Special articleExpert Statement on the Single-Agent Use of Inhaled Bronchodilator in the Treatment of Stable Mild-Moderate Chronic Obstructive Pulmonary DiseaseDocumento de expertos del uso de broncodilatadores inhalados en monoterapia en el tratamiento de la EPOC estable leve-moderada☆
Introduction
Chronic obstructive pulmonary disease (COPD) is a highly prevalent disease among the Spanish population that places a heavy burden on both the patient and the health and social welfare system.1, 2, 3 In Spain, the EPISCAN study reported a prevalence of 10.2% among the adult population aged between 40 and 80 years,1, 4, 5 along with a high rate of underdiagnosis, particularly in individuals with mild disease and/or few symptoms.6
In recent years, new drugs and studies in patients with stable COPD have prompted several scientific societies and expert groups, both in Spain and in other countries, to draw up statements on the use of bronchodilators, which have been included in the consensus recently published by GOLD and other similar documents.7, 8, 9, 10, 11, 12, 13, 14 Professionals responsible for the care of COPD patients with stable disease are currently expressing interest in the need to define and clarify the role of bronchodilators in monotherapy, in dual therapy and even as part of triple therapy in combination with inhaled corticosteroids.15
This document aims to define the degree of agreement among experts, to describe the available evidence regarding the management of patients with stable mild-to-moderate COPD, defined as FEV1≥50%, and to help clarify possible questions and areas of controversy in the use of single-agent bronchodilators. We present a series of statements that are intended to improve quality of care and assist in therapeutic decision-making, and should not be interpreted in any way as guidelines or as a COPD treatment protocol. In short, this document is presented as a tool that may optionally be adopted by clinicians involved in the management of these patients.
Section snippets
Methods
Nominal group techniques and Delphi methodology were used to prepare this document.16 In short, this is an expert consensus document generated by a group of professionals who undertook an extensive, systematic review of the literature in order to draw up statements about topical and/or controversial aspects that may be of value to their colleagues involved in the treatment of these patients. We insist that this not a treatment protocol or guideline, but rather a clinical tool. The degree of
Results
Twelve of the 17 statements generated from the Delphi survey were accepted (see results of the Delphi survey in Table 2).
Discussion
Following the recent incorporation of new drugs in the therapeutic arsenal for the treatment of COPD and the publication of various research studies, the diagnostic and therapeutic management of patients with stable COPD has become the subject of numerous national and international guidelines and recommendations.7, 14, 42 However, treatment indications are less well defined and more controversial for certain individuals among the mild-to-moderate COPD subgroup.
If clinical practice is to
Conclusions
This document has generated a series of statements agreed upon by Spanish experts on the use of inhaled bronchodilator therapy in monotherapy in patients with stable mild-to-moderate COPD. Consensus was reached regarding the indication of monotherapy as an initial treatment in patients with dyspnea mMRC≥1, cough-expectoration-wheezing, CAT≥10, limitation in physical activity. The use of dual bronchodilation is recommended as an initial treatment in patients with mild-to-moderate COPD with
Funding
The project was funded by Gebro Pharma, which did not intervene in the design of the project or in the development of the recommendations.
Conflict of Interests
Juan Antonio Riesco Miranda states that he has received fees for lectures and/or scientific consultancy from AstraZeneca, Boehringer-Ingelheim, Chiesi, Gebro Pharma, Group Ferrer, GSK, Laboratories Esteve, Menarini, Novartis and Pfizer.
Inmaculada Alfageme Michavila states that in the last three years she has received fees for lectures and/or scientific consultancy from AstraZeneca, Gebro Pharma, Roche, GSK, Laboratorios Esteve, Novartis, Teva and Chiesi.
Bernadino Alcázar Navarrete states that
Acknowledgements
Our thanks to all the professionals who participated in the Delphi survey: Doctors José Luis López-Campos, Francisco Javier Callejas, Carlos Cabrera López, Elsa Naval Sendra, Patricia Sobradillo, Juan Luis García Rivero, Juan José Soler Cataluña, Marc Miravitlles Fernández, Juan Antonio Trigueros, Agustín Valido Morales, José María Marín Trigo, José Antonio Quintano, Jesús Molina París, Eduardo Márquez, Myriam Calle Rubio, Adolfo Baloira Villar.
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Please cite this article as: Riesco Miranda JA, Alcázar B, Alfageme I, Casanova C, Celli B, de-Torres JP, et al. Documento de expertos del uso de broncodilatadores inhalados en monoterapia en el tratamiento de la EPOC estable leve-moderada. Arch Bronconeumol. 2017;53:574–582.