Reducing the Risk of Mortality in Chronic Obstructive Pulmonary Disease With Pharmacotherapy: A Narrative Review

Authors

Matthew Mintz, George Washington University School of Medicine and Health Sciences, Washington, DC. Electronic address: drmintz@gmail.com.
Igor Barjaktarevic, Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA.
Donald A. Mahler, Geisel School of Medicine at Dartmouth, Hanover, NH; Director of Respiratory Services, Valley Regional Hospital, Claremont, NH.
Barry Make, Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, CO.
Neil Skolnik, Abington Family Medicine, Jenkintown, PA; Department of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA.
Barbara Yawn, Department of Family Medicine and Community Health, University of Minnesota, Minneapolis.
Bree Zeyzus-Johns, Abington Family Medicine, Jenkintown, PA.
Nicola A. Hanania, Section of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, TX.

Document Type

Journal Article

Publication Date

2-1-2023

Journal

Mayo Clinic proceedings

Volume

98

Issue

2

DOI

10.1016/j.mayocp.2022.09.007

Abstract

In 2020, chronic obstructive pulmonary disease (COPD) was the fifth leading cause of death in the United States excluding COVID-19, and its mortality burden has been rising since the 1980s. Smoking cessation, long-term oxygen therapy, noninvasive ventilation, and lung volume reduction surgery have had a beneficial effect on mortality; however, until recently, the effects of pharmacologic therapies on all-cause mortality have been unclear. Inhaled pharmacologic treatments for patients with COPD include combinations of long-acting muscarinic receptor antagonists (LAMAs), long-acting-βagonists (LABAs), and inhaled corticosteroids (ICS). The recent IMPACT and ETHOS clinical trials reported mortality benefits with ICS/LAMA/LABA triple therapy compared with LAMA/LABA dual therapy. In IMPACT, fluticasone furoate/umeclidinium/vilanterol therapy significantly reduced the risk of on-/off-treatment all-cause mortality vs umeclidinium/vilanterol (hazard ratio, 0.72; 95% CI, 0.53 to 0.99; P=.042). The ETHOS trial found a reduction in the risk of on-/off-treatment all-cause mortality in patients treated with budesonide/glycopyrrolate/formoterol vs glycopyrrolate/formoterol (hazard ratio, 0.51 [0.33 to 0.80]; nominal P=.0035). Both trials included populations of patients with symptomatic COPD at high risk of future exacerbations, and a post hoc analysis of the final retrieved vital status data suggested that the observed mortality benefits are conferred by the ICS component. In conclusion, triple therapy reduces the risk of mortality in patients with symptomatic COPD characterized by moderate or severe airflow obstruction and a recent history of moderate or severe exacerbations. This benefit is likely to be driven by reductions in exacerbations. Future research efforts should focus on improving the long-term prognosis of patients living with COPD.

APA Citation

Mintz, Matthew; Barjaktarevic, Igor; Mahler, Donald A.; Make, Barry; Skolnik, Neil; Yawn, Barbara; Zeyzus-Johns, Bree; and Hanania, Nicola A., "Reducing the Risk of Mortality in Chronic Obstructive Pulmonary Disease With Pharmacotherapy: A Narrative Review" (2023). GW Authored Works. Paper 2467.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/2467

Department

Medicine