Mortality prevention as the center of COPD management

COPD is a major healthcare problem and cause of mortality worldwide. COPD patients at increased mortality risk are those that are more symptomatic, have lower lung function and lower DLCO, have decreased exercise capacity, belong to the emphysematous phenotype and those who have concomitant bronchiectasis. Also mortality risk seems to be greater in patients who experience COPD exacerbations and in those who suffer from concomitant cardiovascular and/or metabolic diseases. To predict the risk of death in COPD patients several composite scores have been created using different parameters. In the previous years, large studies (also called Mega-Trials) have evaluated the efficacy of different therapies on COPD mortality, but until recently only non-pharmaceutical interventions have proven to be effective. However, recent studies on fixed combinations of triple therapy (long-acting beta agonists, long-acting muscarinic antagonists and inhaled corticosteroids) have provided encouraging results, showing for the first time a reduction in mortality compared to dual therapies. The aim of the present review is to summarize available data regarding mortality risk in COPD patients and to describe pharmacologic therapies that have shown effectiveness in reducing mortality.