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<dc:creator>Alcazar Navarrete, Bernardino</dc:creator>
<dc:creator>Riesco Miranda, Juan Antonio</dc:creator>
<dc:creator>Cosio, Borja G</dc:creator>
<dc:creator>de-Torres, Juan P.</dc:creator>
<dc:creator>Celli, Bartolome</dc:creator>
<dc:creator>Jimenez-Ruiz, Carlos A.</dc:creator>
<dc:creator>Casanova Macario, Ciro</dc:creator>
<dc:subject>chronic obstructive pulmonary disease</dc:subject>
<dc:subject>LABA/LAMA</dc:subject>
<dc:subject>LABA/ICS</dc:subject>
<dc:subject>bronchodilator agents</dc:subject>
<dc:subject>inhaled corticosteroids</dc:subject>
<dc:subject>triple therapy</dc:subject>
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<dc:subject>Delphi consensus</dc:subject>
<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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<dc:creator>Alcazar Navarrete, Bernardino</dc:creator>
<dc:creator>Riesco Miranda, Juan Antonio</dc:creator>
<dc:creator>Cosio, Borja G</dc:creator>
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<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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<field name="value">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.</field>
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<field name="value">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.</field>
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<element name="en">
<field name="value">eng</field>
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<element name="publisher">
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<field name="value">Dove Medical Press Ltd</field>
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<field name="value">Attribution-NonCommercial 3.0 Unported</field>
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<element name="uri">
<element name="*">
<field name="value">https://creativecommons.org/licenses/by-nc/3.0/</field>
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<field name="value">A Delphi Consensus Document on the Use of Single-Inhaler Fixed-Dose Triple Therapies in COPD Patients</field>
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<field name="value">International Journal of Chronic Obstructive Pulmonary Disease</field>
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<element name="page">
<element name="initial">
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<field name="value">1801</field>
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<field name="value">https://dx.doi.org/10.2147/COPD.S258818</field>
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<element name="subject">
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<field name="value">chronic obstructive pulmonary disease</field>
<field name="value">LABA/LAMA</field>
<field name="value">LABA/ICS</field>
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<field name="value">triple therapy</field>
<field name="value">statements</field>
<field name="value">Delphi consensus</field>
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