Clinical Question: What treatments are effective for chronic obstructive pulmonary disease (COPD)?

Setting: Various (meta-analysis)

Study Design: Meta-analysis (randomized controlled trials)

Synopsis: The authors of this study thoroughly reviewed the literature for randomized controlled trials (RCTs) evaluating treatments of COPD. Data sources included MEDLINE, the Cochrane Registry, bibliographies, and experts in the field. Only randomized, placebo-controlled trials with blinded outcome assessments and nearly complete follow-up were included. The authors did not specify the percentage of RCTs with or without concealed allocation assignment.

Long-acting beta₂ agonists, inhaled corticosteroids, and anticholinergics reduced exacerbation rates in patients with moderate to severe COPD, but did not affect overall mortality rates. The combination of steroids with long-acting beta₂ agonists was more effective than either agent alone. Pulmonary rehabilitation improved health status in patients with moderate to severe disease but had no effect on long-term survival or hospitalization rates. Home oxygen therapy significantly improved survival, but only in patients with partial pressure of arterial oxygen (PaO₂) less than 60 mm Hg, and not in those without hypoxia at rest. Disease management programs had mixed results, and no benefits were found with non-invasive mechanical ventilation.

Bottom Line: Effective treatments for COPD include smoking cessation, long-acting beta₂ agonists, inhaled corticosteroids, anticholinergics, pulmonary rehabilitation, and home oxygen therapy (but only in patients with PaO₂ less than 60 mm Hg at rest). Uncertain or non-beneficial interventions include disease management programs and noninvasive mechanical ventilation. (Level of Evidence: 1a)