2026-07-21T11:48:50Zhttps://repisalud.isciii.es/rest/oai/request

oai:repisalud.isciii.es:20.500.12105/228792024-11-28T16:52:56Zcom_20.500.12105_15322com_20.500.12105_2051col_20.500.12105_16958col_20.500.12105_16967

00925njm 22002777a 4500 dc Lopez-Campos, Jose Luis author Alcazar Navarrete, Bernardino author Riesco Miranda, Juan Antonio author García-Cosío, Borja author de-Torres, Juan P author Celli, Bartolome author Jimenez-Ruiz, Carlos A author Casanova Macario, Ciro author 2020 Introduction: Despite the evidence provided by clinical trials, there are some uncertainties and controversies regarding the use of triple inhaled therapy. With the aim of evaluating clinical practice in specialized respiratory units, a Delphi consensus document was implemented on the use of single-inhaler fixed-dose triple therapies after 1 year of use in Spain. Methods: A scientific committee of COPD experts defined a thematic index, guided a systematic literature review and helped design the Delphi questionnaire. This was sent to the other 45 COPD experts between April and June 2019. Agreement/disagreement on 58 statements was tested in two rounds using a Likert scale. Replies were classified as a consensus when >= 80% of the panelists agreed; a majority when a degree of agreement of >= 66% was reached; and divergence if agreement was <66%. Results: After two rounds, 44.44% of the statements reached consensus, 14.81% reached majority and 40.74% were divergent. Panelists agreed that escalating from double bronchodilation should be phenotype-based and aim to prevent exacerbations but not for improving symptoms. The addition of an antimuscarinic to inhaled corticosteroids combinations achieves improvement in lung function, symptoms and exacerbation prevention. Main safety concerns included the increased risk of pneumonia as compared to bronchodilator therapies, with similar cardiovascular effects. There was no consensus agreement on patient type response based on blood eosinophil counts or obstruction severity. Conclusion: The low degree of consensus among panelists may reflect the complexity of severe COPD management. The information provided here may be useful to clinicians implementing personalized medicine for COPD patients. Lopez-Campos JL, Alcazar Navarrete B, Riesco Miranda JA, Cosio BG, De-Torres JP, Celli B, et al. A Delphi Consensus Document on the Use of Single-Inhaler Fixed-Dose Triple Therapies in COPD Patients. Int J Chronic Obstr Pulm Dis. 2020;15:1801-11. 10.2147/COPD.S258818 1178-2005 International Journal of Chronic Obstructive Pulmonary Disease http://hdl.handle.net/20.500.13003/17135 32884252 L2004801229 2-s2.0-85089176334 https://hdl.handle.net/20.500.12105/22879 552274600001 Chronic obstructive pulmonary disease LABA/LAMA LABA/ICS Bronchodilator agents Inhaled corticosteroids Triple therapy Statements Delphi consensus A Delphi Consensus Document on the Use of Single-Inhaler Fixed-Dose Triple Therapies in COPD Patients