Important: This guide is about the acute common cold – the viral infection that comes on suddenly and usually resolves in 7–10 days. If you suffer from persistent, recurrent nasal congestion, you may have sinusitis – read about that in the sinusitis and salt therapy guide. If your symptoms occur seasonally, during pollen season, see the hay fever and salt therapy article.
What is the cold (the common cold)?
The common cold – medically acute upper respiratory tract infection or acute rhinopharyngitis – is a viral infection of the nose, throat and sinuses. It is not caused by a single virus but by more than 200 different viral strains; the most common are rhinoviruses (30–50% of cases), seasonal coronaviruses (not COVID types, ~15%), influenza viruses, parainfluenza viruses, respiratory syncytial virus (RSV) and adenoviruses.
This diversity explains why there is no "vaccine against the common cold" – simply far too many viruses can cause it. It also explains why you can catch colds repeatedly: immunity to one virus does not protect you against another.
Infection spreads by respiratory droplets: small droplets expelled when coughing, sneezing or talking, or by touching contaminated surfaces and then touching the face, especially the nose and mouth.
Key point
The common cold usually resolves naturally within 7–10 days. There is no single "cure" for the cold because more than 200 different viruses can cause it. Treatment is symptomatic: rest, fluids, and salt therapy can help speed recovery.
Symptoms of the common cold
Symptoms are characteristic and well known. The course is usually divided into three stages.
In the first 1–2 days (early stage) there is a scratchy throat, sneezing and mild malaise. Many people say at this point: "I feel something coming."
On days 2–4 (peak stage) nasal congestion and runny nose are strongest. Initially the discharge is thin and watery, which may gradually thicken and turn yellowish-green (this does not necessarily indicate a bacterial infection!). Headache, fatigue and low-grade fever (especially in children) may accompany it.
On days 5–10 (recovery stage) symptoms gradually improve. Cough is often the last symptom to resolve and can persist for 2–3 weeks as the airway mucosa regenerates.
The full course is usually 7–10 days, but individual variation exists. It is often longer in children and the elderly.
Why is there no "cure" for the common cold?
People often ask: “Doctor, why can’t they make a medicine for the common cold?” The answer is complex.
First, colds are caused by viruses, not bacteria. Antibiotics work only against bacteria – they are completely ineffective against viruses. Yet unfortunately many doctors still prescribe antibiotics for colds, which is not only unnecessary but also contributes to the global problem of antibiotic resistance.
Second, more than 200 different viruses can cause a cold. A single antiviral drug cannot cover them all.
Third, by the time symptoms appear the virus is already replicating. The immune system has already started its defense – many symptoms are in fact the result of the immune response, not the direct effect of the virus.
Therefore treatment is primarily symptomatic: painkillers, antipyretics, decongestant nasal drops, rest and fluid intake. And this is where salt therapy comes in: it does not "kill" the virus directly, but it can support the body’s natural defenses and shorten the illness.
How does salt therapy help in the common cold?
Salt therapy – especially nasal irrigation and gargling with hypertonic saline – works through several mechanisms in the common cold.
The first and most important is mechanical cleansing. Nasal irrigation physically washes out viruses, secretions, inflammatory mediators and dead cells from the nasal cavity and throat.1 Think of rinsing a contaminated surface: it becomes cleaner. Nasal irrigation does the same for infected mucosa.
The second effect is reduced viral shedding. The 2019 ELVIS study showed that nasal irrigation and gargling with hypertonic saline led to a faster reduction in viral shedding (≥0.5 log₁₀/day).2 This means less virus is released into the environment, reducing the chance of onward transmission.
The third effect is a cellular-level antiviral mechanism. This is the most interesting and recently discovered effect. Researchers at the University of Edinburgh demonstrated in laboratory experiments that cells use chloride ions (from table salt – NaCl) to produce hypochlorous acid (HOCl).3 Hypochlorous acid is the active ingredient in household bleach – it has well-known antiviral and antibacterial properties. So the saline solution not only "washes away" viruses but also boosts the cells’ natural virus-killing mechanism!
The fourth effect is reduction of mucosal swelling. Hypertonic saline has an osmotic effect that "draws" water out of swollen mucosa, reducing nasal congestion.
