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

Identificadores del recurso

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.

1178-2005

http://hdl.handle.net/20.500.13003/17135

10.2147/COPD.S258818

32884252

L2004801229

2-s2.0-85089176334

000552274600001

Procedència

(Docusalut. Repositorio institucional del sistema sanitario público de las Islas Baleares)

Fitxa

Títol:: A Delphi Consensus Document on the Use of Single-Inhaler Fixed-Dose Triple Therapies in COPD Patients
Tema:: chronic obstructive pulmonary disease; LABA/LAMA; LABA/ICS; bronchodilator agents; inhaled corticosteroids; triple therapy; statements; Delphi consensus
Descripció:: 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.; The study has been funded by GlaxoSmithKline. The funder has had no role in the conception of the study, the execution of the field work, the collection of information, the analysis of the results, the preparation or approval of the final version of the article, or the decision to publish it.
Idioma:: English
Relació:: https://dx.doi.org/10.2147/COPD.S258818
Autor/Productor:: Luis Lopez-Campos, Jose; Alcazar Navarrete, Bernardino; Riesco Miranda, Juan Antonio; Cosio, Borja G; de-Torres, Juan P.; Celli, Bartolome; Jimenez-Ruiz, Carlos A.; Casanova Macario, Ciro
Editor:: Dove Medical Press Ltd
Drets:: Attribution-NonCommercial 3.0 Unported; https://creativecommons.org/licenses/by-nc/3.0/; open access
Data:: 2021-08-26T06:51:21Z; 2020
Tipo de recurso:: research article

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2. <dc:creator>Luis Lopez-Campos, Jose</dc:creator>
3. <dc:creator>Alcazar Navarrete, Bernardino</dc:creator>
4. <dc:creator>Riesco Miranda, Juan Antonio</dc:creator>
5. <dc:creator>Cosio, Borja G</dc:creator>
6. <dc:creator>de-Torres, Juan P.</dc:creator>
7. <dc:creator>Celli, Bartolome</dc:creator>
8. <dc:creator>Jimenez-Ruiz, Carlos A.</dc:creator>
9. <dc:creator>Casanova Macario, Ciro</dc:creator>
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11. <dc:subject>LABA/LAMA</dc:subject>
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13. <dc:subject>bronchodilator agents</dc:subject>
14. <dc:subject>inhaled corticosteroids</dc:subject>
15. <dc:subject>triple therapy</dc:subject>
16. <dc:subject>statements</dc:subject>
17. <dc:subject>Delphi consensus</dc:subject>
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10. <dcterms:abstract>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.</dcterms:abstract>
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  8. <dc:creator>Jimenez-Ruiz, Carlos A.</dc:creator>
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  10. <dc: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.</dc:description>
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