title: Inhaled treatment of COPD: a Delphi consensus statement.
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.
  
  
  OBJECTIVE
  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 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 (FEV1)<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.
  
  
  CONCLUSIONS
  Belgian and European experts recommend long-acting bronchodilators as first-choice treatment. Treatment containing ICS was found only appropriate in patients with FEV1<50% and ≥2 moderate exacerbations or 1 severe exacerbation/year.
authors.affiliation: Department of Respiratory Medicine, Saint-Pierre Hospital, Université Libre de Bruxelles, Brussels.
authors.forename: Vincent
authors.initials: V
authors.lastname: Ninane
authors.affiliation: Department of Respiratory Medicine, CHU, Liege.
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Corhay
authors.affiliation: Department of Respiratory Medicine, AZ Maria Middelares, Ghent.
authors.forename: Paul
authors.initials: P
authors.lastname: Germonpré
authors.affiliation: Department of Respiratory Medicine, Katholieke Universiteit, Leuven.
authors.forename: Wim
authors.initials: W
authors.lastname: Janssens
authors.affiliation: Department of Respiratory Medicine, Ghent University Hospital, Ghent.
authors.forename: Guy F
authors.initials: GF
authors.lastname: Joos
authors.affiliation: Department of Respiratory Medicine, University Hospitals Saint-Luc, Brussels.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Liistro
authors.affiliation: Department of Respiratory Medicine, University Hospital Brussels, Brussels.
authors.forename: Walter
authors.initials: W
authors.lastname: Vincken
authors.affiliation: Medical Department, Novartis Pharma, Vilvoorde, Belgium.
authors.forename: Sandra
authors.initials: S
authors.lastname: Gurdain
authors.affiliation: Medical Department, Novartis Pharma, Vilvoorde, Belgium.
authors.forename: Evelyne
authors.initials: E
authors.lastname: Vanvlasselaer
authors.affiliation: Medical Department, Novartis Pharma, Vilvoorde, Belgium.
authors.forename: An
authors.initials: A
authors.lastname: Lehouck
mesh_terms: D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage* / Q000009:adverse effects; D058666:Adrenergic beta-2 Receptor Agonists / Q000008:administration & dosage* / Q000009:adverse effects; D001530:Belgium; D001993:Bronchodilator Agents / Q000008:administration & dosage* / Q000009:adverse effects; D003697:Delphi Technique; D018450:Disease Progression; D004338:Drug Combinations; D019317:Evidence-Based Medicine; D005541:Forced Expiratory Volume; D006801:Humans; D008168:Lung / Q000187:drug effects* / Q000503:physiopathology; D018727:Muscarinic Antagonists / Q000008:administration & dosage* / Q000009:adverse effects; D018579:Patient Selection; D011237:Predictive Value of Tests; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D058666:Adrenergic beta-2 Receptor Agonists; D001993:Bronchodilator Agents; D004338:Drug Combinations; D018727:Muscarinic Antagonists
keywords: chronic obstructive pulmonary disease; guidelines; inhaled corticosteroids; long acting beta agonist; long acting muscarinic antagonist; therapy