Saline nose spray is becoming increasingly popular as a treatment for allergies and sinus problems. And a study suggests the cheap, simple solution helps with severe nosebleeds, too.
Two studies published Tuesday in JAMA, the journal of the American Medical Association, used saline nose spray as a control when testing medications to treat severe nosebleeds caused by a rare genetic condition.
None of the drugs were any better than the saline spray at preventing nosebleeds. But the participants in the U.S.-based study said their nosebleeds were much less severe — even if they were just using the saline.
The participants all have hereditary hemorrhagic telangiectasia, which causes blood vessel malformations. Pretty much everybody with HHT gets bloody noses, ranging from a minor occasional annoyance to several severe nosebleeds a day. Those can be so bad that people need blood transfusions to maintain blood volume and prevent anemia.
Researchers in the U.S. and France decided to test drugs that have been used for years to treat nosebleeds in people with HHT, but have never been properly evaluated in a clinical trial.
One was bevacizumab, commonly known as Avastin, which slows the growth of new blood vessels and is used to treat cancer and macular degeneration. The U.S. researchers also tested estriol, a form of the hormone estrogen, and tranexamic acid, which improves clotting.
None of the drugs, which were administered as nasal sprays, significantly reduced the number of nosebleeds. The French trial was stopped early because of that lack of benefit.
"It's frustrating that the medications didn't have the effect that the anecdotes suggest," says Dr. Kevin Whitehead, an associate professor of cardiovascular medicine at the University of Utah School of Medicine and co-director of the Utah HHT Center of Excellence. He's been treating patients HHT for years and is lead author on the U.S. study. "We had really hoped to see a real impact on the number of nosebleeds."
But there's a silver lining — Whitehead and his colleagues also asked people to track the severity of their nosebleeds. Two-third of the people said their nosebleeds weren't nearly as bad.
When the study was over and the researchers found out which drugs people had used, they were surprised to discover that the people using saline reported as much improvement as the people on meds.
"There was either a placebo effect or a real beneficial effect from the saline," Whitehead says. And though he can't prove it, he thinks the saline is actually doing something.
The most drastic treatment for severe nosebleeds from HHT is to sew the nose shut. That means that a person can no longer breathe through the nose, but it also means the nose doesn't get dried out. And the nosebleeds end.
After the 12-week study ended, the 106 participants in the U.S. trial were told they could continue on any of the medications. Some were interested in bevacizumab, Whitehead says, but reconsidered when they were told that each vial costs $500 to $800.
"At this point, now that we know what people were taking, we're really emphasizing that as a first-line treatment for nosebleed you should try saline nose spray," Whitehead says.
Dry air is a known cause of nosebleeds, so those of us with nosebleeds not caused by a rare genetic disorder can take heart that such a simple intervention has been endorsed by a randomized clinical trial published in a highfalutin medical journal.
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