The ELVIS study: a breakthrough in common cold research
The 2019 Edinburgh and Lothians Viral Intervention Study (ELVIS) was the first randomized controlled trial to examine the effect of hypertonic saline nasal irrigation and gargling in the common cold.2
ELVIS 2019 - Adult trial
Sixty-six adults were enrolled in the study within 48 hours of symptom onset. Participants were randomized into two groups: the intervention group performed nasal irrigation and gargling with hypertonic saline (2.6% NaCl) several times daily, while the control group received usual care.
The results were convincing:
- Illness duration was 22% shorter in the salt therapy group: on average 6.8 days versus 8.7 days in the control group. That is a 1.9-day difference (p=0.01).
- Use of over-the-counter medications decreased by 36% in the salt therapy group (p=0.004).
- Household transmission decreased by 35% (p=0.006).
- Viral shedding declined faster in the salt therapy group (≥0.5 log₁₀/day, p=0.04).
- 93% of participants felt salt therapy helped their symptoms, and 87% found the treatment acceptable.
The reduction in household transmission is particularly important: if you start salt therapy early in a cold, you are less likely to infect family members.
Children and salt therapy
The 2024 ELVIS Kids trial evaluated the effect of hypertonic saline nose drops in children aged 0–6 with the common cold.4
ELVIS Kids 2024 - Pediatric trial
Four hundred and seven children were randomized: 206 received hypertonic saline nose drops (3 drops per nostril, at least 4 times daily until recovery) and 205 received usual care. Of the 407 children, 301 developed colds during the observation period.
Results showed:
- The cold lasted on average 6 days in the salt therapy group versus 8 days in the control group – a 2-day difference.
- Investigators also observed fewer family members became ill in the salt therapy group.
Professor Steve Cunningham, the trial lead, explained the mechanism: “Chloride from salt is used by upper airway epithelial cells to produce more hypochlorous acid, which inhibits viral replication.”
Medical review: What does the evidence say?
The 2015 Cochrane systematic review analyzed 5 randomized controlled trials of nasal irrigation for acute upper respiratory infections, with a total of 749 participants (544 children and 205 adults).5
Cochrane systematic review (2015)
The review concluded that “saline is likely effective in reducing the severity of some symptoms associated with acute upper respiratory tract infections.” In the larger pediatric trial there were significant reductions in nasal discharge scores (MD -0.31) and nasal congestion scores (MD -0.33). Use of decongestant medications was also reduced in the saline group.
Cochrane authors noted that most studies were small and had methodological limitations, but the available evidence supports using saline as an adjunctive treatment for acute colds.
How to prepare hypertonic saline at home?
Participants in the ELVIS study prepared hypertonic saline at home. Here is the recipe and technique.
Saline recipe
Ingredients: 1 liter of boiled (then cooled) or distilled water and 2–3 tablespoons (about 25–30 g) of table salt or sea salt. This yields approximately a 2.5–3% hypertonic solution. The water should be lukewarm, near body temperature (around 37°C).
Important: Never use tap water directly! Microorganisms in tap water can cause infections. Use distilled, sterile or at least water boiled for 5 minutes (then cooled).
Technique for nasal irrigation and gargling
In the ELVIS study participants performed nasal irrigation and gargling several times daily. Steps are as follows.
Step-by-step nasal irrigation
1. Lean forward over a sink.
2. Fill your irrigation device (neti pot, squeeze bottle or syringe) with the saline.
3. Place the tip into one nostril.
4. Gently let the solution flow – it will pass through the nasal cavity and exit the other nostril (or your mouth).
5. Repeat on the other nostril.
6. Blow your nose gently (not too forcefully!).
Step-by-step gargling
1. Take a mouthful of saline.
2. Tilt your head back and gargle for 30–60 seconds.
3. Spit out the solution.
4. Repeat 2–3 times.
My advice: start at the first signs of a cold – scratchy throat, sneezing. The earlier you begin, the more effective it is. In ELVIS participants were enrolled within 48 hours of symptom onset.
When and how often?
Based on the ELVIS study the optimal frequency is 4–6 times daily, but at least 3–4 times. Start treatment at symptom onset and continue until you feel better.
