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

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.

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Journal
Annals of the American Thoracic Society
Published
2026-10-16
DOI
https://doi.org/10.1093/annalsats/aaoag305
Primary Topic
Chronic Obstructive Pulmonary Disease (COPD) Research
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article
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article

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

Masamichi Mineshita, Daiana Stolz, Bartolomé R. Celli, Gerard J. Criner et al.
Annals of the American Thoracic Society
Chronic Obstructive Pulmonary Disease (COPD) Research
article

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

Masamichi Mineshita, Daiana Stolz, Bartolomé R. Celli, Gerard J. Criner, Leonardo Michele Fabbri, Pieter-Paul W. Hekking, Marlies van Dijk, L. Ceulemans, Coenraad F.N. Koegelenberg, Frits M.E. Franssen, Anne Elizabeth Holland, Daisy J.A. Janssen, Folkert Brijker, Wim Janssens, Claudio A. Rabec, Mireille C. Melles, Robin Vos, Federica Meloni, Wolfram Windisch, John Robert Hurst, Johannes C.C.M. in ’t Veen, Surya Prakash Bhatt, Alvin Ing, J Vestbo, Merel E. Hellemons, Kris Mooren, Dirk‐Jan Slebos, Richard E. K. Russell, Mark Greer, Alvar G.N. Agustí, Selim M. Arcasoy, Nicholas Hart, Hugo Goulart de Oliveira, Parameswaran K. Nair, Hilary Pinnock, Claus Franz Vogelmeier, Therese Sophie Lapperre, Marieke Leontine Duiverman, Janwillem W.H. Kocks, Marc Miravitlles, Fabio de Oliveira Pitta, Carli J. Lehr, Sami O. Simons, Huib A. M. Kerstjens, Michael Dreher, G.G. Brusselle, Hopkinson Nicholas, Pascale M.G.A. Lubbers-Van Tuyn, Dave Singh, Nicolas Roche, Emily F A van ’t Wout
article en

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.

Annals of the American Thoracic Society
Universidade Estadual de Londrina (BR), Universidade Federal do Rio Grande do Sul (BR), Cleveland Clinic (US), University Medical Center Groningen (NL), NewYork–Presbyterian Hospital (US), University of Padua (IT), University of Freiburg (DE), Philipps University of Marburg (DE), St. Marianna University School of Medicine (JP), University of Groningen (NL), King's College London (GB), Guy's and St Thomas' NHS Foundation Trust (GB), University of Ferrara (IT), Université Paris Cité (FR), Stellenbosch University (ZA), Columbia University Irving Medical Center (US), Leiden University Medical Center (NL), Maastricht University Medical Centre (NL), Ghent University Hospital (BE), University Medical Center Freiburg (DE), Erasmus MC (NL), Tygerberg Hospital (ZA), University of Alabama at Birmingham (US), Maastricht University (NL), Medizinische Hochschule Hannover (DE), Hôpital Cochin (FR), Manchester University NHS Foundation Trust (GB), General Practitioners Research Institute (NL), Royal Brompton Hospital (GB), Hospital de Clínicas de Porto Alegre (BR), Assistance Publique – Hôpitaux de Paris (FR), Spaarne Ziekenhuis (NL), Lung Institute (US), Antwerp University Hospital (BE), Vall d'Hebron Institut de Recerca (ES), Department of Health (TW), Hospital Clínic de Barcelona (ES), Universitätsklinikum Aachen (DE), Institut d'Investigacions Biomèdiques de Barcelona (ES), Kliniken der Stadt Köln (DE), German Center for Lung Research (DE), Cardiovascular Clinical Science Foundation (US), Department of Health Services (NP), Medicines Evaluation Unit (GB), Spaarne Gasthuis (NL), Alfred Health (AU), Institute of Infection and Immunity (CA), University College London (GB), St. Joseph’s Healthcare Hamilton (CA), Universitat de Barcelona (ES), Temple University (US), University of Amsterdam (NL), University of Lausanne (CH), University of Edinburgh (GB), Macquarie University (AU), KU Leuven (BE)
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