Chronic obstructive pulmonary disease: moving from symptom relief to mortality reduction

Abstract

Chronic obstructive pulmonary disease (COPD) has a 3-year mortality rate up to 37%, 2–6 times higher than the general population. We present evidence supporting pharmacological therapies to improve patient life expectancy, focusing on inhaled corticosteroids (ICSs) combined with long-acting bronchodilators (LABDs). A reduction in 3-year all-cause mortality (ACM) has been shown in patients with severe COPD treated with fluticasone propionate (an ICS) and salmeterol [long-acting beta-agonist (LABA)], compared with placebo. An observational study of elderly patients with severe COPD and multiple comorbidities suggested ICS+LABD reduce ACM compared with LABD monotherapy. Patients with symptomatic COPD at risk of exacerbations saw a mortality benefit with the ICS/long-acting muscarinic antagonist (LAMA)/LABA combinations fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) or budesonide/glycopyrrolate/formoterol (BUD/GLY/FOR) versus UMEC/VI or GLY/FOR (LAMA/LABA combinations) in the IMPACT and ETHOS trials, respectively. Reduced risk of mortality may be due to modulation of airway inflammation, thereby reducing activation of proinflammatory mediators in the peripheral circulation. Importantly, estimated annual risk reduction for ACM with ICS/LAMA/LABA combinations in patients with COPD is of the same order of magnitude as for statins (patients with coronary disease) and angiotensin-converting enzyme inhibitors (patients with vascular disease). Based on the current data, the pharmacological treatment of COPD appears not only able to improve symptoms and reduce the frequency of exacerbations but is also very promising in improving patient prognosis in the long term.

Survival Impacts of Impaired Lung Functions and Comorbidities on Elderly Esophageal Cancer Patients

“…Our model might help clinicians optimize perioperative managements for patients with impaired physiological functions. Pharmacological interventions are reportedly useful for improving the survival of patients with pulmonary diseases [41]. High‐risk patients might be good candidates for long‐term rehabilitation programs.…”

Risk of all-cause mortality or hospitalization for pneumonia associated with inhaled β2-agonists in patients with asthma, COPD or asthma-COPD overlap

“…Surprisingly, the sample size obtained after the TORCH study, following a safety call from a 'follow-up assessment,' was entirely inadequate for generating a statistically significant result. The rate of all-cause mortality is regarded as a comprehensive prognostic indicator for any disease; it is dependable and widely regarded as the gold standard in determining the safety of a given therapy [ 19 ]. Although it is accepted that there is no cure for COPD, we believe it is time to shift the treatment paradigm for patients with COPD at risk of death from symptomatic relief to long-term treatment improvement.…”

Perfil Clínico-epidemiológico de pacientes com Doença Pulmonar Obstrutiva Crônica de um Centro de Referência de Alagoas: um estudo transversal

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