A notable study showed that patients who typically use steroid-based nasal sprays are less likely to develop severe COVID-19 related disease. In fact, this important news generated by the world-renowned Cleveland Clinic reported that of those people using the nasal spray, they were 20-25% less likely to succumb to serious COVID-19 related hospitalization, ICU admission, and death. Led by pulmonologist Joe Zein, MD, Ph.D. and allergist-immunologist and Director of the Cleveland Clinic Ronald A. Strauss, the recent study results were published in the Journal of Allergy and Clinical Immunology: In Practice. TrialSite raises the question—assuming these findings are repeatable—what if a nasal spray can be developed to maximize eradication of the SARS-CoV-2 virus in the nasal regions? What an intriguing possibility for a low-cost treatment regimen for COVID-19, particularly in low-and middle-income countries (LMICs). More study is necessary but given louder calls for treatments (and vaccines) targeting the nasal mucosal region, these findings should be widely disseminated.

Basis for the Study

Driving this Cleveland Clinic-led study was the hypothesis—based on early-stage laboratory reports—that steroid-based nasal spray in vitro reduced the protein receptor ACE2, which allows the SARS-CoV-2 virus to enter the cell and consequently spread the disease. To be specific, if the substance disrupts ACE2, it may make it harder for the COVID-19 pathogen to penetrate and replicate within the cell.

The Treatment

As reported by Cleveland Clinic, this form of treatment known as intranasal corticosteroids falls under the category of steroid medicines. This type of medicine is used mostly to alleviate cold or allergy symptoms, such as stuffy nose, allergies, etc. The Cleveland Clinic shares that to date, no one is certain what the “precise role intranasal corticosteroids play in reducing the severity of COID-19 infection.”

The Study

The Cleveland Clinic study team tracked 72,147 COVID-19 positive individuals aged 18 and up across the Cleveland Clinic health system from April 1, 2020, to March 31, 2021.  Of the total study population, 12,608 (17.5) were hospitalized, 2,935 (4.1%) were admitted to the ICU, and 1,880 (2.6%) died during hospitalization. Within this group, 10,187 (14.1%) of the patients received a steroid nasal spray—also known as intranasal corticosteroids before the actual COVID-19 infection, reports Cleveland Clinic.

The authors reported that those patients using the nasal spray before the COVID-19 infection were 22% less likely to be hospitalized, 23% less likely to be admitted to the intensive care unit, and 24% less likely to die from COVID-19 during hospitalization compared to patients not taking the nasal spray.

Notable Observations

The study led by Drs. Zein and Strauss found that the ACE2 expression, again the protein receptor involved with SARS-CoV-2 cell entry and multiplication, appears most prominent in the nasal mucosa. The Cleveland Clinic suggests that intranasal corticosteroids may suppress nasal-based viral load and receptor expression. However, the authors emphasize more studies need to be in place to corroborate these findings.

Dr. Zein went on the record for Cleveland Clinic Newsroom, declaring, “This study shows the importance of the nose in COVID-19 infection.” He continued, “The nose, in this instance, is the gateway to our bodies, allowing the virus to enter and replicate within. The use of intranasal corticosteroids may help disrupt that gateway.”


What spray could be optimized for maximum effect? Given the economy of this potential treatment, the implications for worldwide access—especially in low-and middle-income countries (LMICs) are considerable. Dr. Strauss concurred with this assessment declaring, “Our findings are particularly significant, as decreased COVID-19 hospitalizations, ICU admissions, and mortality could alleviate the strain on health care systems with limited resources across the globe, especially in developing countries where there is limited access to vaccines and where mutations in SARS-CoV-2 have emerged.

Study Funding

National Heart, Lung and Blood Institute and the National Institute of Neurological Disorders and Stroke of the National Institutes of Health


A real-world observational data study involves a cross-sectional analysis of EHR data and thus is subject to bias introduced by confounding variables and other considerations.

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