Delphi Consensus on the Management of COPD Exacerbation Syndrome in Inpatient and Outpatient Settings

Abstract

Introduction

COPD is a respiratory condition characterized by chronic airflow limitation. Exacerbations are an acute worsening of the symptoms. The objective of this study was to achieve a consensus on the management of COPD exacerbation syndrome in inpatient and outpatient settings.

Material and methods

A committee of experts developed a 60-item questionnaire to be agreed by a panel of experts, categorized into seven sections.

Results

After two rounds, consensus was reached on 81.7% of the items. Strong consensus (more than 85%) was reached on the importance of implementing protocols to help patients with exacerbations in both outpatient (92.7%) and inpatient (94.3%) settings. Regarding the criteria for hospitalization due to an exacerbation, respondents agreed that they are clearly defined (75.5%). Regarding bronchodilator use for CES, the only statement that did not achieve agreement was whether there are clinical differences between the use of nebulized rescue bronchodilators and pressurized metered-dose inhalers (pMDIs) with a spacer. Regarding CES treatment in the outpatient setting, consensus was reached for almost all statements, in contrast to what was found for inpatient treatment. Respondents disagreed with the statement that the use of SABA should be accompanied by the discontinuation of LAMAs or LABAs, with or without corticosteroids (74.8%). In the context of a COPD exacerbation requiring hospitalization, inhaled triple therapy should be prescribed (regardless of prior treatment) in the absence of contraindications. Regarding post-discharge protocols and rehabilitation, respondents reached consensus on all statements.

Conclusions

This Delphi consensus study provides valuable insights into the current management of CES, highlighting several areas where consensus remains elusive.