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Dry NaCl Inhalation Fails to Improve Mucociliary Clearance in COPDInhaled salt fails to clear mucus in COPD trial

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Key Takeaway
Interpret the lack of significant improvement in mucociliary clearance with caution due to the underpowered study design.

This was a randomised, placebo-controlled, crossover study evaluating the effect of inhaled dry NaCl on mucociliary clearance in patients with chronic obstructive pulmonary disease (COPD). The study planned to enroll 35 patients but terminated early due to COVID-19, leaving 25 patients with GOLD stage I-III COPD (72% with excess mucus). Participants inhaled 40 mg dry NaCl from a dry powder inhaler or an empty placebo device.

Primary outcomes were pulmonary mucociliary clearance after 1 and 2 hours. At 1 hour, clearance was 11.3% ± 9.0% with dry NaCl versus 11.4% ± 7.0% with placebo (p = 0.97). At 2 hours, clearance was 15.3% ± 9.8% versus 16.1% ± 8.7% (p = 0.55). Neither difference was statistically significant.

The intervention was well tolerated without acute adverse effects. Key limitations include early termination due to COVID-19, which resulted in an underpowered study and increased risk of type II error. Non-significant findings should not be interpreted as evidence of no effect.

In practice, these data do not support the use of a single dose of inhaled dry NaCl to improve mucociliary clearance in COPD. Further adequately powered studies are needed to determine any potential benefit.

For people with COPD, thick mucus can be a daily struggle. Some have tried inhaling salt to loosen it, but a new study suggests it may not help.

Researchers tested a single dose of dry salt (40 mg) inhaled from a powder device in 25 patients with mild to moderate COPD. Most had excess mucus. After one hour and again after two hours, the salt did not improve mucociliary clearance, the lungs' natural way of sweeping out mucus, compared to an empty placebo.

The results were nearly identical: about 11% clearance at one hour and 15% at two hours for both groups, with no statistical difference.

The trial was originally planned for 35 patients but stopped early because of the COVID-19 pandemic. That makes it too small to detect a real effect, if one exists. The authors caution that the non-significant findings do not prove the salt has no benefit, just that this study couldn't find one.

The salt was well tolerated with no acute side effects. But for now, this approach lacks evidence.

What this means for you:
Inhaled dry salt did not improve mucus clearance in this small, early-terminated COPD trial.

Study Details

Study typeRct
EvidenceLevel 2
PublishedMay 2026
View Original Abstract ↓
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 Tc-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.
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