Can Inhaled Nitric Oxide Improve COVID-19 Symptoms?

louis ignarro md nobel prizeToday’s guest post is written by Louis J. Ignarro, PhD, a medical research scientist who was awarded the Nobel Prize in Physiology or Medicine for his breakthrough discoveries of nitric oxide (NO) and how NO positively impacts health and longevity.



nitric oxide covid

In 1998, I was awarded the Nobel Prize in Physiology or Medicine for my pioneering studies on cardiovascular function and erectile function. We discovered that our bodies produce a small molecule that protects us against hypertension, heart attack and stroke. This same molecule serves as the neurotransmitter released from the nerves that cause penile erection and sexual arousal. The name of the molecule is “nitric oxide”, not to be confused with nitrous oxide (laughing gas), which has totally different properties.

What is Nitric Oxide?

Nitric oxide, also termed NO, is a gaseous molecule that is produced by our arteries in all organs to regulate cardiovascular function. NO causes the muscle cells (smooth muscle) enveloping arteries to relax, thereby causing vasodilation, or widening of the arteries. This physiological action results in a decrease in blood pressure within the arteries and increased blood flow to all organs through the dilated arteries. In the erectile tissue, the NO released during sexual stimulation causes profound relaxation or dilation of the arteries within the erectile tissue, termed the corpus cavernosum. This results in engorgement with blood and consequent penile erection.

Nitric Oxide’s Action on Respiratory Tissue

Not only is vascular smooth muscle is relaxed by NO, but nonvascular smooth muscle such as airway smooth muscle in the trachea and bronchioles of the lungs is also relaxed by NO. Warren Zapol, MD from the Massachusetts General Hospital in Boston took advantage of this bronchodilator action of NO in the lungs, and he discovered that inhalation of very small amounts of NO by newborn babies with persistent pulmonary hypertension (constricted pulmonary arteries), results in a dramatic and permanent reversal of hypertension. Inhaled NO (INO) literally turned blue babies into pink babies. Without INO, most babies would have died while others would have required highly invasive procedures to oxygenate their lungs, and may not have survived.

Can Nitric Oxide Kill Bacteria, Viruses, and Paraistes?

Nitric oxide turns out to be a ubiquitous molecule with many different properties. For example, not only does NO relax smooth muscle, but NO also reacts chemically with certain other molecules in cells to alter their function. The NO produced by our own cells can interact with molecules in invading cells such as bacteria, parasites and viruses to kill them or inhibit their replication or spread. NO has been shown to increase the survival rate of mammalian cells infected with SARS-CoV (Severe Acute Respiratory Syndrome caused by coronavirus). Importantly, in a limited study in 2004, inhaled NO (INO) was demonstrated to be effective against the SARS-CoV in severely ill patients with pneumonia. The mechanism of action was thought to be pulmonary vasodilation and consequent improved oxygenation in the blood of the lungs, thereby killing the virus, which does not do well in a high oxygen environment. In addition, however, I would offer the opinion that the NO also interacts with the virus to kill it directly.

Potential Impact of Nitric Oxide on COVID-19

In view of the above knowledge gained by treating SARS CoV patients with INO, it is scientifically logical that INO might be effective in patients with the current SARS CoV-2, or simply, COVID-19, infection. Indeed, a clinical trial of inhaled nitric oxide (INO) in patients with moderate to severe COVID-19 with pneumonia recently received IRB (Institutional Review Board) approval at the Massachusetts General Hospital. Warren Zapol, MD, is director of this project. In the successful treatment of persistent pulmonary hypertension in newborns, the amount of NO inhaled is generally one ppm (part per million). In the clinical trial using COVID-19 patients, the amount of NO will be 100-fold higher, namely, 100 ppm. This is a safe dose of INO, which could prove to be effective in killing the virus and allowing recovery of the patient.

