Delphi Consensus on the Management of Patients With Advanced COPD: COPD-Avanz Working Group

To reach a multidisciplinary consensus on the management of patients with advanced COPD using Delphi methodology.

A multidisciplinary committee of experts (Pneumology, Physiotherapy, Internal Medicine, Physical Medicine and Rehabilitation, Primary Care, and Nursing) developed a 105-item questionnaire to be agreed by a panel of experts grouped into the following topics: (1) Definition of advanced COPD patients; (2) Management of dyspnoea in patients with advanced COPD; (3) Prevention and recovery of exacerbation in patients with advanced COPD; and (4) Dealing with disease progression.

After two rounds, consensus was reached on 77.1% of the items. The definition proposed for advanced COPD and agreed by 91.5% of the panellists stated: "COPD patient with FEV₁ < 50% and at least two of the following criteria: dyspnoea mMRC 3-4, chronic respiratory insufficiency, and limitation in basic activities of daily living". Other relevant agreements were: the use of opioids, pulmonary rehabilitation and respiratory physiotherapy, or home high-flow therapy and long-term oxygen therapy for the improvement of dyspnoea; the role of comorbidities assessment; the inclusion of these patients in respiratory rehabilitation programmes; the use of inhaled antibiotic treatment in chronic bronchial infection by Pseudomonas aeruginosa in the prevention and recovery of exacerbations; and the criteria for lung transplantation or augmentation therapy in patients with advanced COPD and severe α1-antitrypsin deficiency.

In this document, a broad panel of experts reached a high degree of consensus on the definition of advanced COPD as well as on its approach. The information provided by this consensus is intended to assist the clinician in the identification of these patients as well as to provide guidance on their management.