Patients with Chronic Obstructive Pulmonary Disease Exacerbations: Recommendations for Diagnosis, Treatment and Care

• Published in: Archivos de bronconeumología (English ed.) 2019-09, Vol.55 (9), p.478-487
• Main Authors: Alcázar Navarrete, Bernardino, Ancochea Bermúdez, Julio, García-Río, Francisco, Izquierdo Alonso, José Luis, Miravitlles, Marc, Rodríguez González-Moro, José Miguel, Soler-Cataluña, Juan José
• Format: Article
• Language: eng ; spa
• Subjects: Disease Progression; Health Care Surveys; Humans; Practice Guidelines as Topic; Pulmonary Disease, Chronic Obstructive - diagnosis; Pulmonary Disease, Chronic Obstructive - therapy
• ISSN: 1579-2129
• DOI: 10.1016/j.arbres.2019.02.020

To describe an evidence- and experience-based expert consensus on the most relevant issues of patients with COPD exacerbations. The Delphi technique was used. Evidence was reviewed by a scientific committee and 60 experts. A questionnaire was prepared containing 3 sections: diagnosis of the exacerbator; treatment, and healthcare processes. The survey was answered in 2 rounds by 60 pneumologists on an online platform. Statements were scored on a Likert scale from 1 (total disagreement) to 9 (total agreement). Agreement and disagreement were defined as a score of 7-9 or 1-3, respectively, given by more than two thirds of the participants. A total of 48 statements were included, one of which was added in the second round. Consensus was reached in 37 items (78.7%) after the first round (agreement), and in 43 (89.5%) after the second round (42 agreement, 1 disagreement). The statements with the highest proportion of experts agreeing were as follows: in exacerbators, chronic bronchial infection favors lung function decline (93.1%); long-acting bronchodilators should not be withdrawn (93.1%); treatment must be personalized if new exacerbations occur despite optimal bronchodilator treatment (96.6%); management must be coordinated between primary care and the respiratory medicine department (93.1%), and patients must be followed up in specific integrated multicomponent programs (94.8%). The findings of this study could assist in the diagnosis and treatment of COPD exacerbators in our area.