A Delphi Consensus Project to Capture Greek Experts' Opinion on the Position of Triple Therapies in COPD: Why, When and to Whom.

Background: In recent years, COPD treatment has become more personalized considering specific patient's characteristics. Aim and Methods: We have performed a DELPHI consensus project to assess the level of consensus among Greek experts on the use of triple therapy in COPD as an initial and follow-up treatment. A three-round Delphi online survey was developed. The questionnaire was developed by a 6-member steering committee, included 54 statements, and divided into 3 domains: (A) triple therapy as initial treatment (divided into subdomains examining the impact of exacerbations based on lung function, bronchodilation reversibility and/or blood eosinophil count, smoking, symptoms, and comorbidities), (B) escalation to triple therapy from dual bronchodilation and (C) de-escalation from triple therapy to dual bronchodilation. The survey was funded by AstraZeneca and was hosted and analysed by an independent external company. Results: Consensus was reached in 84.8%, 63% and 80% of statements for domains A, B and C, respectively. Experts agreed that initial treatment with triple therapy is a reasonable option for specific patients, while escalation from dual bronchodilation to triple therapy could be considered, besides frequent exacerbators, also in patients with a history of one moderate exacerbation, mainly in the presence of marked bronchodilator reversibility or high blood eosinophil count. Finally, there was a consensus that de-escalation from triple therapy to dual bronchodilation was inappropriate in patients who had experienced one moderate exacerbation in the previous year. Conclusion: Although consensus was generated in several statements, panelists failed to reach consensus in many aspects of the use of triple therapy, identifying areas for further research.