Especially useful times:
- On waking (secretions accumulate overnight)
- Before meals (clearer breathing improves appetite)
- Before bed (helps restful sleep)
- After sneezing or nose-blowing
Home salt therapy with the SaltDome device
In addition to nasal irrigation and gargling, home salt therapy devices can help during a cold.
The SaltDome ultrasonic salt therapy device disperses salt particles of 2–5 microns into the air. According to Semmelweis University, particles between 0.5–5 microns reach the upper and lower airways.6 The device is best placed in the bedroom and used overnight.
Important note
A home device complements but does not replace nasal irrigation! The best outcome is achieved by combining both: irrigation actively washes out viruses and secretions, while the salt therapy device helps maintain a favorable microenvironment.
Advantages of salt therapy compared to other treatments
Salt therapy has several benefits over conventional cold treatments.
No side effects. Decongestant nasal drops (oxymetazoline, xylometazoline) are effective but prolonged use beyond 3–5 days may cause rebound congestion (rhinitis medicamentosa). Saline can be used indefinitely without side effects.
Safe for children. Many over-the-counter cold medicines are not recommended for children under 6. Saline can be used even in infancy with appropriate technique.
Cheap and accessible. Saline can be prepared at home at minimal cost.
Reduces onward transmission. The ELVIS study reported a 35% reduction in household transmission – important when living with family.
Reduces medication needs. The salt therapy group used 36% fewer over-the-counter medications.
Prevention: Can salt therapy help?
One may ask: if salt therapy shortens the cold, can it also help prevent it?
Šlapak study (2008) – Preventive effect
The 2008 Šlapak study followed 390 children randomized into two groups.7 One group performed regular isotonic saline nasal washes, the other did not. The study had a 3-week treatment phase and a 9-week prevention phase.
Children who performed nasal washes had significantly better outcomes for nasal discharge, congestion and medication use in both phases. Long-term saline nasal irrigation reduced the incidence of acute rhinosinusitis and its complications.
Systematic review (2020) – Meta-analysis
The 2020 systematic review and meta-analysis confirmed: “Long-term saline nasal irrigation reduces the occurrence of acute rhinosinusitis and its complications.”8
On this basis, regular nasal irrigation – especially during cold season – may help with prevention.
Contraindications and precautions
Nasal irrigation and salt therapy are generally safe, but there are some important considerations.
- Using tap water directly – Never use tap water for nasal irrigation! Microorganisms in tap water can cause infections. Use distilled, sterile or water boiled for at least 5 minutes (then cooled).
- Active nosebleed – Do not perform nasal irrigation during an active nosebleed. Wait until bleeding has completely stopped.
- Severe septal deviation or nasal polyps – Consult your physician before starting nasal irrigation.
- Ear problems – In cases of eustachian tube dysfunction or otitis media perform irrigation cautiously and avoid forceful nose-blowing afterwards.
Medical consultation recommended
If you have any severe nose, ear or throat inflammation, or unusual symptoms not typically seen, consult your doctor before starting nasal irrigation.
Possible side effects
Side effects of nasal irrigation are usually mild and transient.
Nasal irritation and burning may occur, especially with hypertonic solutions or on first use. If bothersome, reduce the concentration.
Sneezing after irrigation is a normal reaction – the nasal mucosa is responding to the stimulus.
Tinnitus or a feeling of ear fullness may occur if solution reaches the eustachian tube. This can be avoided by not blowing the nose too forcefully.
The Cochrane review found that “saline is safe but can cause mild adverse effects such as irritation or a burning sensation, especially with higher concentration or pressure.”5
When to see a doctor?
The common cold usually resolves on its own in 7–10 days. See a doctor if:
- Symptoms last more than 10 days or worsen,
- You develop a high fever (above 38.5°C) that does not come down,
- Severe headache, facial pain or ear pain occurs,
- Shortness of breath or difficulty breathing develops,
- Your nasal discharge is bloody,
- You are immunocompromised, an infant, elderly, have chronic disease, or experience unusual symptoms.
Warning signs
These signs may indicate bacterial complications (sinusitis, otitis, bronchitis, pneumonia) that require medical treatment.
Practical tips for a cold
If you have a cold and start salt therapy, here are some practical additional tips.