How to Increase Your Body’s Nitric Oxide Production Naturally (Hint: It’s Free)

One thing I urge everyone to practice during this coronavirus pandemic is to breathe or inhale through your NOSE and exhale through your mouth. The cells and tissues in the nose, but not the mouth, constantly and continuously produce nitric oxide, which is a gas. The physiological significance of this is that nasally-derived NO improves oxygen delivery into the lungs by causing bronchodilation – the relaxation and widening of the bronchi and bronchioles in the lungs. Moreover, when inhaling through the nose, your nasal nitric oxide is inhaled into your lungs, where it stands a chance of meeting up with the virus particles. Inhaling through your mouth will NOT accomplish this. By the same token, exhaling through your nose is highly wasteful in that you would be expelling the NO away from the lungs, where it is needed most.

Tip: If you’d like to develop the habit, set a reminder on your phone to chime every hour or so when you’ll practice breathing in through your nose and out through your mouth. 


About the Author

louis ignarro md nobel prizeLouis Ignarro is a medical research scientist who was awarded the Nobel Prize in Physiology or Medicine for his breakthrough discoveries of nitric oxide (NO) and how NO positively impacts health and longevity. His discovery of this unique signaling molecule and all of its biological actions ranging from lowering your blood pressure to stimulating penile erection and sexual arousal is widely known as the information that led to the development of Viagra.

Ignarro earned his B.S. in Pharmacy/Chemistry from Columbia College in 1962, and received his Ph.D. in Pharmacology from the University of Minnesota in 1966. He also did post-graduate studies in Chemical Pharmacology at the National Institutes of Health.

Besides receiving the Nobel Prize in Physiology or Medicine (1998), Ignarro has received numerous awards and honors including: Distinguished Scientist Award of the American Heart Association, Roussel Uclaf Prize of France, National Academy of Sciences, National Academy of Medicine, American Academy of Arts and Sciences, American Philosophical Society, and the American Academy of Achievement’s Golden Plate Award, given annually to those who have contributed most to human kind.

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52 thoughts on “Can Inhaled Nitric Oxide Improve COVID-19 Symptoms?”

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  1. I had also heard that humming increases nitric oxide amounts – is this true? If so, humming the happy birthday song or the alphabet song to help time how long to wash your hands might be doubly useful!

  2. this is so cool. I read about this decades ago, perhaps it was Louis Ignarro’s research at the time, who knows, and I have always practiced nose in, mouth out breathing for all physical activities. I also found it a very good measure of cardiovascular effort if I could maintain this type of breathing and not have to switch to mouth in/out.

  3. Wow, great research and analysis. Thanks for inviting him to post.

  4. Great post. Curious, isn’t sunlight a potent source of nitric oxide? Along with garlic?

  5. The Wim Hif Method is alleged to increase nitric oxide levels, but is that rise therapeutically significant in this context?

  6. I feel like this is pretty dangerous territory; I should stress that I’m not an expert in anything relevant. Inhaling through your nose and exhaling through your mouth sounds pretty harmless*, but I fear people are going to take any advice around proofing themselves to COVID-19 and do it crazy.

    I’m a huge fan of NO! I’m a Somnifix user! And, we’d know less about it without Dr. Ignarro’s work. He’s certainly entitled to promote his ideas about it. But, I don’t think this blog should be suggesting treatments for COVID-19. We have a good sense that better fitness and lower inflammation reduce our risks of being symptomatic and it seems pretty harmless to promote that. But, “reducing symptoms with Nitric Oxide” just raises a lot of bad possibilities. Maybe if you called it “inhaling through your nose?” I admit that’s a little clunky.

    Sorry, I live in a country where the leader just admitted to taking malaria medication to prevent the disease. I’m on edge.

    *it sounds to me like it would increase your need for water, but as long as you have essentially unlimited access to drinking water like — not to brag — I do, that’s fine

    1. I happily live in a country where the leader said hydroxychloroquine is an effective prophylaxis. It’s true! Just ask the hundreds of frontline docs using it. Since when can’t people in consultation with their doctors in a free country decide on their medical treatments? I think people are smart enough to hear others’ opinions and weigh in on their own.

      1. Yes I completely agree. Patient and doctor decide on treatment. There is a study ongoing to determine if any Lupus patients have Covid-19. Early results are showing they don’t which may show hydro chloroquine is profilactly keeping the virus at bay while treating their lupus.

