A Delphi Consensus Project to Capture Experts’ Opinion on the Position of Triple Therapies in COPD:Why, When and to Whom

Nowadays, COPD treatment is personalized considering specific patient’s characteristics. We have performed a DELPHI consensus project to assess the level of consensus among Greek experts on the use of triple therapy in COPD as initial and follow up treatment. A three-round Delphi online survey was developed. The questionnaire was developed by a 6-member steering committee, and included 54 statements, divided into 3 domains:(1) triple therapy as initial treatment (divided in subdomains examining the impact of exacerbations according to lung function, bronchodilation reversibility and/or blood eosinophil count, smoking, symptoms, and comorbidities) (2)step-up to triple therapy from LABA/LAMA and (3)step-down from triple therapy to LABA/LAMA. The survey was funded by AstraZeneca and was hosted and analysed by an independent external company. Consensus was reached in 84.8%, 63% and 80% for domains 1, 2 and 3 respectively. Experts agreed that initial treatment with triple therapy is a reasonable option for specific patients, while stepping up from dual bronchodilation to triple therapy could be considered, besides frequent exacerbators, also in patients with a history of one moderate exacerbation mainly in the presence of marked bronchodilator reversibility or high blood eosinophil count. Finally, there was a consensus that stepping down from triple therapy to dual bronchodilation was inappropriate in patients who had experienced one moderate exacerbation in the previous year. Although consensus was generated in several statements, several aspects on the position of triple therapy remain controversial, identifying areas for further research to inform future guidelines.