Is there a role for Dimethyl Sulfoxide (DMSO) in the management of Chronic Obstructive Pulmonary Disease (COPD)?

DMSO Has No Role in COPD Management

There is no evidence supporting the use of dimethyl sulfoxide (DMSO) in the treatment of chronic obstructive pulmonary disease, and it should not be prescribed for this indication.

Evidence-Based COPD Pharmacotherapy

The established pharmacological management of COPD is well-defined and does not include DMSO:

First-Line Treatments

• Bronchodilators are the cornerstone of COPD therapy, including short-acting beta-agonists, anticholinergics, and long-acting formulations 1.
• Long-acting beta-agonist (LABA) and long-acting muscarinic antagonist (LAMA) combination therapy is strongly recommended over monotherapy for patients with dyspnea or exercise intolerance 2.
• These medications reduce exacerbations by 13-25% compared to placebo 1.

Disease Severity-Based Approach

• Mild COPD: Symptomatic patients should receive as-needed inhaled beta-agonist or anticholinergic therapy 1.
• Moderate COPD: Most patients are controlled on single-agent bronchodilators, with some requiring combination therapy 1.
• Severe COPD: Combination LABA/LAMA therapy is justified, with theophyllines as an option when monitored for side effects 1.

Agents Without Evidence in COPD

Multiple guidelines explicitly state there is no role for various agents in COPD management 1:

• Sodium cromoglycate
• Nedocromil sodium
• Antihistamines
• Prophylactic antibiotics (continuous or intermittent)
• Pulmonary vasodilators for COPD-associated pulmonary hypertension 1

DMSO falls into this category of agents lacking evidence for COPD treatment.

Non-Pharmacological Interventions with Proven Benefit

Beyond bronchodilators, only specific interventions have demonstrated mortality or quality-of-life benefits:

• Supplemental oxygen reduces mortality in patients with resting hypoxia (PaO2 ≤7.3 kPa or 55 mmHg), with relative risk reduction of 0.61 1.
• Pulmonary rehabilitation improves health status and dyspnea but not walking distance 1.
• Smoking cessation is the only intervention proven to reduce progressive lung function decline 1, 3.

Clinical Pitfalls

Avoid prescribing unproven therapies that divert resources from evidence-based treatments:

• The guidelines from multiple international societies (BTS, ERS, GOLD, ATS) spanning 1995-2020 consistently identify which agents lack efficacy 1, 2.
• No pharmacologic therapy except oxygen has been shown to improve survival in COPD 4.
• Mucolytic agents remain controversial with variable trial results and cannot be broadly recommended 1.

Treatment Algorithm

For any patient with COPD:

1. Confirm diagnosis with spirometry showing FEV1/FVC ratio below predicted values 1.
2. Initiate bronchodilator therapy based on symptom severity 1.
3. Add LABA/LAMA combination for persistent dyspnea or exercise intolerance 2.
4. Consider triple therapy (ICS/LABA/LAMA) only for patients with ≥1 exacerbation in the past year 2.
5. Prescribe supplemental oxygen for documented resting hypoxia 1.
6. Refer to pulmonary rehabilitation for symptomatic patients 1.

DMSO has no place in this algorithm and should not be considered as COPD therapy.