Targeted Literature Review (TLR) on the Mortality in Patients With Moderate-to-Severe Chronic Obstructive Pulmonary Disease (COPD) in the USA

OBJECTIVES: Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory disease of the respiratory system resulting in airflow limitation and tissue destruction and is the third leading cause of death worldwide. Mortality rates in relation to (1) patient characteristics (demographics, morbidity, Global Initiative for Obstructive Lung Disease [GOLD] status, eosinophil (EOS) level), (2) treatment (type and course of COPD combination therapy, admittance to emergency room/intensive care unit), and (3) disease severity are unknown.

METHODS: A targeted literature review (TLR) was conducted following the Population, Intervention, Comparator, Outcome (PICO) framework. Publications were identified from electronic databases (Embase, Medline) and grey literature. Primary outcomes of interest included mortality by age, gender, smoking status (all-cause and COPD-related mortality) in the USA, and secondary outcomes of interest included patient characteristics, treatment patterns, and disease/exacerbation severity.

RESULTS: Twenty-two publications were included out of 2,352 records identified through electronic databases and 579 through grey literature. Fourteen studies reported mortality data (primary outcome), and eight studies reported data on secondary outcomes. Most of the studies were US-based, with some studies being multinational inclusive of USA. All-cause mortality ranged from 13.9 to 91.4 per 1000 person-years depending on disease severity. Studies reported higher COPD mortality with increasing disease severity, hospitalizations, male sex, and current smoker status (versus former or never smoking status). Studies also reported divergence from GOLD recommendations and underutilization of controller medication/triple therapy. Choice of initial treatment was linked to mortality differences. Disease severity was commonly assessed using GOLD criteria, while exacerbation definitions included treatment and healthcare resource use. There was no evidence identified linking mortality to EOS level.

CONCLUSIONS: This review highlighted high overall mortality in patients with moderate-to-severe COPD despite current treatments, its associated risk factors, and the treatment strategies that should be offered to patients to mitigate disease progression.