Pneumology Department, Hospital Universitari Vall d'Hebron/Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus; CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain.
Emerging Markets, GlaxoSmithKline, Singapore.
Int J Chron Obstruct Pulmon Dis. 2023 Aug 28;18:1853-1866. doi: 10.2147/COPD.S424128. eCollection 2023.
Role of triple therapy in chronic obstructive pulmonary disease (COPD) management is supported by growing evidence, but consensus is lacking on various aspects. We conducted a Delphi survey in respiratory experts on the effects of triple therapy on exacerbation reduction, early optimization, pneumonia risk, and mortality benefits in COPD management.
The study comprised 2-round online surveys and a participant meeting with 21 respiratory experts from 10 countries. The 31-statement questionnaire was prepared using Decipher software after literature review. Responses were recorded using Likert scale ranging from 1 (disagreement) to 9 (agreement) with a consensus threshold of 75%.
All experts participated in both surveys and 14/21 attended participant meeting. Consensus was reached on 13/31 questions in first survey and 4/14 in second survey on: mortality benefits of triple therapy; comparable pneumonia risk between single inhaler triple therapy (SITT) and multiple inhaler triple therapy (81%); preference of SITT for patients with high eosinophil count (95%); exacerbation risk reduction and healthcare cost benefits with early initiation of SITT post exacerbation-related hospitalization (<30 days) (86%). No consensus was reached on first line SITT use after first exacerbation resulting in COPD diagnosis (62%).
This study demonstrated that there is consensus among experts regarding many of the key concepts about appropriate clinical use and benefits of triple therapy in COPD. More evidence is required for evaluating the benefits of early optimisation of triple therapy.
越来越多的证据支持三联疗法在慢性阻塞性肺疾病（COPD）管理中的作用，但在许多方面尚未达成共识。我们对呼吸专家进行了一项关于三联疗法在 COPD 管理中对减少加重、早期优化、肺炎风险和降低死亡率的影响的 Delphi 调查。
该研究包括两轮在线调查和一次有 10 个国家的 21 名呼吸专家参加的会议。该 31 项陈述的调查问卷是在文献复习后使用 Decipher 软件编写的。使用李克特量表记录专家的回答，范围从 1（不同意）到 9（同意），共识阈值为 75%。
所有专家都参加了两轮调查，其中 14 名专家参加了会议。在第一轮调查中有 13/31 个问题达成了共识，在第二轮调查中有 4/14 个问题达成了共识，这些共识包括：三联疗法的死亡率益处；单吸入器三联疗法（SITT）和多吸入器三联疗法（81%）的肺炎风险相当；对于嗜酸性粒细胞计数高的患者，倾向于使用 SITT（95%）；在因加重相关住院（<30 天）后早期开始 SITT 可降低加重风险和节省医疗保健费用（86%）。在首次加重后首次使用 SITT 作为一线治疗（62%）方面，未达成共识。
本研究表明，专家们在三联疗法在 COPD 中的适当临床应用和获益的许多关键概念方面存在共识。需要更多的证据来评估早期优化三联疗法的获益。
