What provokes experienced COPD clinical practitioners in the UK to initiate or change medication? a consensus study

Abstract

Background: In the absence of clarity in national guidelines, this study aimed to reach a consensus among experts in chronic obstructive pulmonary disease (COPD) regarding when medication should be initiated or changed in patients demonstrating a gradual decline. Methods: An electronic three-stage Delphi exercise was undertaken with 37 leading UK experts in COPD. The panel submitted criteria which they scored in subsequent rounds. Consensus was defined as >80% of the panel scoring an item as important. Results: Consensus was reached on seven criteria: decreased exercise tolerance (97%); increased breathlessness at rest or on exertion (97%); quality of life impairment (91%); low or reduced oxygen saturations based on pulse oximetry readings (86%); ability to perform activities of daily living independently (85%); increase in sputum (80%); and increase in wheeze (80%). Conclusions: These criteria could be used to guide clinical practice. Empirical research is now required to test their reliability and validity. © 2011 Primary Care Respiratory Society UK. All rights reserved.