Which intervention has been shown to decrease mortality and improve survival in COPD?

• A. Bronchodilator therapy
• B. Pulmonary rehabilitation
• C. Oral glucocorticosteroids
• D. Smoking cessation

Answer: (D)

Stopping smoking targets the driving force of COPD progression. Ongoing tobacco exposure accelerates lung function decline and fuels cardiovascular disease, lung cancer, and infections, all of which contribute to mortality. When patients quit, the pace of lung function decline slows and the risks of COPD exacerbations, cardiovascular events, and other smoking-related deaths decrease, leading to improved overall survival compared with continuing to smoke.

Bronchodilator therapy and pulmonary rehabilitation primarily improve symptoms, exercise tolerance, and quality of life, and they can reduce hospitalizations, but their effects on mortality are not as clearly demonstrated across major trials. Long-term oral glucocorticoids carry significant adverse effects and have not shown a mortality benefit. Therefore, quitting smoking is the intervention most consistently shown to decrease mortality and improve survival in COPD.