Clinical Concepts for Triple Therapy Use in Patients with COPD: A Delphi Consensus

Figures & data

Figure 1 Survey 1 responses on exacerbation reduction concept and number of exacerbations for triple therapy initiation.

Notes: (a) Overall responses on exacerbation reduction concept (Survey 1). (b) Number of moderate and severe exacerbation for initiation of triple therapy (Survey 1).

Abbreviations: COPD, chronic obstructive pulmonary disease; SD, standard deviation; Max, maximum; Min, minimum.

Figure 2 Survey 1 responses on early optimization concept, blood eosinophil count and benefits of early triple therapy initiation.

Notes: (a) Overall responses on early optimization concept (Survey 1). (b) Responses on blood eosinophil count threshold (Survey 1). (c): Responses on patient population likely to benefit from early initiation of triple therapy (Survey 1).

Abbreviations: COPD, chronic obstructive pulmonary disease; SD, standard deviation; Max, maximum; Min, minimum.

Figure 3 Survey 1 responses on pneumonia risk concept and risk factors for pneumonia.

Notes: (a) Overall responses on pneumonia risk concept (Survey 1). (b) Responses on factors contributing to risk of pneumonia (Survey 1).

Abbreviations: COPD, chronic obstructive pulmonary disease; SD, standard deviation; Max, maximum; Min, minimum.

Table 1 Baseline Characteristics of the COPD Patients That May Be the Risk Factors for Mortality (Mortality Benefit – Q5: What Baseline Characteristics of the COPD Patients Do You Think May Be the Risk Factors for Increased Mortality?)

Risk Factors	Number of Times Reported by Experts	Total
Exacerbations	Frequent exacerbator (8), exacerbations (5), history of hospitalization (3), moderate-to-severe exacerbations (1), previous use of antibiotics and systemic steroids (1), recent hospitalization (1), recurrent exacerbations (1), frequent moderate exacerbation (1), repeated hospital admission (1), moderate exacerbations (1), severe exacerbation (1),	24
Age	Elderly (4), elderly >65 years (2), Age (1), Frailty (1)	8
Low BMI	Low BMI (3), malnutrition (2), low BMI <18 (1), undernutrition (1)	7
Exercise capacity	Exercise capacity (1), impaired exercise capacity (1), low adherence to exercise (1), low VO2 max (1), physical activity capacity (1)	5
COPD severity^a	COPD severity (3), FEV1 (2), poor lung function (2), severe obstruction (2), bronchial obstruction (1), category D (1), COPD gold 3–4 (1), dyspnea MRC 3–4 (1), FEV1 less than 50% (1), FEV1% less than 30% (1), high symptoms burden (1), level of Dyspnea (1), low inspiratory capacity (IC)/total lung capacity (TLC) (1), worsening of dyspnea (1)	19
Pulmonary Treatable Traits	Lung destruction/emphysema (3), oxygen supplementation (3), hypoxemia (2), pulmonary hypertension (2), bronchiectasis (1), level of desaturation or PaO2 (1), advanced airflow limitation with respiratory failure (1)	13
Behavioral Treatable Traits	Smoking (8), socioeconomic factors (2), lack of support net (1), low adherence to treatment (1), lower capacity increased mortality-Failure to follow their medical prescriptions (1), suboptimal treatment (1)	14
Extrapulmonary Treatable Traits	Comorbidities (7), cardiovascular disease (3), cardiac comorbidities (1)	11
Multidimensional risk assessment	High score BODE index^b (1)	1
Other factors	Family history of COPD (1), male gender (1), purulent bronchorrhea (1)	3

Notes: ^aCOPD severity means: GOLD grades and severity of airflow limitation obstruction in COPD) GOLD 1 mild: FEV1: 80% predicted; GOLD 2 moderate: 50% < FEV1 < 80% predicted; GOLD 3 severe: 30% < FEV1 < 50% predicted and GOLD 4 very severe: FEV1 < 30% predicted. ^bThe BODE index, a simple multidimensional grading system, is better than the FEV1 at predicting the risk of death from any cause and from respiratory causes among patients with COPD.²⁴.

Abbreviations: BMI, body mass index; COPD, chronic obstructive pulmonary disease, FEV1, Forced expiratory volume at 1 second, MRC, Medical Research Council, BODE, body-mass index, degree of airway obstruction, dyspnea, and exercise capacity.

Figure 4 Overall responses on questions on mortality benefits concept (Survey 1).

Abbreviations: COPD, chronic obstructive pulmonary disease; SD, standard deviation; Max, maximum; Min, minimum.

Figure 5 Overall responses on questions on exacerbation reduction concept (Survey 2).

Abbreviations: COPD, chronic obstructive pulmonary disease; SD, standard deviation; Max, maximum; Min, minimum.

Figure 6 Survey 2 responses on early optimization concept and benefits of early triple therapy initiation.

Notes: (a): Overall responses on questions on early optimization concept (Survey 2). (b) Responses on patient population likely to benefit from early initiation of triple therapy (Survey 2).

Abbreviations: COPD, chronic obstructive pulmonary disease; SD, standard deviation; Max, maximum; Min, minimum.

Figure 7 Survey 2 responses on pneumonia risk concept and risk factors for pneumonia.

Notes: (a) Overall responses on questions on pneumonia risk concept (Survey 2). (b) Responses on factors contributing to risk of pneumonia (Survey 2).

Abbreviations: COPD, chronic obstructive pulmonary disease; SD, standard deviation; Max, maximum; Min, minimum.

Monteagudo M, Barrecheguren M, Solntseva I, et al. Clinical characteristics, and factors associated with triple therapy use in newly diagnosed patients with COPD. NPJ Prim Care Respir Med. 2021;31(1):16. doi:10.1038/s41533-021-00227-x

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