Solidoro Paolo, Dente Federico, Micheletto Claudio, Pappagallo Giovanni, Pelaia Girolamo, Papi Alberto
University of Turin, Medical Sciences Department, Pneumology Unit U, Cardiovascular and Thoracic Department, AOU Città Della Salute e Della Scienza di Torino, Italy.
Respiratory Pathophysiology Unit, Department of Surgery, Medicine, Molecular Biology, and Critical Care, University of Pisa, Pisa, Italy.
Multidiscip Respir Med. 2024 Sep 18;19(1):949. doi: 10.5826/mrm.2024.949.
The management of chronic obstructive pulmonary disease (COPD) lacks standardization due to the diverse clinical presentation, comorbidities, and limited acceptance of recommended approaches by physicians. To address this, a multicenter study was conducted among Italian respiratory physicians to assess consensus on COPD management and pharmacological treatment.
The study employed the Delphi process using the Estimate-Talk-Estimate method, involving a scientific board and expert panel. During a 6-month period, the scientific board conducted the first Delphi round and identified 11 broad areas of COPD management to be evaluated while the second Delphi round translated all 11 items into statements. The statements were subsequently presented to the expert panel for independent rating on a nine-point scale. Consensus was considered achieved if the median score was 7 or higher. Consistently high levels of consensus were observed in the first rating, allowing the scientific board to finalize the statements without requiring further rounds.
Topics generating substantial discussion included the pre-COPD phase, patient-reported outcomes, direct escalation from a single bronchodilator to triple therapy, and the role of adverse events, particularly pneumonia, in guiding triple therapy prescriptions. Notably, these topics exhibited higher standard deviations, indicating greater variation in expert opinions.
The study emphasized the significance that Italian pulmonologists attribute to managing mortality, tailoring treatments, and addressing cardiovascular comorbidities in COPD patients. While unanimous consensus was not achieved for all statements, the results provide valuable insights to inform clinical decision-making among physicians and contribute to a better understanding of COPD management practices in Italy.
由于慢性阻塞性肺疾病（COPD）临床表现多样、存在合并症且医生对推荐方法的接受程度有限，其管理缺乏标准化。为解决这一问题，在意大利呼吸内科医生中开展了一项多中心研究，以评估COPD管理和药物治疗方面的共识。
该研究采用德尔菲法，运用“估计-讨论-估计”方法，涉及一个科学委员会和专家小组。在6个月的时间里，科学委员会进行了第一轮德尔菲调查，确定了11个需要评估的COPD管理广泛领域，而第二轮德尔菲调查将所有11项内容转化为陈述。随后将这些陈述提交给专家小组，以九点量表进行独立评分。如果中位数得分达到7分或更高，则认为达成了共识。在第一次评分中观察到始终较高的共识水平，使得科学委员会无需进一步轮次即可确定陈述内容。
引发大量讨论的主题包括COPD前期阶段、患者报告的结果、从单一支气管扩张剂直接升级为三联疗法，以及不良事件，尤其是肺炎，在指导三联疗法处方中的作用。值得注意的是，这些主题的标准差较高，表明专家意见存在更大差异。
该研究强调了意大利肺科医生对COPD患者管理死亡率、量身定制治疗方案以及处理心血管合并症的重视。虽然并非所有陈述都达成一致共识，但研究结果为医生的临床决策提供了有价值的见解，并有助于更好地理解意大利的COPD管理实践。
