International Expert Consensus on Demulcents as Mucosal Barriers in Upper Respiratory Tract Infections

Purpose Demulcents form protective mucoadhesive films on oropharyngeal mucosa and provide symptomatic relief in upper respiratory tract infections, yet their mode of action, clinical indications, and desirable properties remain poorly defined. An international advisory board convened on 19 February 2026 comprising experts in otorhinolaryngology, phoniatrics, and pharmacology from Germany, Croatia, Colombia, and Ecuador. The panel reviewed preclinical data, alongside targeted literature evidence, and discussed clinical experiences with demulcents and their use in patients. Major findings Reviewed clinical studies suggested symptomatic benefit, particularly in reducing throat irritation, dryness, and cough-associated discomfort, although the available evidence remains limited. Consensus was achieved across four domains: (I) mechanism of action - local physical barrier formation through mucoadhesive film; (II) clinical indications - common cold with sore throat and dry cough, laryngopharyngeal reflux, vocal fatigue, allergy-related irritation, and post-operative throat discomfort; (III) desirable properties - rapid onset, prolonged mucosal contact, acceptable taste, and broad safety profile; (IV) research priorities - prospective studies evaluating complication reduction using symptom scales and objective endpoints such as antibiotic prescriptions and healthcare utilization. Conclusions Together, experts agreed that demulcents represent a rational treatment approach to symptomatic upper respiratory symptom management through local barrier formation.