Clinical Concepts for Triple Therapy Use in Patients with COPD: A Delphi Consensus

Area of Science:

• Pulmonology
• Respiratory Medicine
• Clinical Practice Guidelines

Background:

• Growing evidence supports triple therapy in chronic obstructive pulmonary disease (COPD) management.
• Consensus on optimal use, benefits, and risks of triple therapy remains limited.

Purpose of the Study:

• To achieve expert consensus on the role of triple therapy in COPD management.
• To evaluate effects on exacerbation reduction, early optimization, pneumonia risk, and mortality benefits.

Main Methods:

• A 2-round Delphi survey involving 21 respiratory experts from 10 countries.
• A 31-statement questionnaire assessed using a 9-point Likert scale with a 75% consensus threshold.
• Responses analyzed after online surveys and a participant meeting.

Main Results:

• Consensus reached on mortality benefits, comparable pneumonia risk between single and multiple inhaler triple therapy (SITT/MITT).
• Experts preferred SITT for high eosinophil counts (95%) and early initiation post-hospitalization (86%).
• No consensus on first-line SITT use after initial COPD diagnosis exacerbation.

Conclusions:

• Expert consensus exists on key aspects of triple therapy use and benefits in COPD.
• Further evidence is needed to evaluate the benefits of early triple therapy optimization.