Condition

Chronic Bronchitis

Long-term inflammation of the bronchi

100M
People Affected
50
Active Trials
3M
New Cases/Year
20K
Deaths/Year

Treatment Rankings

Ranked by evidence volume first. Medicine has spent centuries ranking things by vibes. This is an improvement.

1
Budesonide/Glycopyrronium/Formoterol
82% Effectiveness• 95% Confidence• 50% Safety• 15 trials• 15K participants
HIGH EvidenceModerate ValueDose: Specific to combination (e.g., Budesonide 160mcg / Glycopyrronium 7.2mcg / Formoterol 4.8mcg twice daily)
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
50
DangerousModerateSafe

Time to Effect

Weeks to months

Duration

Lifetime

Response Rate

80%

Remission Rate

5%

Number Needed to Treat (NNT)

7

Common Side Effects:

Nasopharyngitis: 7%
Oral candidiasis: 4%
Pneumonia: 4%
Headache: 5%
Urinary tract infection: 2.5%

Annual Cost of Care

Drug Cost

$6,500

Monitoring

$600

Side Effects

$200

Total Annual

$7,300

Cost-Effectiveness

MODERATE

QALYs Gained

0.15

ICER

$110,000/QALY

Cost per Remission

$146,000

Cost per Responder

$9,125

Treatment Outcomes
Efficacy Outcomes
Overall Effectiveness
+82%
Response Rate
+80%
Remission Rate
+5%
Common Side Effects
Nasopharyngitis
+7%
Oral candidiasis
+4%
Pneumonia
+4%

Clinical Trial Phases:

Phase 3Phase 4
2
Indacaterol/Glycopyrronium
78% Effectiveness• 92% Confidence• 60% Safety• 100 trials• 25K participants
HIGH EvidenceGood ValueDose: 27.5 mcg/15.6 mcg or 110 mcg/50 mcg once daily
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
60
DangerousModerateSafe

Time to Effect

Within 5 minutes

Duration

Lifetime

Response Rate

75%

Remission Rate

5%

Number Needed to Treat (NNT)

9

Common Side Effects:

Nasopharyngitis: 6.5%
Cough: 5.5%
Headache: 3.5%
Urinary tract infection: 2.5%
Dry mouth: 1.5%

Annual Cost of Care

Drug Cost

$5,500

Monitoring

$600

Side Effects

$100

Total Annual

$6,200

Cost-Effectiveness

GOOD

QALYs Gained

0.1

ICER

$60,000/QALY

Cost per Remission

$124,000

Cost per Responder

$8,267

Treatment Outcomes
Efficacy Outcomes
Overall Effectiveness
+78%
Response Rate
+75%
Remission Rate
+5%
Common Side Effects
Nasopharyngitis
+6.5%
Cough
+5.5%
Headache
+3.5%

Clinical Trial Phases:

Phase 3Phase 4
3
Fluticasone/Salmeterol
75% Effectiveness• 90% Confidence• 55% Safety• 5 trials• 40K participants
HIGH EvidenceGood ValueDose: 250 mcg/50 mcg twice daily (Diskus) or 230 mcg/21 mcg twice daily (HFA)
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
55
DangerousModerateSafe

Time to Effect

Weeks

Duration

Lifetime

Response Rate

70%

Remission Rate

5%

Number Needed to Treat (NNT)

10

Number Needed to Harm (NNH)

25

Common Side Effects:

Oral candidiasis: 7.5%
Pneumonia: 4.5%
Hoarseness: 3.5%
Headache: 12.5%
Upper respiratory tract infection: 17.5%

Annual Cost of Care

Drug Cost

$4,000

Monitoring

$600

Side Effects

$200

Total Annual

$4,800

Cost-Effectiveness

GOOD

QALYs Gained

0.07

ICER

$65,000/QALY

Cost per Remission

$96,000

Cost per Responder

$6,857

Treatment Outcomes
Primary Outcomes
FEV1 (Forced Expiratory Volume in 1 second)1.25 L
+12% (+0.15 L)
Annual Moderate-to-Severe Exacerbation Rate1.6 exacerbations/year
-27% (-0.43 exacerbations/year)
St. George's Respiratory Questionnaire (SGRQ) Total Score58 points (Scale 0-100, higher worse)
-7% (-4 points)
Secondary Benefits
Daily Rescue Salbutamol Use3.5 puffs/day
-20% (-0.7 puffs/day)
6-Minute Walk Distance320 meters
+7% (+22 meters)
Night-time Awakenings (due to COPD symptoms) per week2.1 awakenings/week
-35% (-0.74 awakenings/week)
Common Side Effects
Oral candidiasis
+7.5%
Pneumonia
+4.5%
Hoarseness
+3.5%

Clinical Trial Phases:

Phase 3Phase 4
4
Tiotropium
70% Effectiveness• 90% Confidence• 60% Safety• 11 trials• 60K participants
HIGH EvidenceExcellent ValueDose: 18 mcg once daily (HandiHaler) or 2.5 mcg (Respimat) once daily
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
60
DangerousModerateSafe

