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Abstract：
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.
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%.
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.
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.
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%.
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.
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.
摘要：
尽管临床试验提供了证据，关于三联吸入疗法的使用存在一些不确定性和争议.为了评估专门呼吸单位的临床实践，在西班牙使用1年后实施了一项关于使用单一吸入器固定剂量三联疗法的Delphi共识文件.
COPD专家科学委员会定义了一个主题指数，指导了系统的文献综述，并帮助设计了德尔菲问卷。这是在2019年4月至6月期间发送给其他45名COPD专家的。使用李克特量表分两轮测试了对58项陈述的同意/分歧。当≥80％的小组成员同意时，答复被归类为共识；当达到≥66％的同意程度时，答复被归类为多数；如果协议<66％，则存在分歧。
两轮过后,44.44%的声明达成共识,14.81%达到多数，40.74%出现分歧。小组成员一致认为，从双重支气管扩张升级应基于表型，旨在防止恶化，但不是为了改善症状。在吸入型皮质类固醇组合中添加抗毒蕈碱药物可改善肺功能，症状和恶化预防。主要的安全问题包括与支气管扩张剂治疗相比，肺炎的风险增加，具有类似的心血管效应。根据血液嗜酸性粒细胞计数或阻塞严重程度，对患者类型的反应没有达成共识。
小组成员的共识程度低可能反映了严重COPD管理的复杂性。此处提供的信息可能对为COPD患者实施个性化医疗的临床医生有用。
COPD专家科学委员会定义了一个主题指数，指导了系统的文献综述，并帮助设计了德尔菲问卷。这是在2019年4月至6月期间发送给其他45名COPD专家的。使用李克特量表分两轮测试了对58项陈述的同意/分歧。当≥80％的小组成员同意时，答复被归类为共识；当达到≥66％的同意程度时，答复被归类为多数；如果协议<66％，则存在分歧。
两轮过后,44.44%的声明达成共识,14.81%达到多数，40.74%出现分歧。小组成员一致认为，从双重支气管扩张升级应基于表型，旨在防止恶化，但不是为了改善症状。在吸入型皮质类固醇组合中添加抗毒蕈碱药物可改善肺功能，症状和恶化预防。主要的安全问题包括与支气管扩张剂治疗相比，肺炎的风险增加，具有类似的心血管效应。根据血液嗜酸性粒细胞计数或阻塞严重程度，对患者类型的反应没有达成共识。
小组成员的共识程度低可能反映了严重COPD管理的复杂性。此处提供的信息可能对为COPD患者实施个性化医疗的临床医生有用。
