Absolute benefit measures are essential for guiding therapies in COPD in an era of precision medicine: a viewpoint on “number needed to treat”

Chronic obstructive pulmonary disease (COPD) affects more than 380 million persons worldwide and is the 3rd leading cause of mortality [1, 2]. Most of the morbidity and mortality occur during periods of exacerbations, which are characterized by significant worsening of respiratory symptoms that typically lead to intensification of treatment with bronchodilators, antibiotics, or systemic corticosteroids [3]. Registration agencies such as the US Food and Drug Administration use findings from large Phase III trials, powered on exacerbations and other endpoints such as lung function or health-related quality of life, for approval of new therapeutics for COPD [4]. Notably, healthcare professionals rate exacerbation reduction as the single most important endpoint in their choice of a COPD drug [5].