Enhancing approaches to the treatment of patients with chronic obstructive pulmonary disease (COPD)

Background: patients with chronic obstructive pulmonary disease (COPD) are characterized by goblet cell hyperplasia and submucosal gland hypertrophy, leading to increased mucus secretion and sputum production due to heightened functional activation. The resulting pathophysiological effects include airway obstruction and impaired gas exchange. Moreover, dysfunction of mucociliary clearance, associated with reduced bronchial secretion clearance, promotes bacterial colonization, which predisposes patients to recurrent respiratory infections and exacerbations of COPD. Hypertonic saline (HS) has shown a beneficial impact on the rheological properties of sputum and enhances mucociliary clearance. A synergistic clinical effect is observed when HS is combined with hyaluronic acid. Aim: to assess the effects of a combined inhalation therapy comprising 7% hypertonic saline (NaCl) and 0.1% sodium hyaluronate on the severity and productive nature of cough in COPD patients, as well as its safety profile in clinical practice. Materials and Methods: a total of 50 patients with COPD classified as GOLD stages II–III, receiving basic therapy in accordance with clinical guidelines, were examined during the remission phase and monitored over a 10-day period. The cohort was divided into two groups of 25 participants each. In the main group, patients received, in addition to their standard therapy, a combination treatment of 7% hypertonic saline and 0.1% sodium hyaluronate administered via nebulizer inhalation twice daily for 10 days. The control group continued with standard therapy alone and did not receive the combined drug. Outcome measures included assessments of cough severity (utilizing a cough severity scale, dyspnea scale, cough and sputum scale), clinical and biochemical blood parameters, ECG, and spirometry. Results: the main group demonstrated a statistically significant reduction in cough intensity — from 2.5±0.24 to 1.2±0.54 points — as well as a decrease in sputum volume, measured at 2.3±0.84 to 1.4±0.65 points. No serious adverse events were reported in either group.Conclusion: the combination of 7% hypertonic saline and 0.1% sodium hyaluronate improves sputum clearance and reduces cough severity in patients with COPD. The therapy was well-tolerated, exhibiting a favorable safety profile with no clinically significant adverse events. Keywords: COPD, remission, cough, mucociliary clearance, hypertensive solution, hyaluronic acid. For citation: Kuzubova N.A., Titova O.N., Sklyarova D.B. Enhancing approaches to the treatment of patients with chronic obstructive pulmonary disease (COPD). RMJ. 2025;1:23–26. DOI: 10.32364/2225-2282-2025-1-5