Impact of pharmacological and non-pharmacological interventions on mortality in chronic obstructive pulmonary disease (COPD) patients

Abstract

Purpose: This review aimed to summarise evidence about the impact of pharmacological and non-pharmacological interventions on survival in COPD patients.

Methods: We performed a narrative literature review on the effect of pharmacological and non-pharmacological interventions on survival in COPD patients.

Results: Inhaled therapies are central to reduce symptoms in COPD. In particular, inhaled steroids seem to have the greatest effect on mortality. Despite the anti-inflammatory effects attributed to statins, their benefit in COPD has been shown only in cases of combined cardiovascular diseases. The use of beta-blockers in COPD has not been associated with increased COPD-related mortality and a beneficial effect on all-cause mortality has even been shown in COPD patients with cardiovascular diseases. Influenza and pneumococcal vaccination reduced the occurrence of exacerbations and mortality due to COPD. In addition, long-term oxygen therapy (LTOT) (≥15h/day) in COPD patients with severe hypoxemia had a positive effect on survival. Regarding non-pharmacological interventions, it has been demonstrated that smoking cessation, treatment compliance and nutritional supplementation for underweight patients also have a positive effect on survival. Non-invasive ventilation results were dependent on patient PaCO₂ levels. In patients with advanced COPD, further prospective studies are needed to know the effect of bronchoscopic lung volume reduction and lung transplant on COPD survival. Regarding lung transplant, a survival benefit in patients with a pre-transplant BODE score of ≥7 has been shown in retrospective studies.

Conclusion: Most of the studies did not evaluate survival as the main criteria and further long-term studies on the global management of COPD are required.

Keywords: Chronic obstructive pulmonary disease (COPD); Inhaled therapy; Mortality; Non-invasive ventilation endobronchial volume reduction; Oxygen therapy; Pharmacological treatment; Pulmonary rehabilitation; Survival.