My tips for recovery
Start immediately! In the ELVIS study those who began within 48 hours had the best results. The earlier you start, the shorter the illness.
Combine! Nasal irrigation + gargling + SaltDome together are more effective than any alone.
Drink plenty of fluids! Adequate hydration thins secretions and helps viral clearance.
Rest! Your body needs energy to fight viruses. Don’t overexert yourself.
Watch humidity! Dry air irritates mucosa. Use a humidifier.
Wash your hands frequently! This not only helps recovery but reduces the risk of spreading the infection.
Summary – Quick overview
URTI – Upper Respiratory Tract Infection.
Rhinovirus – the most common cause of the common cold.
Hypertonic saline – 2–3% NaCl solution.
ELVIS study – Edinburgh and Lothians Viral Intervention Study.
Hypochlorous acid (HOCl) – a natural antiviral compound.
Frequently asked questions
The ELVIS study used a 2.5–3% hypertonic saline (about 25–30 g salt per 1 liter water). This is more effective than an isotonic solution.
4–6 times daily, but at least 3–4 times. The earlier and more frequently you perform it, the better the result.
Yes! The ELVIS Kids trial demonstrated efficacy and safety in 0–6-year-old children. For younger children nose drops or nasal spray may be more practical than irrigation.
The ELVIS study found an average shortening of 1.9 days in adults, and ELVIS Kids found 2 days in children.
Research suggests regular nasal irrigation, especially in cold season, can reduce infection frequency and complications.
For best results start at the first signs (scratchy throat, sneezing), ideally within 48 hours.
Detailed guides by condition
If you are interested in a specific disease or condition, read our detailed guides where we present salt therapy options backed by scientific studies:
Sinusitis and salt therapy – Get rid of sinusitis
Asthma and salt therapy – Natural breathing support
Cystic fibrosis and salt therapy – Secretion clearance and respiratory support- COPD and salt therapy – Easier breathing, better quality of life
Hay fever and salt therapy – Relieving allergic symptoms
Post-pneumonia recovery – Salt therapy as an adjunctive treatment
Snoring and salt therapy – How it can help freer breathing
Dermatological issues and salt therapy – Adjunctive treatment for eczema and psoriasis
Sources
- Rabago D, Zgierska A. (2009). Saline Nasal Irrigation for Upper Respiratory Conditions. American Family Physician, 80(10):1117-1119. AAFP
- Ramalingam S, et al. (2019). A pilot, open labelled, randomised controlled trial of hypertonic saline nasal irrigation and gargling for the common cold. Scientific Reports, 9:1015. PubMed: 30705369
- Ramalingam S, et al. (2018). Antiviral innate immune response in non-myeloid cells is augmented by chloride ions via an increase in intracellular hypochlorous acid levels. Scientific Reports, 8:13630.
- Ramalingam S, et al. (2024). A randomised controlled trial of hypertonic saline nose drops as a treatment in children with the common cold (ELVIS-Kids trial). Presented at European Respiratory Society Congress, Vienna. ERS Abstract
- King D, et al. (2015). Saline nasal irrigation for acute upper respiratory tract infections. Cochrane Database of Systematic Reviews, 4:CD006821. PubMed: 25892369
- Semmelweis University, Department of Otorhinolaryngology and Head-Neck Surgery. Effects of salt therapy. semmelweis.hu
- Šlapak I, et al. (2008). Efficacy of isotonic nasal wash (seawater) in the treatment and prevention of rhinitis in children. Archives of Otolaryngology–Head & Neck Surgery, 134(1):67-74.
- Chirico G, et al. (2020). Saline nasal irrigation for acute upper respiratory tract infections in infants and children: A systematic review and meta-analysis. Paediatric Respiratory Reviews, 34:36-42. PubMed: 32312677
- Azevedo Simoes E, et al. (2024). Nasal Irrigation With Saline Solution for Pediatric Acute Upper Respiratory Infections: A Systematic Review. Cureus, 16(12):e75404. PubMed: 39669647
- Szabó K, et al. (2021). Salt Therapy as a Complementary Method for the Treatment of Respiratory Tract Diseases. Alternative Therapies in Health and Medicine. PubMed: 34726628
