The quest for a mortality benefit in chronic obstructive pulmonary disease has been long, and Astrazeneca joined Glaxosmithkline this week in finally claiming victory. The Ethos trial of Breztri Aerosphere was primarily designed to show that the triple therapy could reduce exacerbations, while all-cause mortality was a key secondary measure. Astra said last year that the primary endpoint was hit, and an NEJM publication this week unveiled a 46% reduction in the risk of death in patients treated with Breztri Aerosphere versus Bevespi Aerosphere; the former adds the steroid budesonide to glycopyrronium, a LAMA, and formoterol fumarate, a LABA. Glaxo’s Impact trial has previously demonstrated a 29% reduction in all-cause mortality for its triple versus its double – Trelegy Ellipta and Anoro Ellipta respectively. The FDA refused to approve Breztri Aerosphere last year, requesting more clinical data, and Astra will hope that the Ethos readout fulfils that demand. The company has some way to catch up with Glaxo, which is already on the way to making Trelegy Ellipta a blockbuster. Still, Glaxo's attempts to get the mortality data on Trelegy's label have been frustrated by the Covid-19 pandemic: an advisory committee meeting scheduled for April has been postponed.