US: Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease, which includes chronic bronchitis and emphysema, is a long-term lung disease that causes difficulty breathing. It is the third leading cause of death, although it is preventable and treatable. Most people die due to exacerbations of COPD.

In order to reduce this mortality, Dr. Lipson from Perelman School of Medicine, University of Pennsylvania, and his colleagues conducted an IMPACT study which showed once-daily treatment of patients with chronic obstructive pulmonary disease (COPD) with an inhaler combining fluticasone furoate (FF), umeclidinium (UMEC), and vilanterol (VI) reduced all-cause mortality by 42 percent. This study is published in the American Journal Of Respiratory and Critical Care Medicine.

Fluticasone furoate is an inhaled corticosteroid, while umeclidinium is a long-acting muscarinic antagonist (a type of bronchodilator), and vilanterol is a long-acting ß2 agonist (another type of bronchodilator).

More than 10,000 IMPACT participants with COPD who were at risk for severe exacerbations (flare-ups) were randomized to be in one of three groups:

• Those receiving once-daily inhalations of FF/UMEC/VI
• FF/VI
• UMEC/VI combinations

IMPACT participants were followed for one year. The study focused on patients with a history of exacerbations of their COPD.

The initial IMPACT study showed that daily inhalation of FF/UMEC/VI led to more significant reductions in moderate/severe exacerbations and COPD hospitalizations, as well as improved lung function and health-related quality of life than the two dual combination therapies. The study also showed patients on triple therapy had lower death rates than those on VI/UMEC.

"Because the number of missing patients exceeded the numbers of deaths in the study, we felt caution was warranted in the interpretation of the original published findings," stated Dr. Lipson. "Given the importance of this finding for patients and physicians, we undertook a global collection of the missing data at week 52. These new repeat analyses demonstrate the robustness of the original finding. We have concluded that we can improve survival in symptomatic patients with COPD at risk of exacerbation." he added.

"We believe that the mortality finding with FF/UMEC/VI compared to UMEC/VI was primarily driven by the steroid component and its effect on reducing exacerbations, especially hospitalized exacerbations. Frequently exacerbating patients are at higher risk of hospitalization and death. These are the patients who appear to achieve the greatest survival benefit with once-daily FF/UMEC/VI triple therapy." concluded Dr. Lipson.

For further reading, click on the following link: https://doi.org/10.1164/rccm.201911-2207OC