Management of the COPD Patient with Comorbidities: An Experts Recommendation Document

Abstract

Background

Chronic obstructive pulmonary disease (COPD) is associated with multiple comorbidities, which impact negatively on patients and are often underdiagnosed, thus lacking a proper management due to the absence of clear guidelines.

Purpose

To elaborate expert recommendations aimed to help healthcare professionals to provide the right care for treating COPD patients with comorbidities.

Methods

A modified RAND-UCLA appropriateness method consisting of nominal groups to draw up consensus recommendations (6 Spanish experts) and 2-Delphi rounds to validate them (23 Spanish experts) was performed.

Results

A panel of Spanish internal medicine experts reached consensus on 73 recommendations and 81 conclusions on the clinical consequences of the presence of comorbidities. In general, the experts reached consensus on the issues raised with regard to cardiovascular comorbidity and metabolic disorders. Consensus was reached on the use of selective serotonin reuptake inhibitors in cases of depression and the usefulness of referring patients with anxiety to respiratory rehabilitation programmes. The results also showed consensus on the usefulness of investigating the quality of sleep, the treatment of pain with opioids and the evaluation of osteoporosis by lateral chest radiography.

Conclusion

This study provides conclusions and recommendations that are intended to improve the management of the complexity of patients with COPD and important comorbidities, usually excluded from clinical trials.

Keywords:

• chronic obstructive pulmonary disease
• COPD
• comorbidities
• modified RAND-UCLA
• Delphi technique

Acknowledgments

The authors would like to thank Heather Hamilton, specialized biomedical translator, for her translation of the manuscript into English. The authors would like to thank Boehringer Ingelheim for their continued and constant support for this project, and GOC Networking team for their support and collaboration in the development of this document and for editorial assistance. The authors would also like to thank the 23 experts who participated in the Delphi process for the validation of the conclusions and recommendations prepared by the RPG: Dr. Fernando Javier Sánchez Lora (Hospital Virgen de la Victoria, Malaga); Dr. Jesús Castiella Herrero (Hospital Fundación de Calahorra, La Rioja), Dr. Joaquín Antón Martínez (Hospital San Pedro Alcántara, Cáceres); Dr. Manuel Jesús Menduiña Guillén (Hospital Clínico San Cecilio, Granada); Dr. José Portillo Sánchez (Hospital General De Ciudad Real, Ciudad Real); Dr. Ramón Boixeda i Viu (Hospital De Mataró, Barcelona); Dr. Xoel Pena Pérez (Hospital Sant Joan De Deu, Barcelona); Dr. Elena Zubillaga Azpiroz (Hospital De Zumárraga, Guipúzcoa); Dr. María del Carmen Romero Pérez (Hospital Severo Ochoa, Madrid); Dr. María Gómez Antúnez (Hospital Gregorio Marañón, Madrid); Dr. Mercedes Racionero Moreno (Hospital Virgen De La Luz, Cuenca); Dr. Núria Galofré Álvaro (Hospital Municipal de Badalona, Barcelona); Dr. Olga H. Torres Bonafonte (Hospital Santa Creu i Sant Pau, Barcelona); Dr. Meritxell Salvadó Soro (Hospital de Mollet, Barcelona); Dr. Jorge Cabello Carro (Hospital Clínico San Carlos, Madrid); Dr. Robert Hurtado García (Hospital de la Vega Baja de Orihuela, Alicante); Dr. Lorena Montero Rivas (Hospital Infanta Margarita De Cabra, Córdoba); Dr. María Luz Calero Bernal (Hospital de San Juan de Dios de Bormujos, Seville); Dr. Pilar Martínez Heras (Hospital Miguel Servet, Zaragoza); Dr. José Luis Fernández Reyes (Complejo Hospitalario de Jaén, Jaén); Dr. María Belén Alonso Ortiz (Hospital Juan Negrín, Las Palmas de Gran Canaria); Dr. Carlos Trescolí* (Hospital de la Ribera, Valencia), and Dr. Enrique Peral Gutiérrez de Ceballos* (Hospital Virgen de la Macarena, Seville) *These panelists only participated in the first of the 2 Delphi rounds.

Author Contributions

All the authors of this document made substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; took part in drafting the article or revising it critically for important intellectual content; gave final approval of the version to be published; and agree to be accountable for all aspects of the work.

Disclosure

Jesús Recio Iglesias has received speaker or consulting fees from Boehringer Ingelheim, Chiesi, Ferrer and Novartis unrelated to this manuscript. Jesús Díez Manglano has received speaker or consulting fees from Bayer, Bristol-Myers-Squibb, Chiesi, and Novartis unrelated to this manuscript. Francisco López García has received speaker or consulting fees from Boehringer Ingelheim, Chiesi, GSK and Novartis unrelated to this manuscript. José Antonio Díaz Peromingo has received speaker or clinical trials fees from Boehringer, Chiesi, Bayer, Bristol, Novartis, Faes, GSK and Sanofi. Pere Almagro Mena has received grants from Astra Zeneca and SEPAR, personal fees from Chiesi, Boehringer Ingelheim and GSK and travel support from Rovi and Esteve, outside the submitted work. Jose Manuel Varela Aguilar has received speaker or consulting fees from Astra Zeneca, Boehringer Ingelheim, Chiesi, GSK, Menarini, Novartis, Novo Nordisk and Rovi. The authors report no other conflicts of interest in this work.