Condition

COPD

Chronic obstructive pulmonary disease

213M
People Affected
883
Active Trials
16.2M
New Cases/Year
3.5M
Deaths/Year

Treatment Rankings

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

1
Pulmonary Rehabilitation
95% Effectiveness• 98% Confidence• 95% Safety• 533 trials• 15K participants
HIGH EvidenceExcellent ValueDose: 30-60 minutes exercise, 2-3 times/week
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
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95
DangerousModerateSafe

Time to Effect

2-3 months

Duration

6-12 weeks (requires maintenance)

Response Rate

85%

Remission Rate

0%

Number Needed to Treat (NNT)

3

Common Side Effects:

Muscle soreness: 20%
Fatigue: 10%
Joint pain: 5%

Annual Cost of Care

Drug Cost

$0

Monitoring

$600

Side Effects

$50

Total Annual

$650

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.1

ICER

$20,000/QALY

Cost per Responder

$3,529

Treatment Outcomes
Primary Outcomes
6-Minute Walk Distance350 meters
+11.43% (+40 meters)
St. George's Respiratory Questionnaire (SGRQ) Total ScoreSGRQ score: 55/100
-14.55% (-8 points)
Modified Medical Research Council (mMRC) Dyspnea ScalemMRC score: 2.5/4
-32% (-0.8 points)
Secondary Benefits
Hospital Anxiety and Depression Scale (HADS) - Depression SubscaleHADS-Depression score: 10/21
-25% (-2.5 points)
Isokinetic Quadriceps Strength80 Nm
+15% (+12 Nm)
COPD Assessment Test (CAT) ScoreCAT score: 25/40
-16% (-4 points)
Common Side Effects
Muscle soreness
+20%
Fatigue
+10%
Joint pain
+5%

Clinical Trial Phases:

Phase 4
2
Long-Term Oxygen Therapy (LTOT)
90% Effectiveness• 98% Confidence• 90% Safety• 21 trials• 5K participants
HIGH EvidenceExcellent ValueDose: 1-4 L/min via nasal cannula
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
90
DangerousModerateSafe

Time to Effect

Immediate (physiological), 6-12 months (survival)

Duration

Lifetime

Response Rate

70%

Remission Rate

0%

Number Needed to Treat (NNT)

5

Common Side Effects:

Dry nasal passages: 20%
Skin irritation from cannula: 10%
Fire hazard: 0.1%

Annual Cost of Care

Drug Cost

$4,500

Monitoring

$300

Side Effects

$50

Total Annual

$4,850

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.2

ICER

$25,000/QALY

Cost per Responder

$6,929

Treatment Outcomes
Primary Outcomes
5-Year Survival Rate35%
+42.8% (+15 percentage points)
Arterial Oxygen Partial Pressure (PaO2)50 mmHg
+30% (+15 mmHg)
Mean Pulmonary Artery Pressure (mPAP)30 mmHg
-16.7% (-5 mmHg)
Hematocrit55%
-12.7% (-7 percentage points)
Secondary Benefits
Modified Medical Research Council (mMRC) Dyspnea ScalemMRC score: 3/5
-16.7% (-0.5 points)
6-Minute Walk Distance (6MWD)200 meters
+20% (+40 meters)
St. George's Respiratory Questionnaire (SGRQ) Total ScoreSGRQ Total Score: 60/100
-13.3% (-8 points)
Common Side Effects
Dry nasal passages
+20%
Skin irritation from cannula
+10%
Fire hazard
+0.1%

Clinical Trial Phases:

Phase 4
3
LAMA/LABA Combination (e.g., Umeclidinium/Vilanterol)
85% Effectiveness• 95% Confidence• 55% Safety• 50 trials• 50K participants
HIGH EvidenceModerate ValueDose: Umeclidinium 62.5 mcg/Vilanterol 25 mcg once daily
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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

15-30 minutes (bronchodilation), days-weeks (symptoms)

Duration

Lifetime

Response Rate

70%

Remission Rate

0%

Number Needed to Treat (NNT)

8

Common Side Effects:

Nasopharyngitis: 10%
Headache: 8%
Upper respiratory tract infection: 7%
Cough: 5%
Dry mouth: 3%

Annual Cost of Care

Drug Cost

$5,400

Monitoring

$800

Side Effects

$100

Total Annual

$6,300

Cost-Effectiveness

MODERATE

QALYs Gained

0.1

ICER

$120,000/QALY

Cost per Responder

$9,000

Treatment Outcomes
Efficacy Outcomes
Overall Effectiveness
+85%
Response Rate
+70%
Common Side Effects
Nasopharyngitis
+10%
Headache
+8%
Upper respiratory tract infection
+7%

Clinical Trial Phases:

Phase 3Phase 4
4
LAMA Monotherapy (e.g., Tiotropium)
80% Effectiveness• 95% Confidence• 55% Safety• 100 trials• 100K participants
HIGH EvidenceExcellent ValueDose: Tiotropium 18 mcg or 2.5 mcg once daily
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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

30 minutes (bronchodilation), days-weeks (symptoms)

Duration

Lifetime

Response Rate

60%

Remission Rate

0%

Number Needed to Treat (NNT)

10

Number Needed to Harm (NNH)

15

Common Side Effects:

Dry mouth: 15%
Pharyngitis: 10%
Upper respiratory tract infection: 8%
Sinusitis: 5%
Constipation: 3%

