The effect of inhaled dry salt on pulmonary mucociliary clearance in obstructive lung disease: A randomised, placebo-controlled, crossover study.

BACKGROUND

Inhaled saline may improve mucus transport in respiratory diseases, for example, cystic fibrosis. This randomised, placebo-controlled, crossover study examined the effect of inhaled dry NaCl on mucociliary clearance in patients with chronic obstructive pulmonary disease (COPD).

METHODS

Twenty-five patients with GOLD stage I-III COPD (72% with excess mucus) were tested on two separate days after inhalation from a dry powder inhaler containing either 40 mg dry NaCl or placebo (empty). Pulmonary mucociliary clearance was assessed using inhalation of a radioactive 99mTc-labelled nanocolloid tracer and gamma camera imaging. Clearance was measured for 2 h post-intervention. Co-primary outcomes were clearance after 1 and 2 h.

RESULTS

The study was terminated early due to COVID-19 after enrolling 25 of 35 planned patients. No significant differences were observed in mucociliary clearance between NaCl and placebo after 1 h (11.3% ± 9.0% vs. 11.4% ± 7.0%, p = 0.97) or 2 h (15.3% ± 9.8% vs.16.1% ± 8.7%, p = 0.55). Normalised clearance based on initial radioaerosol deposition also showed no difference.

CONCLUSIONS

Inhalation of 40 mg dry NaCl was well tolerated without acute adverse effects in COPD patients. However, early termination left the study underpowered, increasing the risk of type II error. Non-significant findings should not be interpreted as evidence of no effect. Larger, adequately powered trials are needed to clarify the impact of dry NaCl inhalation on mucociliary clearance in COPD.