Patient responses to nebulised 0.9% sodium chloride in COPD with exacerbations: not a simple solution

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Background: Nebulised 0.9% sodium chloride (NaCl) is used in COPD as a treatment or placebo, including in frequent exacerbators, but some report symptom worsening. Aims: Assess subjective and objective responses to nebulised 0.9% NaCl in COPD, with focus on frequent exacerbators, during stable state. Method: 50 ex-smokers with GOLD II-IV COPD with exacerbations were enrolled (FEV1 0.84L±0.34, moderate and severe exacerbations in prior year 3.16±1.40). While exacerbation free, they nebulised 0.9% NaCl with pre and post spirometry and rated chest discomfort and dyspnoea pre and post NaCl using visual analogue scales (VAS). Other symptoms and cough were recorded. Analyses as whole group, and subgroup by exacerbator group: high exacerbator (HE) ≥3 exacerbations/yr, n=28; low exacerbator (LE) ≤2 exac/yr, n=22. Results: 31 (62%) patients’ FEV1 fell post NaCl, 14 (28%) improved, 5 were unchanged. 7 (14%) patients’ FEV1 fell by ≥10% (10% cut off used in some challenge tests); all were in HE group. FEV1 %change post NaCl significantly differed in HE vs LE group (-4.75%±7.15 vs -1.35±4.64, p=0.048), suggesting more bronchoconstriction in HE group. FEV1 %change showed a weak non-significant association with baseline FEV1 (r=0.25, p=0.083) and no correlation with eos (r=0.16, p=0.28). VAS dyspnoea and chest discomfort change strongly correlated (r=0.80, p<0.0005), but not with FEV1 %change. 20 (40%) had cough, also not associated with FEV1 %change (r=0.067, p=0.65). 7 (14%) had other adverse symptoms e.g. wheeze, light headedness. Conclusion: Nebulised 0.9% NaCl can cause bronchoconstriction in this population; particular caution may be needed in frequent exacerbators. Further work needed.

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