Prevention of Death in COPD

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Abstract
Calverley et al. do not sufficiently emphasize some aspects of their study on the use of salmeterol and fluticasone in patients with chronic obstructive pulmonary disease (COPD) (Feb. 22 issue).1 Their study, called the Towards a Revolution in COPD Health (TORCH) trial, showed that treatment with fluticasone alone actually increased mortality at the end of 3 years, although the increase was not significant. This finding contrasts markedly with retrospective analyses and meta-analyses showing a substantial reduction in mortality from all causes by about 25% associated with the drug.2,3 This discrepancy between the results of a well-conducted, randomized, controlled trial and historical analyses highlights how misleading the latter may be. The net effect of therapy with inhaled corticosteroids for patients who have COPD may be detrimental in view of the increased episodes of pneumonia associated with such agents.1,4 Another important result of the TORCH study was the failure of inhaled corticosteroids, even when combined with salmeterol, to reduce the annual decline in lung function. The lack of effect of inhaled corticosteroids on mortality and disease progression may reflect resistance to the antiinflammatory effects of corticosteroids in COPD.5