Background: Global Initiative for Chronic Obstructive Lung Disease (GOLD) global strategy (2015) provides guidance for the treatment of chronic obstructive pulmonary disease (COPD) with different first-choice options per GOLD category without specification.<br />Objectives: To evaluate the level of medical experts' consensus on their preferred first-choice treatment within different COPD categories.<br />Methods: A two-round Delphi Panel consisting of 15 questions was completed by Belgian pulmonologists (n=31) and European (n=10) COPD experts.<br />Results: Good consensus was reached by both expert groups for long-acting bronchodilators instead of short-acting bronchodilators as first-choice treatment in GOLD A. Single bronchodilation with long-acting muscarinic antagonist (LAMA) was preferred over long-acting β2-agonist (LABA) and LABA/LAMA as first-choice treatment in GOLD B and GOLD C. For GOLD D patients based on the forced expiratory volume in 1 second (FEV <subscript>1</subscript> )<50%, a very good consensus was reached for LAMA/LABA as first-choice treatment. For GOLD D patients based on frequent or severe exacerbations, there was a good consensus for LABA/LAMA/inhaled corticosteroids (ICS) as first choice in the Belgian group. According to the European experts, both LABA/LAMA and LABA/LAMA/ICS could be the first choice for these patients.<br />Conclusion: Belgian and European experts recommend long-acting bronchodilators as first-choice treatment. Treatment containing ICS was found only appropriate in patients with FEV <subscript>1</subscript> <50% and ≥2 moderate exacerbations or 1 severe exacerbation/year.<br />Competing Interests: Disclosure VN has been on advisory boards for GlaxoSmithKline (GSK), AstraZeneca (AZ), Novartis (N), and Boehringer Ingelheim (BI). PG received fees for attending advisory board from N, AZ, GSK, and BI. He also received educational grant from Chiesi (C). WJ has been on advisory boards and has accepted lecture fees from GSK, AZ, N, C and BI. GFJ has been on advisory boards or has accepted fees for lecture from GSK, AZ, N, C, BI, Mundipharma, Sandoz and Teva. GL has been on advisory boards for N, BI, and C. WV has been on advisory board for N, GSK, AZ, BI, and C including travel expenses from BI. SG, and EV are both employees of N. JLC and AL declared no conflicts of interest. The authors report no other conflicts of interest in this work.
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{"article_title":"Inhaled treatment of COPD: a Delphi consensus statement.","author":"Ninane V, Corhay JL, Germonpr\u00e9 P, Janssens W, Joos GF, Liistro G, Vincken W, Gurdain S, Vanvlasselaer E, Lehouck A","journal_title":"International journal of chronic obstructive pulmonary disease","issn":"1178-2005","isbn":"","publication_date":"2017-03-06","volume":"12","issue":"","first_page":"793","page_count":"","accession_number":"28293106","doi":"","publisher":"DOVE Medical Press","doctype":"Journal Article","subjects":"Adrenal Cortex Hormones administration & dosage; Adrenergic beta-2 Receptor Agonists administration & dosage; Bronchodilator Agents administration & dosage; Delphi Technique; Lung drug effects; Muscarinic Antagonists administration & dosage; Pulmonary Disease, Chronic Obstructive drug therapy; Administration, Inhalation; Adrenal Cortex Hormones adverse effects; Adrenergic beta-2 Receptor Agonists adverse effects; Belgium; Bronchodilator Agents adverse effects; Consensus; Disease Progression; Drug Combinations; Evidence-Based Medicine; Forced Expiratory Volume; Humans; Lung physiopathology; Muscarinic Antagonists adverse effects; Patient Selection; Predictive Value of Tests; Pulmonary Disease, Chronic Obstructive diagnosis; Pulmonary Disease, Chronic Obstructive physiopathology; Risk