Annual Cost of Care

Drug Cost

$4,500

Monitoring

$800

Side Effects

$80

Total Annual

$5,380

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.08

ICER

$40,000/QALY

Cost per Responder

$8,967

Treatment Outcomes
Efficacy Outcomes
Overall Effectiveness
+80%
Response Rate
+60%
Common Side Effects
Dry mouth
+15%
Pharyngitis
+10%
Upper respiratory tract infection
+8%

Clinical Trial Phases:

Phase 3Phase 4
5
LABA/ICS Combination (e.g., Fluticasone/Salmeterol)
75% Effectiveness• 90% Confidence• 50% Safety• 1 trials• 60K participants
HIGH EvidenceExcellent ValueDose: Fluticasone 250 mcg/Salmeterol 50 mcg 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

15-30 minutes (bronchodilation), weeks-months (exacerbation reduction)

Duration

Lifetime

Response Rate

60%

Remission Rate

0%

Number Needed to Treat (NNT)

10

Number Needed to Harm (NNH)

15

Common Side Effects:

Nasopharyngitis: 15%
Headache: 12%
Oral candidiasis: 10%
Pneumonia: 6%
Bronchitis: 5%

Annual Cost of Care

Drug Cost

$3,600

Monitoring

$800

Side Effects

$150

Total Annual

$4,550

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.03

ICER

$45,000/QALY

Cost per Responder

$7,583

Treatment Outcomes
Primary Outcomes
FEV1 (Forced Expiratory Volume in 1 second)1.3 L
+10% (+0.13 L)
Annualized COPD Exacerbation Rate1.5 exacerbations/year
-25% (-0.38 exacerbations/year)
SGRQ Total Score50/100
-8% (-4 points)
mMRC Dyspnea Scale2.5/4
-20% (-0.5 points)
Secondary Benefits
Time to First COPD Exacerbation120 days
+15% (+18 days)
Rescue Medication Use (SABA puffs/day)4 puffs/day
-30% (-1.2 puffs/day)
Daily Physical Activity (steps/day)3000 steps/day
+10% (+300 steps/day)
Common Side Effects
Nasopharyngitis
+15%
Headache
+12%
Oral candidiasis
+10%

Clinical Trial Phases:

Phase 3Phase 4
6
Triple Therapy (LAMA/LABA/ICS, e.g., Fluticasone furoate/Umeclidinium/Vilanterol)
70% Effectiveness• 90% Confidence• 48% Safety• 10 trials• 20K participants
HIGH EvidencePoor ValueDose: Fluticasone furoate 100 mcg/Umeclidinium 62.5 mcg/Vilanterol 25 mcg once daily
Find Trials

Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
48
DangerousModerateSafe

Time to Effect

15-30 minutes (bronchodilation), weeks-months (exacerbation reduction)

Duration

Lifetime

Response Rate

75%

Remission Rate

0%

Number Needed to Treat (NNT)

10

Number Needed to Harm (NNH)

15

Common Side Effects:

Nasopharyngitis: 18%
Headache: 15%
Oral candidiasis: 12%
Pneumonia: 8%
Upper respiratory tract infection: 10%

Annual Cost of Care

Drug Cost

$6,600

Monitoring

$800

Side Effects

$200

Total Annual

$7,600

Cost-Effectiveness

POOR

QALYs Gained

0.07

ICER

$180,000/QALY

Cost per Responder

$10,133

Treatment Outcomes
Efficacy Outcomes
Overall Effectiveness
+70%
Response Rate
+75%
Common Side Effects
Nasopharyngitis
+18%
Headache
+15%
Oral candidiasis
+12%

Clinical Trial Phases:

Phase 3Phase 4
7
Roflumilast (PDE4 Inhibitor)
60% Effectiveness• 85% Confidence• 55% Safety• 4 trials• 15K participants
HIGH EvidencePoor ValueDose: Roflumilast 500 mcg once daily
Find Trials

Comparative Safety Scale(Higher is safer)

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

Time to Effect

Weeks-months (exacerbation reduction)

Duration

Lifetime

Response Rate

50%

Remission Rate

0%

Number Needed to Treat (NNT)

10

Number Needed to Harm (NNH)

7

Common Side Effects:

Diarrhea: 15%
Nausea: 8%
Headache: 7%
Weight loss: 5%
Insomnia: 4%

Annual Cost of Care

Drug Cost

$5,400

Monitoring

$800

Side Effects

$100

Total Annual

$6,300

Cost-Effectiveness

POOR

QALYs Gained

0.02

ICER

$200,000/QALY

Cost per Responder

$12,600

Treatment Outcomes
Primary Outcomes
Moderate-to-Severe COPD Exacerbation Rate1.3 exacerbations/patient-year
-17% (-0.22 exacerbations/patient-year)
Pre-bronchodilator FEV11.05 L
+4.3% (+0.045 L)
St. George's Respiratory Questionnaire (SGRQ) Total Score52 points
-7.7% (-4 points)
Secondary Benefits
COPD Assessment Test (CAT) Score21 points
-7.1% (-1.5 points)
Daily Rescue Bronchodilator Puffs2.8 puffs/day
-7% (-0.2 puffs/day)
COPD-related Hospitalization Rate0.25 events/patient-year
-15% (-0.04 events/patient-year)
Common Side Effects
Diarrhea
+15%
Nausea
+8%
Headache
+7%

Clinical Trial Phases:

Phase 3Phase 4