A Delphi Consensus Document on the Use of Single-Inhaler Fixed-Dose Triple Therapies in COPD Patients

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-...

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Autores: López-Campos Bodineau, José Luis, Alcázar Navarrete, Bernardino, Riesco Miranda, Juan Antonio, Cosío, Borja G., de Torres, Juan P., Celli, Bartolomé, Jiménez-Ruiz, Carlos A, Casanova Macario, Ciro
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2020
País:España
Institución:Universidad de Sevilla (US)
Repositorio:idUS. Depósito de Investigación de la Universidad de Sevilla
OAI Identifier:oai:idus.us.es:11441/151707
Acceso en línea:https://hdl.handle.net/11441/151707
https://doi.org/10.2147/COPD.S258818
Access Level:acceso abierto
Palabra clave:Chronic obstructive pulmonary disease
Bronchodilator agents
Inhaled corticosteroids
Triple therapy
Statements
Delphi consensus
LABA/LAMA
LABA/ICS
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spelling A Delphi Consensus Document on the Use of Single-Inhaler Fixed-Dose Triple Therapies in COPD PatientsLópez-Campos Bodineau, José Luis Alcázar Navarrete, BernardinoRiesco Miranda, Juan AntonioCosío, Borja G.de Torres, Juan P.Celli, BartoloméJiménez-Ruiz, Carlos ACasanova Macario, CiroChronic obstructive pulmonary diseaseBronchodilator agentsInhaled corticosteroidsTriple therapyStatementsDelphi consensusLABA/LAMALABA/ICSIntroduction: 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.GlaxoSmithKlineDovepressMedicina2020info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfapplication/pdfhttps://hdl.handle.net/11441/151707https://doi.org/10.2147/COPD.S258818reponame:idUS. Depósito de Investigación de la Universidad de Sevillainstname:Universidad de Sevilla (US)InglésInternational Journal of Chronic Obstructive Pulmonary Disease, 15, 1801-1811.info:eu-repo/semantics/openAccessoai:idus.us.es:11441/1517072026-06-17T12:51:07Z
dc.title.none.fl_str_mv A Delphi Consensus Document on the Use of Single-Inhaler Fixed-Dose Triple Therapies in COPD Patients
title A Delphi Consensus Document on the Use of Single-Inhaler Fixed-Dose Triple Therapies in COPD Patients
spellingShingle A Delphi Consensus Document on the Use of Single-Inhaler Fixed-Dose Triple Therapies in COPD Patients
López-Campos Bodineau, José Luis
Chronic obstructive pulmonary disease
Bronchodilator agents
Inhaled corticosteroids
Triple therapy
Statements
Delphi consensus
LABA/LAMA
LABA/ICS
title_short A Delphi Consensus Document on the Use of Single-Inhaler Fixed-Dose Triple Therapies in COPD Patients
title_full A Delphi Consensus Document on the Use of Single-Inhaler Fixed-Dose Triple Therapies in COPD Patients
title_fullStr A Delphi Consensus Document on the Use of Single-Inhaler Fixed-Dose Triple Therapies in COPD Patients
title_full_unstemmed A Delphi Consensus Document on the Use of Single-Inhaler Fixed-Dose Triple Therapies in COPD Patients
title_sort A Delphi Consensus Document on the Use of Single-Inhaler Fixed-Dose Triple Therapies in COPD Patients
dc.creator.none.fl_str_mv López-Campos Bodineau, José Luis
Alcázar Navarrete, Bernardino
Riesco Miranda, Juan Antonio
Cosío, Borja G.
de Torres, Juan P.
Celli, Bartolomé
Jiménez-Ruiz, Carlos A
Casanova Macario, Ciro
author López-Campos Bodineau, José Luis
author_facet López-Campos Bodineau, José Luis
Alcázar Navarrete, Bernardino
Riesco Miranda, Juan Antonio
Cosío, Borja G.
de Torres, Juan P.
Celli, Bartolomé
Jiménez-Ruiz, Carlos A
Casanova Macario, Ciro
author_role author
author2 Alcázar Navarrete, Bernardino
Riesco Miranda, Juan Antonio
Cosío, Borja G.
de Torres, Juan P.
Celli, Bartolomé
Jiménez-Ruiz, Carlos A
Casanova Macario, Ciro
author2_role author
author
author
author
author
author
author
dc.contributor.none.fl_str_mv Medicina
dc.subject.none.fl_str_mv Chronic obstructive pulmonary disease
Bronchodilator agents
Inhaled corticosteroids
Triple therapy
Statements
Delphi consensus
LABA/LAMA
LABA/ICS
topic Chronic obstructive pulmonary disease
Bronchodilator agents
Inhaled corticosteroids
Triple therapy
Statements
Delphi consensus
LABA/LAMA
LABA/ICS
description 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.
publishDate 2020
dc.date.none.fl_str_mv 2020
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://hdl.handle.net/11441/151707
https://doi.org/10.2147/COPD.S258818
url https://hdl.handle.net/11441/151707
https://doi.org/10.2147/COPD.S258818
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv International Journal of Chronic Obstructive Pulmonary Disease, 15, 1801-1811.
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
application/pdf
dc.publisher.none.fl_str_mv Dovepress
publisher.none.fl_str_mv Dovepress
dc.source.none.fl_str_mv reponame:idUS. Depósito de Investigación de la Universidad de Sevilla
instname:Universidad de Sevilla (US)
instname_str Universidad de Sevilla (US)
reponame_str idUS. Depósito de Investigación de la Universidad de Sevilla
collection idUS. Depósito de Investigación de la Universidad de Sevilla
repository.name.fl_str_mv
repository.mail.fl_str_mv
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