study assistant at the Institute of General Medicine in Würzburg.

Reducing the Impact of Infectious Diseases

"If ECRAID-Prime proves that NONS can speed up recovery and reduce the spread of viruses, this would be another important step towards containing future waves of colds and flu at an early stage," emphasises Nicolas Schwager. "The faster we act where the infectious diseases originate, namely directly in the community, the better we can prevent future outbreaks."

Reducing the impact of respiratory diseases on the health of individuals and the population is also the declared aim of ECRAID. ECRAID stands for European Clinical Research Alliance on Infectious Diseases. It is the first network of its kind in Europe to offer centralised access to a pan-European network for clinical research in the field of infectious diseases. This also has an economic impact. For example, colds are one of the most common causes of sick leave. According to a DAK analysis, the overall sickness rate in the first half of 2025 was 5.4 per cent, slightly below the previous year's level (5.7 per cent. However, the number of days absent due to flu and colds rose by 13 per cent compared to the same period last year. While colds and flu caused around 196 days of absence per 100 insured persons in the first half of 2024, the figure was around 221 days from January to June 2025. At 22.4 per cent, respiratory diseases accounted for the largest proportion of sick days overall. The Federal Institute for Occupational Safety and Health (BAuA) estimated the economic production losses due to incapacity to work at a total of 128 billion euros in 2023.

Publication

* Tandon M, Wu W, Moore K et al: SARS-CoV-2 accelerated clearance using a novel nitric oxide nasal spray (NONS) treatment: A randomised trial. Lancet Reg Health Southeast Asia. 2022 Aug;3:100036. DOI: 10.1016/j.lansea.2022.100036