Long-term survival outcomes associated with inhalation therapy in chronic obstructive pulmonary disease: a 5-year multicenter prospective cohort study

Chronic obstructive pulmonary disease (COPD) represents a significant global health challenge, characterized by high mortality rates. While inhalation therapies, specifically long-acting bronchodilators (LABD) and inhaled corticosteroids (ICS), are known to relieve symptoms and enhance lung function, their long-term effects on survival remain inadequately explored. This 5-year prospective, multicenter observational cohort study included 370 spirometry-confirmed COPD patients recruited from 29 hospitals in Japan. Patients who had undergone lung resection surgery or who lacked follow-up information were excluded. Patients were categorized based on their use of LABD or ICS. Overall survival was evaluated using Kaplan–Meier curves and multivariable-adjusted Cox proportional hazards models. ICS use did not show a significant effect on survival outcomes. In contrast, use of LABD was associated with significantly improved overall survival, especially in patients with severe or very severe COPD (P < 0.01). The multivariable-adjusted hazard ratio for all-cause mortality associated with LABD use was significantly lower at 0.32 (95% confidence interval 0.13–0.82, P = 0.02). LABD might be effective in improving long-term survival in COPD patients, particularly those in the severe or very severe stage. The use of ICS did not significantly affect survival outcomes. These results support the use of LABD in managing COPD and suggest that further research is needed to better understand the role of ICS in COPD management.