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.

Pulmonary Rehabilitation

95% Effectiveness• 98% Confidence• 95% Safety• 533 trials• 15K participants

HIGH EvidenceExcellent ValueDose: 30-60 minutes exercise, 2-3 times/week

Find Trials

Comparative Safety Scale(Higher is safer)

Cyanide☠️

Meth💀

Cigarettes🚬

Chemo☢️

Alcohol🍺

Morphine💊

Antibiotics💉

Tylenol💊

Exercise🏃

Water💧

DangerousModerateSafe

Time to Effect

2-3 months

Duration

6-12 weeks (requires maintenance)

Response Rate

85%

Remission Rate

Number Needed to Treat (NNT)

Common Side Effects:

Muscle soreness: 20%

Fatigue: 10%

Joint pain: 5%

Annual Cost of Care

Drug Cost

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

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

Find Trials

Comparative Safety Scale(Higher is safer)

Cyanide☠️

Meth💀

Cigarettes🚬

Chemo☢️

Alcohol🍺

Morphine💊

Antibiotics💉

Tylenol💊

Exercise🏃

Water💧

DangerousModerateSafe

Time to Effect

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

Duration

Lifetime

Response Rate

70%

Remission Rate

Number Needed to Treat (NNT)

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

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

Find Trials

Comparative Safety Scale(Higher is safer)

Cyanide☠️

Meth💀

Cigarettes🚬

Chemo☢️

Alcohol🍺

Morphine💊

Antibiotics💉

Tylenol💊

Exercise🏃

Water💧

DangerousModerateSafe

Time to Effect

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

Duration

Lifetime

Response Rate

70%

Remission Rate

Number Needed to Treat (NNT)

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

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

Find Trials

Comparative Safety Scale(Higher is safer)

Cyanide☠️

Meth💀

Cigarettes🚬

Chemo☢️

Alcohol🍺

Morphine💊

Antibiotics💉

Tylenol💊

Exercise🏃

Water💧

DangerousModerateSafe

Time to Effect

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

Duration

Lifetime

Response Rate

60%

Remission Rate

Number Needed to Treat (NNT)

Number Needed to Harm (NNH)

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

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

Find Trials

Comparative Safety Scale(Higher is safer)

Cyanide☠️

Meth💀

Cigarettes🚬

Chemo☢️

Alcohol🍺

Morphine💊

Antibiotics💉

Tylenol💊

Exercise🏃

Water💧

DangerousModerateSafe

Time to Effect

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

Duration

Lifetime

Response Rate

60%

Remission Rate

Number Needed to Treat (NNT)

Number Needed to Harm (NNH)

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

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💧

DangerousModerateSafe

Time to Effect

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

Duration

Lifetime

Response Rate

75%

Remission Rate

Number Needed to Treat (NNT)

Number Needed to Harm (NNH)

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

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💧

DangerousModerateSafe

Time to Effect

Weeks-months (exacerbation reduction)

Duration

Lifetime

Response Rate

50%

Remission Rate

Number Needed to Treat (NNT)

Number Needed to Harm (NNH)

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