Solutions to Improve COPD Patients' Clinical Outcomes and Quality of Care: Recommendations From the CARABELA Initiative.

Introduction: Chronic obstructive pulmonary disease (COPD) remains a priority in clinical practice, but it still presents gaps in care coordination, diagnosis, and treatment that have tangible impact on patients' outcomes. The CARABELA-COPD previously identified key improvement areas within the Spanish healthcare system, setting the foundation for enhanced COPD care. As a continuation of the initiative, this document presents expert-driven recommendations to improve COPD care in the Spanish healthcare system. Material and methods: The CARABELA-COPD methodology involved seven pilot hospitals across Spain and included national and regional expert meetings. Through thematic discussions and prioritization exercises, key areas for COPD care improvement were identified and refined. This manuscript summarizes the resulting recommendations for the areas prioritized by the experts. Results: The proposed strategies emphasize the importance of early detection, optimizing healthcare resource use, and implementing standardized care pathways to ensure a more uniform and effective management of the disease. Specific focus is placed on the role of specialized nursing, ensuring smooth transitions between levels of care, and integrating digital tools to facilitate clinical decisions. Conclusions: These recommendations are intended to close the gap between evidence-based guidelines and real clinical practice, so that every patient receives high-quality individualized care. Through collaboration between healthcare professionals, scientific societies, and policymakers, CARABELA-COPD seeks to reduce disparities in care, enhance system effectiveness, and ultimately improve quality of life for patients with COPD.