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Publications

Journal Article Ahead of print

PubMed: 42885566 DOI: 10.1093/annalsats/aaoag305

A Proposed Consensus Definition of Severe COPD: a modified Delphi Study.

Ann Am Thorac Soc

Authors: Mireille C Melles, Marlies van Dijk, Marieke L Duiverman, Frits M E Franssen, Merel E Hellemons, Daisy J A Janssen, Pascale M G A Lubbers-van Tuyn, Dirk-Jan Slebos, Alvar Agustí, Selim M Arcasoy, Surya P Bhatt, Folkert Brijker, Guy G Brusselle, Bartolome R Celli, Laurens J Ceulemans, Gerard J Criner, Michael Dreher, Leonardo M Fabbri, Mark Greer, Nicholas Hart, Anne E Holland, Nicholas Hopkinson, John R Hurst, Alvin J Ing, Wim Janssens, Huib A M Kerstjens, Janwillem W H Kocks, Coenraad F N Koegelenberg, Thérèse S Lapperre, Carli J Lehr, Federica Meloni, Masamichi Mineshita, Marc Miravitlles, Kris Mooren, Parameswaran K Nair, Hugo G de Oliveira, Hilary Pinnock, Fabio Pitta, Claudio Rabec, Nicolas Roche, Richard E K Russell, Sami O Simons, Dave Singh, Daiana Stolz, Jørgen Vestbo, Claus F Vogelmeier, Robin Vos, Wolfram Windisch, Emily F A van 't Wout, Johannes C C M In 't Veen … and 1 other author

Affiliations

  • University of Groningen, University Medical Center Groningen, department of Pulmonary Diseases and Tuberculosis, Groningen, the Netherlands; Groningen Research Institute of Asthma and COPD (GRIAC), University of Groningen, Groningen, the Netherlands; Department of Respiratory Diseases, STZ Centre of Excellence for Asthma, COPD & Respiratory Allergy, Franciscus Hospital, Rotterdam, the Netherlands.
  • University of Groningen, University Medical Center Groningen, department of Pulmonary Diseases and Tuberculosis, Groningen, the Netherlands; Groningen Research Institute of Asthma and COPD (GRIAC), University of Groningen, Groningen, the Netherlands.
  • Department of Research & Development, Ciro, Horn, the Netherlands; Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, the Netherlands.
  • Department of Respiratory Medicine and Transplantation Institute, Erasmus University Medical Center, Rotterdam, the Netherlands.
  • Department of Research & Development, Ciro, Horn, the Netherlands; Department of Health Services Research and Department of Family Medicine, Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands; Department of Expertise and Treatment, Proteion, Horn, the Netherlands.
  • Longfonds, Amersfoort, the Netherlands.
  • Medicine Department, University of Barcelona, Barcelona, Spain; Respiratory Institute, Clinic Barcelona, Barcelona, Spain; FCRB-IDIBAPS, Barcelona, Spain; CIBERES, Madrid, Spain.
  • Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York, USA.
  • Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, USA; Center for Lung Analytics and Imaging Research, University of Alabama at Birmingham, Birmingham, USA.
  • Department of Pulmonary Medicine, Spaarne Gasthuis, Haarlem, the Netherlands.
  • Department of Respiratory Medicine, University Hospital Ghent, Ghent, Belgium; Department of Respiratory Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands.
  • Director Clinical Research Foundation, Boston, Massachusetts, USA.
  • Respiratory Division, University Hospitals Leuven, Leuven, Belgium; Laboratory of Respiratory Diseases and Thoracic Surgery, KU Leuven, Leuven, Belgium.
  • Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, USA.
  • Department of Pneumonology and Intensive Care Medicine, University Hospital Aachen, Aachen, Germany.
  • Section of Respiratory Medicine, Department of Translational Medicine, University of Ferrara, Ferrara, Italy.
  • Department of Respiratory Medicine and Infectious Diseases, Hannover Medical School, Hannover, Germany.
  • Lane Fox Clinical Respiratory Physiology Research Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK; Centre for Human and Applied Physiological Sciences, King's College London, UK.
  • Respiratory Research@Alfred, School of Translational Medicine, Monash University, Melbourne, Australia; Institute for Breathing and Sleep, Melbourne, Australia; Department of Physiotherapy, Alfred Health, Melbourne, Australia.
  • National Heart and Lung Institute, Imperial College, Royal Brompton Hospital Campus, London, UK.
  • UCL Respiratory, University College London, London, UK.
  • Macquarie University, Faculty of Medicine, Health and Human Sciences, Sydney, New South Wales, Australia.
  • General Practitioners Research Institute, Groningen, the Netherlands; Observational and Pragmatic Research Institute, Singapore, Singapore; Groningen Research Institute of Asthma and COPD (GRIAC), University of Groningen, Groningen, the Netherlands; University of Groningen, University Medical Center Groningen, department of Pulmonary Diseases and Tuberculosis, Groningen, the Netherlands.
  • Division of Pulmonology, Department of Medicine, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa.
  • Department of Pneumology, Antwerp University Hospital, Edegem, Belgium; Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp, Belgium.
  • Department of Pulmonary and Critical Care Medicine, Integrated Hospital Care Institute, Cleveland Clinic, Cleveland, Ohio, US.
  • Department of Cardio-Thoracic and Vascular Sciences, University of Padova and AOPD, Padua, Italy.
  • Department of Respiratory Diseases, St. Marianna University School of Medicine, Kawasaki, Japan.
  • Pneumology Department, Hospital Universitari Vall d'Hebron; Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.
  • Department of Pulmonary Medicine, Spaarne Gasthuis, Haarlem, The Netherlands.
  • Firestone Institute for Respiratory Health, St Joseph's Healthcare Hamilton, Hamilton, Canada; Department of Medicine, Division of Respirology, McMaster University, Hamilton, Canada.
  • Pulmonology Service, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Medical School, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.
  • Usher Institute, The University of Edinburgh, Edinburgh, UK.
  • Departamento de Fisioterapia, Laboratório de Pesquisa em Fisioterapia Respiratória (LFIP), Universidade Estadual de Londrina, Londrina, Brasil.
  • Division of Pulmonary Diseases, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland.
  • Service de Pneumologie, Assistance Publique-Hôpitaux de Paris Centre, Université Paris Cité, Hôpital et Institut Cochin, Paris, France.
  • King's Centre for Lung Health, Peter Gorer Department of Immunobiology, King's College London, London, UK.
  • Department of Respiratory Medicine, NUTRIM Institute of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands.
  • Division of Immunology, Immunity to Infection and Respiratory Medicine, The University of Manchester, Manchester, UK; North West Lung Centre, Manchester University NHS Foundation Trust, Manchester, UK; Medicines Evaluation Unit, Wythenshawe, Greater Manchester, UK.
  • Clinic of Respiratory Medicine, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
  • Division of Immunology, Immunity to Infection and Respiratory Medicine, The University of Manchester, Manchester, UK.
  • Department of Medicine, Pulmonary, and Critical Care Medicine, German Center for Lung Research (DZL), University of Marburg, Baldingerstrasse, Marburg, 35033, Marburg, Germany.
  • Department of Pneumology, Kliniken der Stadt Köln gGmbH, University Witten/Herdecke, Cologne, Germany.
  • Department of Pulmonology, Leiden University Medical Center, Leiden, The Netherlands.
  • Department of Respiratory Diseases, STZ Centre of Excellence for Asthma, COPD & Respiratory Allergy, Franciscus Hospital, Rotterdam, the Netherlands.