Time to Effect

Within 30 minutes

Duration

Lifetime

Response Rate

65%

Remission Rate

5%

Number Needed to Treat (NNT)

13

Common Side Effects:

Dry mouth: 13%
Upper respiratory tract infection: 5%
Pharyngitis: 3%
Cough: 2.5%
Dyspepsia: 1.5%

Annual Cost of Care

Drug Cost

$4,500

Monitoring

$600

Side Effects

$100

Total Annual

$5,200

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.08

ICER

$35,000/QALY

Cost per Remission

$104,000

Cost per Responder

$8,000

Treatment Outcomes
Primary Outcomes
Trough FEV11.25 L
+12% (+0.15 L)
Annualized COPD Exacerbation Rate1.4 exacerbations/year
-25% (-0.35 exacerbations/year)
St. George's Respiratory Questionnaire (SGRQ) Total Score52 units (scale 0-100)
-9.6% (-5 units)
Modified Medical Research Council (mMRC) Dyspnea Scale Score2.5 units (scale 0-4)
-20% (-0.5 units)
Secondary Benefits
COPD Assessment Test (CAT) Score25 units (scale 0-40)
-12% (-3 units)
Rescue Medication Use4.5 puffs/day
-24.4% (-1.1 puffs/day)
6-Minute Walk Distance (6MWD)350 meters
+5% (+17.5 meters)
Common Side Effects
Dry mouth
+13%
Upper respiratory tract infection
+5%
Pharyngitis
+3%

Clinical Trial Phases:

Phase 3Phase 4
5
Roflumilast
68% Effectiveness• 85% Confidence• 45% Safety• 5 trials• 10K participants
MODERATE EvidenceExcellent ValueDose: 500 mcg once daily
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
45
DangerousModerateSafe

Time to Effect

3-6 months

Duration

Lifetime

Response Rate

55%

Remission Rate

0%

Number Needed to Treat (NNT)

18

Number Needed to Harm (NNH)

13

Common Side Effects:

Diarrhea: 9%
Nausea: 5%
Weight decrease: 4%
Headache: 3.5%
Insomnia: 2.5%

Annual Cost of Care

Drug Cost

$9,000

Monitoring

$600

Side Effects

$300

Total Annual

$9,900

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.05

ICER

$40,000/QALY

Cost per Responder

$18,000

Treatment Outcomes
Primary Outcomes
Moderate-to-Severe COPD Exacerbations (Annual Rate)1.6 exacerbations/year
-17% (-0.27 exacerbations/year)
FEV1 (Forced Expiratory Volume in 1 second)1.1 L
+4.5% (+50 mL)
Daily Respiratory Symptom Score (e.g., for cough and sputum severity)Average score: 2.5/5
-15% (-0.38 points)
Secondary Benefits
St. George's Respiratory Questionnaire (SGRQ) Total Score48 points
-5.2% (-2.5 points)
Days with Productive Cough/Sputum per Month22 days/month
-12% (-2.6 days/month)
Hospitalizations due to COPD Exacerbations (Annual Rate)0.25 hospitalizations/year
-18% (-0.045 events/year)
Common Side Effects
Diarrhea
+9%
Nausea
+5%
Weight decrease
+4%

Clinical Trial Phases:

Phase 3Phase 4
6
Azithromycin
60% Effectiveness• 80% Confidence• 50% Safety• 22 trials• 5K participants
MODERATE EvidenceExcellent ValueDose: 250 mg 3 times per week, or 500 mg 3 times per week
Find Trials

Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
50
DangerousModerateSafe

Time to Effect

Weeks to months

Duration

6-12 months, or longer

Response Rate

50%

Remission Rate

0%

Number Needed to Treat (NNT)

7

Number Needed to Harm (NNH)

10

Common Side Effects:

Diarrhea: 7.5%
Nausea/Abdominal pain: 6.5%
Hearing impairment: 7.5%
QT prolongation: 0.5%

Annual Cost of Care

Drug Cost

$300

Monitoring

$850

Side Effects

$100

Total Annual

$1,250

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.04

ICER

$25,000/QALY

Cost per Responder

$2,500

Treatment Outcomes
Primary Outcomes
Annual Rate of Acute Exacerbations of COPD1.8 exacerbations/year
-25% (-0.45 exacerbations/year)
Time to First COPD Exacerbation125 days
+39% (+49 days)
COPD Assessment Test (CAT) Score20 points (scale 0-40, higher is worse)
-10% (-2 points)
Secondary Benefits
Hospitalizations due to COPD Exacerbations0.4 hospitalizations/year
-25% (-0.1 hospitalizations/year)
Systemic Corticosteroid Courses for Exacerbations1.5 courses/year
-20% (-0.3 courses/year)
Days of Purulent Sputum per Month10 days/month
-25% (-2.5 days/month)
Common Side Effects
Diarrhea
+7.5%
Nausea/Abdominal pain
+6.5%
Hearing impairment
+7.5%

Clinical Trial Phases:

Phase 4