BMJ Open (Nov 2021)

Rhinothermy delivered by nasal high flow therapy in the treatment of the common cold: a randomised controlled trial

  • Nick Shortt,
  • James Fingleton,
  • Mark Weatherall,
  • Richard Beasley,
  • Irene Braithwaite,
  • Nethmi Kearns,
  • James Harper,
  • Grace Bird,
  • Iris Koorevaar,
  • Meik Dilcher,
  • Lance Jennings,
  • Marthe van den Berg,
  • Ingrid Maijers

DOI
https://doi.org/10.1136/bmjopen-2020-047760
Journal volume & issue
Vol. 11, no. 11

Abstract

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Background The common cold is the most common infectious disease affecting humans and has a substantial economic impact on society. Human rhinoviruses, which cause almost two-thirds of colds, have demonstrated temperature-dependent replication which is optimal between 33°C and 35°C.Methods This randomised, single-blind, parallel-group trial completed at a single-centre in New Zealand, recruited 170 participants aged 18–75 years (mean age 27.5 years) who were within 48 hours of common cold symptom onset and had a symptom score (the Modified Jackson Score (MJS)) ≥7 and a negative point-of-care test for influenza. Participants were blinded to the intervention and randomised (1:1) to 5 days of either nasal high flow rhinothermy (rNHF) (100% humidified air delivered at 35 L/min and 41°C for 2 hours daily) (n=85) or ‘sham’ rhinothermy (100% humidified air delivered at 10 L/min and 31°C for 10 min daily) (n=85) and completed daily symptom diaries, which included the MJS, for 14 days, to investigate whether rNHF reduced common cold symptom severity and duration compared with ‘sham’ rhinothermy.Results An intention-to-treat superiority analysis included all randomised participants and showed no difference between treatment groups for the primary outcome, the day 4 MJS analysed by analysis of covariance: mean (SD) 6.33 (3.97) for rNHF vs 5.8 (3.15) for ‘sham’; estimated difference (95% CI) 0.37 (−0.69 to 1.42), p=0.49. There was no difference in time until resolution of symptoms: mean (SD) 5.96 (4.47) days for rNHF vs 6.42 (4.09) days for ‘sham’; estimated difference (95% CI) 1.02 (0.75 to 1.38), p=0.91. There were no serious adverse events related to the study treatments.Conclusions This well-powered, single-blind randomised controlled trial does not provide evidence that 5 days of rNHF (100% humidified air heated to 41°C delivered at 35 L/min for 2 hours daily) reduces common cold symptom severity or duration. However, investigation of rNHF in the treatment of influenza is warranted.Trial registration number ACTRN12617001340325.