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Inhaled treatment of COPD: a Delphi consensus statement.
Vincent Ninane1, Jean-Louis Corhay2, Paul Germonpré3
1Department of Respiratory Medicine, Saint-Pierre Hospital, Université Libre de Bruxelles, Brussels.
Summary
Experts recommend long-acting bronchodilators as the preferred first-line treatment for chronic obstructive pulmonary disease (COPD) across GOLD categories. Inhaled corticosteroids are reserved for specific severe cases.
Area of Science:
- Pulmonology
- Respiratory Medicine
- Clinical Practice Guidelines
Background:
- The Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy provides COPD treatment guidelines.
- Current guidelines lack specific first-choice treatment recommendations for different COPD categories.
- Expert consensus is needed to refine initial COPD management strategies.
Purpose of the Study:
- To assess expert agreement on preferred first-line COPD treatments within specific GOLD categories.
- To identify consensus-driven adjustments to existing COPD treatment algorithms.
Main Methods:
- A two-round Delphi panel survey was conducted.
- The survey included 15 questions for Belgian pulmonologists (n=31) and European COPD experts (n=10).
Main Results:
- Strong consensus supports long-acting bronchodilators over short-acting ones for GOLD A COPD.
- Long-acting muscarinic antagonists (LAMAs) were preferred over long-acting beta-agonists (LABAs) or LAMA/LABA combinations for GOLD B and C.
- For GOLD D with FEV1<50%, LAMA/LABA showed high consensus; for exacerbations, LABA/LAMA/inhaled corticosteroids (ICS) were favored by Belgian experts, with European experts considering both LABA/LAMA and LABA/LAMA/ICS.
Conclusions:
- Belgian and European experts advocate for long-acting bronchodilators as initial COPD therapy.
- Inhaled corticosteroids (ICS) are recommended only for patients with FEV1<50% and significant exacerbation history (≥2 moderate or 1 severe per year).
