Year: 2026
Type: article
Abstract: RATIONALE: Advanced interventions are available for patients with more severe COPD despite guideline-recommended therapies, yet this population is heterogeneously defined and inconsistently recognized, and a standardized work-up is lacking, which could lead to mismanagement. OBJECTIVES: To formulate a new, expert-based consensus definition of severe COPD and a minimal set of diagnostics and characteristics to be assessed in the work-up of these patients. METHODS: A modified Delphi study with two online rounds was conducted between June 2024 and January 2025 with 55 international COPD experts representing all areas of disease management. Sixty-seven (round 1) and 20 (round 2) statements were tested in seven domains: (A) the need for a definition, (B) symptoms, (C) functional impairment, (D) quality of life, (E) physiological impairment, (F) framework definition, and (G) risk factors. Consensus was defined as ≥ 75% agreement. RESULTS: Consensus was reached for 46 (69%) statements in round 1 and 15 (75%) in round 2. Among patients with confirmed COPD, severe COPD was defined as: (1) persistent symptoms, functional impairment, or severely reduced quality of life; (2) despite optimal treatment and not due to comorbidities; and (3) including at least one clinical characteristic: severe airflow obstruction, severely impaired diffusion capacity, severe hyperinflation, frequent exacerbations, chronic respiratory insufficiency, pulmonary hypertension related to COPD, or cachexia or unintentional weight loss related to COPD. The proposed standardized work-up comprised: (1) assessment of patient-reported outcomes for symptoms, quality of life, anxiety and depression; (2) assessment of exacerbation frequency and severity; (3) comprehensive diagnostic testing, including lung function testing, blood gas analysis, imaging, cardiac assessment, and exercise-tolerance testing; and (4) assessment of risk factors for more severe and progressive disease. CONCLUSIONS: Using expert consensus, we devised an internationally-supported, proposed definition and work-up for 'severe COPD', accounting for disease heterogeneity. This definition may improve identification of the population and supports a structured evaluation of this often under-recognized and potentially undertreated population. Future studies are warranted to determine its clinical impact, prognostic value, and utility in research.
Authors: Mireille C Melles, Marlies van Dijk, Marieke L Duiverman, Frits M E Franssen, Merel E Hellemons, Daisy J A Janssen, Pascale M G A Lubbers-van Tuyn, Dirk-Jan Slebos, Alvar Agustí, Selim M Arcasoy, Surya P Bhatt, Folkert Brijker, Guy G Brusselle, Bartolome R Celli, Laurens J Ceulemans, Gerard J Criner, Michael Dreher, Leonardo M Fabbri, Mark Greer, Nicholas Hart, Anne E Holland, Nicholas Hopkinson, John R Hurst, Alvin J Ing, Wim Janssens, Huib A M Kerstjens, Janwillem W H Kocks, Coenraad F N Koegelenberg, Thérèse S Lapperre, Carli J Lehr, Federica Meloni, Masamichi Mineshita, Marc Miravitlles, Kris Mooren, Parameswaran K Nair, Hugo G de Oliveira, Hilary Pinnock, Fabio Pitta, Claudio Rabec, Nicolas Roche, Richard E K Russell, Sami O Simons, Dave Singh, Daiana Stolz, Jørgen Vestbo, Claus F Vogelmeier, Robin Vos, Wolfram Windisch, Emily F A van ’t Wout, Johannes C C M in ’t Veen, Pieter-Paul W Hekking
Institutions: University Medical Center Groningen, University of Groningen, Maastricht University Medical Centre, Maastricht University, Erasmus MC, Department of Health, Department of Health Services, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques de Barcelona, Universitat de Barcelona, NewYork–Presbyterian Hospital, Columbia University Irving Medical Center, University of Alabama at Birmingham, Spaarne Ziekenhuis, Spaarne Gasthuis, Ghent University Hospital, Cardiovascular Clinical Science Foundation, KU Leuven, Temple University, Universitätsklinikum Aachen, University of Ferrara, Medizinische Hochschule Hannover, Guy's and St Thomas' NHS Foundation Trust, Alfred Health, Royal Brompton Hospital, Lung Institute, University College London, Macquarie University, General Practitioners Research Institute, Stellenbosch University, Tygerberg Hospital, Antwerp University Hospital, Cleveland Clinic, University of Padua, St. Marianna University School of Medicine, Vall d'Hebron Institut de Recerca, St. Joseph’s Healthcare Hamilton, Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, University of Edinburgh, Universidade Estadual de Londrina, University of Lausanne, Université Paris Cité, Hôpital Cochin, Assistance Publique – Hôpitaux de Paris, King's College London, Manchester University NHS Foundation Trust, Medicines Evaluation Unit, University of Freiburg, University Medical Center Freiburg, Institute of Infection and Immunity, Philipps University of Marburg, German Center for Lung Research, Kliniken der Stadt Köln, Leiden University Medical Center, University of Amsterdam
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W7222727985
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