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Delphi Consensus on the Management of Patients With Advanced COPD: COPD-Avanz Working Group.
Juan Marco Figueira Gonçalves1, Javier de Miguel Díez2, Bernardino Alcázar Navarrete3
1Servicio de Neumología, Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain.
Open Respiratory Archives
|March 19, 2025
Summary
Experts reached a consensus on defining and managing advanced Chronic Obstructive Pulmonary Disease (COPD). This guidance aids clinicians in identifying and treating patients with severe COPD, improving their quality of life.
Area of Science:
- Pulmonology
- Respiratory Medicine
- Clinical Practice Guidelines
Background:
- Advanced Chronic Obstructive Pulmonary Disease (COPD) requires a multidisciplinary approach for optimal patient management.
- Existing guidelines may not fully address the complexities of advanced COPD care, necessitating expert consensus.
- The Delphi methodology was employed to achieve consensus among a diverse group of specialists.
Purpose of the Study:
- To establish a multidisciplinary consensus on the definition and management of advanced COPD patients.
- To provide clear guidance for clinicians on identifying and treating individuals with severe COPD.
- To address key aspects of advanced COPD care, including dyspnea management, exacerbation prevention, and disease progression.
Main Methods:
- A multidisciplinary expert committee developed a 105-item questionnaire covering advanced COPD definition and management.
- The Delphi methodology involved multiple rounds of expert review and feedback to reach consensus.
- Experts were grouped by specialty: Pneumology, Physiotherapy, Internal Medicine, Physical Medicine and Rehabilitation, Primary Care, and Nursing.
Main Results:
- Consensus was achieved on 77.1% of the items after two rounds of the Delphi process.
- A definition for advanced COPD was agreed upon: FEV1 < 50% with mMRC 3-4, chronic respiratory insufficiency, or limitation in daily living activities.
- Key management agreements included the use of opioids, pulmonary rehabilitation, high-flow/long-term oxygen therapy for dyspnea, comorbidity assessment, and inhaled antibiotics for Pseudomonas aeruginosa.
Conclusions:
- A high degree of expert consensus was reached on the definition and management approach for advanced COPD.
- The established consensus provides valuable information to assist clinicians in identifying and managing advanced COPD patients.
- This expert-driven guidance aims to improve the care and outcomes for individuals suffering from severe COPD.
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