COPD treatments for smokers don't prolong life

Constructive obstructive pulmonary disease COPD is a consequence of lifelong smoking. It is non-treatable - in the sense that no current treatments delay mortality.

Allan S. Brett, MD in Journal Watch General Medicine February 21, 2007 provides an over view of 2 recent articles in the New England Journal of Medicine (subscription only) relating to the industry-sponsored international trial (known as TORCH), where researchers randomized more than 6000 COPD patients who had a history of smoking, to receive :

1. Inhaled salmeterol plus Fluticasone (Advair 50/500)
2. Salmeterol (Serevent)
3. Fluticasone (Flovent)
4. A placebo

At 3 years, the following outcomes were noted:

* All-cause mortality (the primary endpoint) was 12.6% with combined therapy, 13.5% with salmeterol, 16.0% with fluticasone, and 15.2% with placebo. The difference between combined therapy and placebo did not quite reach significance (P=0.052).
* Combined therapy and salmeterol alone, but not fluticasone alone, significantly reduced the rate of hospitalization for COPD exacerbation.
* Pneumonia occurred more frequently in the two groups receiving fluticasone (about 19%) than in the placebo or salmeterol-alone groups (about 13%).
* Combined therapy was superior to both monotherapies — which, in turn, were superior to placebo — in reducing the number of moderate or severe COPD exacerbations and in mitigating the declines in FEV1 and health status scores.

What is evident is that no treatments reduce mortality . The benefits of treatment combined with the current debates about the potential harm with long-acting ß-agonists in asthma are the subject of continuing discussion. Whilst the inhalers provide some temporary relief, this declines and may increase susceptibility to pneumonia.

Any smoker would be well advised to consider this information on NO Smoking Day. If you know a smoker you will do them a favour by bringing this information and these graphs to their attention.

Calverley PMA et al. Salmeterol and fluticasone propionate and survival in chronic obstructive pulmonary disease. N Engl J Med 2007 Feb 22; 356:775-89.

Rabe KF. Treating COPD — The TORCH trial, P values, and the dodo. N Engl J Med 2007 Feb 22; 356:851-4.