Factors; Time Factors; Treatment Outcome","interest_area":["Pulmonology"],"abstract":"Background: Global Initiative for Chronic Obstructive Lung Disease (GOLD) global strategy (2015) provides guidance for the treatment of chronic obstructive pulmonary disease (COPD) with different first-choice options per GOLD category without specification. Objectives: To evaluate the level of medical experts' consensus on their preferred first-choice treatment within different COPD categories. Methods: A two-round Delphi Panel consisting of 15 questions was completed by Belgian pulmonologists (n=31) and European (n=10) COPD experts. Results: Good consensus was reached by both expert groups for long-acting bronchodilators instead of short-acting bronchodilators as first-choice treatment in GOLD A. Single bronchodilation with long-acting muscarinic antagonist (LAMA) was preferred over long-acting \u03b22-agonist (LABA) and LABA\/LAMA as first-choice treatment in GOLD B and GOLD C. For GOLD D patients based on the forced expiratory volume in 1 second (FEV 1 )<50%, a very good consensus was reached for LAMA\/LABA as first-choice treatment. For GOLD D patients based on frequent or severe exacerbations, there was a good consensus for LABA\/LAMA\/inhaled corticosteroids (ICS) as first choice in the Belgian group. According to the European experts, both LABA\/LAMA and LABA\/LAMA\/ICS could be the first choice for these patients. Conclusion: Belgian and European experts recommend long-acting bronchodilators as first-choice treatment. Treatment containing ICS was found only appropriate in patients with FEV 1 <50% and \u22652 moderate exacerbations or 1 severe exacerbation\/year. Competing Interests: Disclosure VN has been on advisory boards for GlaxoSmithKline (GSK), AstraZeneca (AZ), Novartis (N), and Boehringer Ingelheim (BI). PG received fees for attending advisory board from N, AZ, GSK, and BI. He also received educational grant from Chiesi (C). WJ has been on advisory boards and has accepted lecture fees from GSK, AZ, N, C and BI. GFJ has been on advisory boards or has accepted fees for lecture from GSK, AZ, N, C, BI, Mundipharma, Sandoz and Teva. GL has been on advisory boards for N, BI, and C. WV has been on advisory board for N, GSK, AZ, BI, and C including travel expenses from BI. SG, and EV are both employees of N. JLC and AL declared no conflicts of interest. The authors report no other conflicts of interest in this work.","url":"https:\/\/search.ebscohost.com\/login.aspx?direct=true&db=mdl&AN=28293106","isPdfLink":true,"isSAML":false,"an":"28293106","number_other":"","type_pub":"","issn_electronic":"1178-2005","languages":"English","language":"eng","date_entry":"","date_update":"","titleSource":"International journal of chronic obstructive pulmonary disease [Int J Chron Obstruct Pulmon Dis] 2017 Mar 06; Vol. 12, pp. 793-801. Date of Electronic Publication: 2017 Mar 06 (Print Publication: 2017).","date_pub_cy":"","type_document":"","contract_publisher":"","authored_on":"2017-03-06","description":"Background: Global Initiative for Chronic Obstructive Lung Disease (GOLD) global strategy (2015) provides guidance for the treatment of chronic obstructive pulmonary disease (COPD) with different first-choice options per GOLD category without specification.<br \/>Objectives: To evaluate the level of medical experts' consensus on their preferred first-choice treatment within different COPD categories.<br \/>Methods: A two-round Delphi Panel consisting of 15 questions was completed by Belgian pulmonologists (n=31) and European (n=10) COPD experts.