        1. Actually, that was a rumour. The Lupus Foundation put out a statement saying that lupus patients (and those using HCQ for rheumatoid arthritis) who have been using HCQ for years are still getting COVID-19 like anyone else. And the more comorbidities one has (obesity, type 1&2 diabetes, hypertension, copd, etc) the more at risk someone is to have the severe form of C-19, as well..

      2. My sister took the Hydroxychloroquine in the earlier days of COVID when it was the only game in town and survived. 74 years old with many respiratory and health comormidities.

      3. Agreed, In the USA the pharmaceutical companies own the media and doctors. Alternative ways of health are not covered by insurance and are always discouraged. As a people, we have lost the ability to take care of ourselves. Its fast approaching that even homeopathic remedies will be banned.

    2. I don’t think breathing in through you nose and out through your mouth can cause anyone harm or be taken to an extreme. Could someone surmise the good Dr. is stating it should be their only treatment should they contract the virus? Yep, but they probably eat Tide Pods too.

  7. There’s another way to increase NO in the bloodstream, and I think would also qualify as a micro workout. Look up Zach Bush nitric oxide workout.

  8. Thanks for this article. I recently learned about the significance of NO on our bodies’ health. I’ve heard that HIIT & Metabolic Training creates a huge increase in NO in the body. Is that true?

  9. Mr. Ignarro, not sure what difference exhaling through the mouth really makes. If NO is somehow produced by the cells and tissue in the nose, then it makes sense NO is constantly inhaled as we naturally inhale through the nose. I would get that exhaling through the nose might be a waste of the naturally produced NO. But once NO is inhaled and in the lung why would exhaling through the mouth make any difference? The NO is already in the lungs and no mater how you exhale some of it will get out anyway. Maybe holding your breath for a little while would make more sense to let the NO do its work. Hope you can clarify.

    1. @Jorge; I think that what he is saying is that if the NO is produced and emitted in our nasal passages, then imagine little wisps of NO slowly coming out and then as you breathe, they join in with the stream of air. Breathing in will grab and pull into the lungs. Breathing out will push them out into the atmosphere. If you breath out through the mouth, they will be building longer in the nasal passages for inhalation. I think that’s the idea, anyway. I will add that not all are in agreement with this approach. Look into Oxygen Advantage videos and website. The guy who promotes that is also very NO aware and is in favor of pure nose breathing.
      A key to this that he mentions is lighter breathing, not too turbulent, so that the NO is picked up evenly.

      Finally, I will add that there are startup companies producing portable tank-less NO devices that work like CPAP machines. Originally developed for infant respiratory issues, now they are in trials for COVID treatment. Coming soon?

    2. Many people today, because of poor nutrition and lack of breast suckling in infancy, suffer skeletal deformities which render them mouth-breathers. Look up “lip incompetence” and pay attention next time you’re in public (of course now everyone is wearing masks…). Lots of kids today can’t even close their mouths fully without deliberate effort. Nose breathing is not necessarily automatic as it should be.

  10. Any other proven way besides the breathing technique described in the article to increase NO. I know there are supplements and that supposedly do it and that UV-A from the sun encourages it’s production. Any good supplements to consider or particular bulbs to use for UV-A when I can’t get sun in Chicago?

    1. Mouth taping during sleep is a way to ensure a good amount of nose breathing. Becoming quite a common practice for NO.

  11. Dangerous. This drug is overused as a party drug by people. It can kill you. It has been used as an anesthetic in the medical and dental fields. It’s use should be only to make whipped cream when not used by a trained licensed medical practitioner in a monitored setting

    1. Please remember that not everyone is intelligent enough to to differentiate between what is natural or safe. Hydroxichloriqine is also used in fish tank and kill two people who could not understand science. Hydroxichloraquine is not being used in my hospital anymore on covid patients because it was not only found to cause cardiac arrhythmia sand heart failure but had no measurable positive outcomes. Please proceed with caution. Do no harm is the first line in medicine for a reason.

      1. BTW, cardiac arrhythmia observed in the use of hydroxychoroquine are exceedingly rare, almost non existent. Drug has been used 60+years worldwide, is on the World Health Organizations list of Essential Medicines, has been studied extensively with millions of doses given. Try to find any negative articles about the drug dated before the President made mention of it, you won’t. Its has been politicalized completely.