Abstract

RATIONALE

Advanced interventions are available for patients with more severe COPD despite guideline-recommended therapies, yet this population is heterogeneously defined and inconsistently recognized, and a standardized work-up is lacking, which could lead to mismanagement.

OBJECTIVES

To formulate a new, expert-based consensus definition of severe COPD and a minimal set of diagnostics and characteristics to be assessed in the work-up of these patients.

METHODS

A modified Delphi study with two online rounds was conducted between June 2024 and January 2025 with 55 international COPD experts representing all areas of disease management. Sixty-seven (round 1) and 20 (round 2) statements were tested in seven domains: (A) the need for a definition, (B) symptoms, (C) functional impairment, (D) quality of life, (E) physiological impairment, (F) framework definition, and (G) risk factors. Consensus was defined as ≥ 75% agreement.

RESULTS

Consensus was reached for 46 (69%) statements in round 1 and 15 (75%) in round 2. Among patients with confirmed COPD, severe COPD was defined as: (1) persistent symptoms, functional impairment, or severely reduced quality of life; (2) despite optimal treatment and not due to comorbidities; and (3) including at least one clinical characteristic: severe airflow obstruction, severely impaired diffusion capacity, severe hyperinflation, frequent exacerbations, chronic respiratory insufficiency, pulmonary hypertension related to COPD, or cachexia or unintentional weight loss related to COPD. The proposed standardized work-up comprised: (1) assessment of patient-reported outcomes for symptoms, quality of life, anxiety and depression; (2) assessment of exacerbation frequency and severity; (3) comprehensive diagnostic testing, including lung function testing, blood gas analysis, imaging, cardiac assessment, and exercise-tolerance testing; and (4) assessment of risk factors for more severe and progressive disease.

CONCLUSIONS

Using expert consensus, we devised an internationally-supported, proposed definition and work-up for 'severe COPD', accounting for disease heterogeneity. This definition may improve identification of the population and supports a structured evaluation of this often under-recognized and potentially undertreated population. Future studies are warranted to determine its clinical impact, prognostic value, and utility in research.

MeSH

Research Design, Quality Of Life, Signs And Symptoms, Pulmonary Disease, Chronic Obstructive, Work, Risk Factors, Therapeutics