<br \/>Results: Good consensus was reached by both expert groups for long-acting bronchodilators instead of short-acting bronchodilators as first-choice treatment in GOLD A. Single bronchodilation with long-acting muscarinic antagonist (LAMA) was preferred over long-acting \u03b22-agonist (LABA) and LABA\/LAMA as first-choice treatment in GOLD B and GOLD C. For GOLD D patients based on the forced expiratory volume in 1 second (FEV <subscript>1<\/subscript> )<50%, a very good consensus was reached for LAMA\/LABA as first-choice treatment. For GOLD D patients based on frequent or severe exacerbations, there was a good consensus for LABA\/LAMA\/inhaled corticosteroids (ICS) as first choice in the Belgian group. According to the European experts, both LABA\/LAMA and LABA\/LAMA\/ICS could be the first choice for these patients.<br \/>Conclusion: Belgian and European experts recommend long-acting bronchodilators as first-choice treatment. Treatment containing ICS was found only appropriate in patients with FEV <subscript>1<\/subscript> <50% and \u22652 moderate exacerbations or 1 severe exacerbation\/year.<br \/>Competing Interests: Disclosure VN has been on advisory boards for GlaxoSmithKline (GSK), AstraZeneca (AZ), Novartis (N), and Boehringer Ingelheim (BI). PG received fees for attending advisory board from N, AZ, GSK, and BI. He also received educational grant from Chiesi (C). WJ has been on advisory boards and has accepted lecture fees from GSK, AZ, N, C and BI. GFJ has been on advisory boards or has accepted fees for lecture from GSK, AZ, N, C, BI, Mundipharma, Sandoz and Teva. GL has been on advisory boards for N, BI, and C. WV has been on advisory board for N, GSK, AZ, BI, and C including travel expenses from BI. SG, and EV are both employees of N. JLC and AL declared no conflicts of interest. The authors report no other conflicts of interest in this work.","upload_link":"https:\/\/search.ebscohost.com\/login.aspx?direct=true&site=eds-live&db=mdl&AN=28293106&authtype=shib&custid=ns346513&group=main&profile=eds","no_of_pages":"","authored_by":"Ninane V, Corhay JL, Germonpr\u00e9 P, Janssens W, Joos GF, Liistro G, Vincken W, Gurdain S, Vanvlasselaer E, Lehouck A","header":{"DbId":"mdl","DbLabel":"MEDLINE Ultimate","An":"28293106","RelevancyScore":"817","PubType":"Academic Journal","PubTypeId":"academicJournal","PreciseRelevancyScore":"816.907775878906"},"plink":"https:\/\/search.ebscohost.com\/login.aspx?direct=true&site=eds-live&db=mdl&AN=28293106&authtype=shib&custid=ns346513&group=main&profile=eds","physicalDescription":{"Pagination":{"StartPage":"793"}},"additionalInfo":{"Authored_By":"Ninane V, Corhay JL, Germonpr\u00e9 P, Janssens W, Joos GF, Liistro G, Vincken W, Gurdain S, Vanvlasselaer E, Lehouck A","Journal_Info":"Publisher: DOVE Medical Press Country of Publication: New Zealand NLM ID: 101273481 Publication Model: eCollection Cited Medium: Internet ISSN: 1178-2005 (Electronic) Linking ISSN: 11769106 NLM ISO Abbreviation: Int J Chron Obstruct Pulmon Dis Subsets: MEDLINE","Publication_Type":"Journal Article; Practice Guideline","Published_Date":"2017-03-06","Source":"International journal of chronic obstructive pulmonary disease [Int J Chron Obstruct Pulmon Dis] 2017 Mar 06; Vol. 12, pp. 793-801. Date of Electronic Publication: 2017 Mar 06 (Print Publication: 2017).","Languages":"English","Electronic_ISSN":"1178-2005","MeSH_Terms":"Delphi Technique*, Adrenal Cortex Hormones\/*administration & dosage , Adrenergic beta-2 Receptor Agonists\/*administration & dosage , Bronchodilator Agents\/*administration & dosage , Lung\/*drug effects , Muscarinic Antagonists\/*administration & dosage , Pulmonary Disease, Chronic Obstructive\/*drug therapy, Administration, Inhalation ; Adrenal Cortex Hormones\/adverse effects ; Adrenergic beta-2 Receptor Agonists\/adverse effects ; Belgium ; Bronchodilator Agents\/adverse effects ; Consensus ; Disease Progression ; Drug Combinations ; Evidence-Based Medicine ; Forced Expiratory Volume ; Humans ; Lung\/physiopathology ; Muscarinic Antagonists\/adverse effects ; Patient Selection ; Predictive Value of Tests ; Pulmonary Disease, Chronic Obstructive\/diagnosis ; Pulmonary Disease, Chronic Obstructive\/physiopathology ; Risk Factors ; Time Factors ; Treatment Outcome","Subjects":"Administration, Inhalation, Adrenal Cortex Hormones adverse effects, Adrenergic beta-2 Receptor Agonists adverse effects, Belgium, Bronchodilator Agents adverse effects, Consensus, Disease Progression, Drug Combinations, Evidence-Based Medicine, Forced Expiratory Volume, Humans, Lung physiopathology, Muscarinic Antagonists adverse effects, Patient Selection, Predictive Value of Tests, Pulmonary Disease, Chronic Obstructive diagnosis, Pulmonary Disease, Chronic Obstructive physiopathology, Risk Factors, Time Factors, Treatment Outcome, Adrenal Cortex Hormones administration & dosage, Adrenergic beta-2 Receptor Agonists administration & dosage, Bronchodilator Agents administration & dosage, Delphi Technique, Lung drug effects, Muscarinic Antagonists administration & dosage, Pulmonary Disease, Chronic Obstructive drug therapy","Title_Abbreviations":"International journal of chronic obstructive pulmonary disease","Volume":"12"}}
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["Ninane V, Corhay JL, Germonpr\u00e9 P, Janssens W, Joos GF, Liistro G, Vincken W, Gurdain S, Vanvlasselaer E, Lehouck A","Publisher: DOVE Medical Press Country of Publication: New Zealand NLM ID: 101273481 Publication Model: eCollection Cited Medium: Internet ISSN: 1178-2005 (Electronic) Linking ISSN: 11769106 NLM ISO Abbreviation: Int J Chron Obstruct Pulmon Dis Subsets: MEDLINE","Journal Article; Practice Guideline","2017-03-06","International journal of chronic obstructive pulmonary disease [Int J Chron Obstruct Pulmon Dis] 2017 Mar 06; Vol. 12, pp. 793-801. Date of Electronic Publication: 2017 Mar 06 (Print Publication: 2017).","English","1178-2005","Delphi Technique*, Adrenal Cortex Hormones\/*administration & dosage , Adrenergic beta-2 Receptor Agonists\/*administration & dosage , Bronchodilator Agents\/*administration & dosage , Lung\/*drug effects , Muscarinic Antagonists\/*administration & dosage , Pulmonary Disease, Chronic Obstructive\/*drug therapy, Administration, Inhalation ; Adrenal Cortex Hormones\/adverse effects ; Adrenergic beta-2 Receptor Agonists\/adverse effects ; Belgium ; Bronchodilator Agents\/adverse effects ; Consensus ; Disease Progression ; Drug Combinations ; Evidence-Based Medicine ; Forced Expiratory Volume ; Humans ; Lung\/physiopathology ; Muscarinic Antagonists\/adverse effects ; Patient Selection ; Predictive Value of Tests ; Pulmonary Disease, Chronic Obstructive\/diagnosis ; Pulmonary Disease, Chronic Obstructive\/physiopathology ; Risk Factors ; Time Factors ; Treatment Outcome","Administration, Inhalation, Adrenal Cortex Hormones adverse effects, Adrenergic beta-2 Receptor Agonists adverse effects, Belgium, Bronchodilator Agents adverse effects, Consensus, Disease Progression, Drug Combinations, Evidence-Based Medicine, Forced Expiratory Volume, Humans, Lung physiopathology, Muscarinic Antagonists adverse effects, Patient Selection, Predictive Value of Tests, Pulmonary Disease, Chronic Obstructive diagnosis, Pulmonary Disease, Chronic Obstructive physiopathology, Risk Factors, Time Factors, Treatment Outcome, Adrenal Cortex Hormones administration & dosage, Adrenergic beta-2 Receptor Agonists administration & dosage, Bronchodilator Agents administration & dosage, Delphi Technique, Lung drug effects, Muscarinic Antagonists administration & dosage, Pulmonary Disease, Chronic Obstructive drug therapy","International journal of chronic obstructive pulmonary disease","12"]
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