Inhaled corticosteroid withdrawal and mortality rate in trials of triple therapy inhalers for COPD

The Efficacy and Safety of Triple Therapy in Obstructive Lung Disease (ETHOS) and Informing the Pathway of Chronic Obstructive Pulmonary Disease (COPD) Treatment (IMPACT) trials have been interpreted as showing a mortality benefit from introducing triple therapy inhalers in patients with COPD. However, reanalysis of the trial data instead reveals an excess mortality arising from the withdrawal of maintenance inhaled corticosteroids from patients with COPD randomised to the dual therapy long-acting muscarinic antagonist-long-acting beta-agonist inhaler used as the comparator, as dictated by the trial protocols. The findings from this reanalysis are of direct relevance to guidelines and management of COPD.