[Impact of efficacy and mortality studies (TORCH and UPLIFT) in bronchodilator treatment of chronic obstructive pulmonary disease]

The TORCH and UPLIFT studies are probably the most ambitious clinical trials performed to date in chronic obstructive pulmonary disease (COPD). Unfortunately, the main objectives were not achieved. Compared with placebo, combination therapy with salmeterol and fluticasone did not significantly reduce all-cause mortality, nor did tiotropium slow lung function deterioration over 4 years. However, careful analysis of the results reduces the initial disappointment to a minimum and leads to moderate optimism, as both trials showed a decrease in the number of exacerbations, improvement in health-related quality of life (HRQoL) and, in general, a good safety profile throughout the studies. Moreover, some benefits on survival were noted. This latter observation opens new horizons as it suggests that, apart from lung function, there are other therapeutic targets with prognostic importance. When analyzed overall, the UPLIFT and TORCH studies confirm and highlight the key role of prolonged action bronchodilators in the management of COPD. Although inhaled corticosteroids, administered in monotherapy, reduce exacerbations and improve HRQoL, these drugs show no benefit on survival and increase the risk of adverse effects. Nevertheless, when inhaled corticosteroids are associated with bronchodilator treatment, their benefits seem to be enhanced.