The sentinel Towards a Revolution in COPD Health (TORCH) trial represented an approach to such an aim. This study, which has been published,[2] examined whether combination therapy (salmeterol/fluticasone propionate combination [SFC]) with a high-dose inhaled steroid (fluticasone) and a long-acting beta2-agonist (salmeterol) could improve survival compared with placebo over 3 years in COPD patients with moderate-to-severe airflow obstruction (forced expiratory volume in 1 second [FEV1] < 60% predicted). The study included 2 additional arms (salmeterol and fluticasone alone) allowing additional prespecified comparisons. The primary results suggested a trend toward improved mortality with SFC compared with placebo (hazard ratio [HR] 0.825, 95% confidence interval [CI] 0.861-1.002; P = .052 after adjustment for 2 interim analyses).

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