Chronic Obstructive Pulmonary Disease: Lessons from the Important Treatment Trials

Abstract

Since 1999, clinical trials have more precisely defined the impact of various treatments on important patient-centred outcomes, allowing the development of treatment guidelines and leading to personalised treatment. The use of larger populations, seen in the Toward a Revolution in COPD Health (TORCH), Understanding Potential Long-Term Impacts on Function with Tiotropium (UPLIFT) and The Study to Understand Mortality and Morbidity (SUMMIT) trials, has allowed hypotheses to be answered clearly albeit not always positively. Notwithstanding, each study has provided important information, often through secondary outcomes, which have been prospectively tested in other trials. Nearly two decades on, we are clearer as to the role of lung volume reduction procedures, who should and shouldn't be prescribed inhaled steroids and long-acting bronchodilators and in what combinations, and who may benefit from roflumilast. Unexpected findings such as pneumonia risk from inhaled steroids and use of eosinophil count to direct their use have an important clinical impact now and in the future. (BRN Rev. 2017;3:286-98)