        1. Yes, the drug sadly has been politicized. Its 65 year safety profile is incredible. Information about its efficacy for COVID-19 when used early and prophylactically has been suppressed by the mainstream media.

          The VA study concluding it was not effective has been debunked for many reasons including that the drug was given to very sick patients after they were already intubated.

        2. I watched these arrhythmias and new onset of heart failure first hand. I am currently still actively working as a medical professional in an icu with covid positive patients.

          1. Has anyone ever thought it could be the addition of Z-pac with the hydroxychloroquine causing so many side effects with the older patients?

      2. So opinions should be suppressed because someone disagrees or deems them untrue or dangerous or unworthy? Or because people are not smart enough to synthesize the information and decide for themselves? Who should decide what information is worthy of sharing or not? Who should decide if people are smart enough to read the information?

      3. The evidence seems to show “Fish Tank Cleaner” story could very well have been a hoax to cover up a premeditated murder.

    2. First post gone, try again.

      Nitrous oxide is not nitric oxide. Re-read paragraph #1 above.

      1. T’is sad that a cat has better reading comprehension than some of the people commenting here.

    3. Lbd RN ICU

      Nitrous oxide is different from nitric oxide.

      1. Yes, and the article was about nitric oxide, not nitrous oxide which was the content of your post. Check for fumes.

      2. That’s great that you can differentiate. Most people can’t. The public at large is not well informed. Nitrous oxides is an easily obtained inexpensive gas in small cartridges It is highly abused by recreational and addicted drug users. The ill effects have long term implications. Medical information is easily confused with social media. W I have seen the effects unfortunately first hand in the icu where I practice. These things are well documented in medical journals. That’s why there is no crossover from medicine to mechanics. It’s just not how things work. A PHD is not an MD

        1. The point being that the misinformed will take a bit of information and apply it dangerously. Care needs to be taken with information and how it is delivered. A scientific paper would have delivered that information in a fact based manor. This article is opinion based. The expression of opinions has been put in vulgar terms but is true. Medicine, medical treatment and science are based facts and studies that have been carefully and methodically proven. Speculation is dangerous until proven otherwise

        2. The point being that the misinformed will take a bit of information and apply it dangerously. Care needs to be taken with information and how it is delivered. A scientific paper would have delivered that information in a fact based manor. This article is opinion based. The expression of opinions has been put in vulgar terms but is true. Medicine, medical treatment and science are based facts and studies that have been carefully and methodically proven. Speculation is dangerous until proven otherwise. The public at large should not be giving or taking medical advise from anyone other than a person who actually practices medicine

          1. Well that rules out several governors, many health department heads in large cities and states from making
            decisions on the kung flu treatments based on their non medical backgrounds. And lets not forget 2 states in the northeast sent covid-19(84) patients to nursing homes where havoc ensued and many unavoidable deaths occurred, directed by their chief administrator, the governor. We live in a very polarized world unfortunately.

          2. @Lbd rnicu

            Maybe a few good whippits will help calm you down?

    4. Just to clarify, Lbd RN ICU is referring to Nitric Oxide as a party drug.

      However, it is NITROUS OXIDE (laughing gas) which is inhaled using whipped cream cans.

      Nitric oxide is a totally different molecule.

  12. I have recently been made aware of the possibility of dairy products, specifically casein in promoting the risk of prostate cancer in men. Consequently I have stop drinking my favorite drink, kefir.
    What are your thoughts on this, Mark.

    1. For all I know you may be wong but you may be white, you may be wong but you may be white.

  13. Thank you so much for this wonderful advice! It provides much peace of mind, and is a great comfort.

  14. Soooo, the yogis are right. Inhaling through the nose and exhaling through the mouth is powerful!

  15. This is a subject of a great deal of interest to me recently as I learn that my athletically induced asthma is probably related to constrictions in lungs pathways and it seems like nitric oxide would be a good treatment. But I already practice nose breathing. Are there specific breathing techniques I could practice to increase the exposure?

  16. Breating out through your nose vs mouth, why would that change NO in the lungs ?
    Air is moved out of the lungs in both scenarios