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Abstract
Purpose
There is a lack of consensus on the most appropriate early diagnostic strategy, criteria for early access to treatment and follow-up approach for patients with COPD.
Materials and methods
A Delphi consensus project investigated the early management of COPD. We formulated two questionnaires for completion by pneumologists in Italy.
Results
A total of 207 specialists completed questionnaire 1 and 184 of them questionnaire 2, between November 2016 and October 2017. Early diagnosis of COPD was considered uncommon for 93.2% of the expert panel. Regardless of the definition of “early diagnosis” – a diagnosis made before the clinical manifestation of the disease for most responders (60.4%) – experts were confident of the positive effects of early disease management, which they consider is effective in modifying the natural history of the disease. Lack of awareness of the disease was considered the first limiting factor to early COPD management for 78% of respondents. The most effective steps to reduce functional decline were considered to be smoking cessation, followed by long-acting β2-agonist (LABA)/long-acting muscarinic antagonist (LAMA), LAMA, LABA, and finally inhaled corticosteroid/LABA (P<0.01 for each paired comparison). Specialists considered it “inappropriate” for general practitioners to perform both the early diagnosis and therapy of COPD without the involvement of a specialist.
Conclusion
Early management of COPD is uncommon, and although data on the effects of early disease management on long-term outcomes are limited, Italian experts are confident of the clinical efficacy of this approach.
Acknowledgments
This study was supported by an unrestricted grant from AstraZeneca. The funding source had no role in the study design, data collection and analysis, decision to publish, or preparation of manuscript. The authors would like to thank ThinkTank, Milan, for support in implementing the Delphi Methodology.
Author contributions
FDM and MC acted as manuscript coordinators and Patrizio Pasqualetti carried out the statistical analysis. All authors contributed to data analysis, drafting or revising the article, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.
Disclosure
Dr. Di Marco has received honoraria for lectures at national and international meetings from Almirall, AstraZeneca, Boehringer Ingelheim, Chiesi Farmaceutici, Dompe, Guidotti/Malesci, GlaxoSmithKline, Menarini, Novartis, and Zambon. He has served as a consultant for AstraZeneca, Chiesi Farmaceutici, Novartis, and Zambon. He has received financial support for research from Novartis and Boehringer Ingelheim. Prof. Dr. de Blasio has served as a consultant for AstraZeneca, and Dr. Santus has served as a consultant for AstraZeneca, Boehringer Ingelheim, Zambon Italia, Guiodotti, GSK, and Chiesi Farmaceutici. The authors report no other conflicts of interest in this work.