A Proposed Consensus Definition of Severe COPD: a modified Delphi Study
Severe COPD: Why a Consensus Definition Is Needed
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.
Expert Consensus Through a Modified Delphi Study
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.
Proposed Severe COPD Definition and Standardized Work-Up
Among patients with confirmed COPD, severe COPD was defined as:
- Persistent symptoms, functional impairment, or severely reduced quality of life;
- Despite optimal treatment and not due to comorbidities; and
- 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:
- Assessment of patient-reported outcomes for symptoms, quality of life, anxiety and depression;
- Assessment of exacerbation frequency and severity;
- Comprehensive diagnostic testing, including lung function testing, blood gas analysis, imaging, cardiac assessment, and exercise-tolerance testing; and
- Assessment of risk factors for more severe and progressive disease.
Clinical Impact and Prognostic Value Require Further Study
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
Melles MC, van Dijk M, Duiverman ML, Franssen FME, Hellemons ME, Janssen DJA, Lubbers-van Tuyn PMGA, Slebos D-J, Agustí A, Arcasoy SM, Bhatt SP, Brijker F, Brusselle GG, Celli BR, Ceulemans LJ, Criner GJ, Dreher M, Fabbri LM, Greer M, Hart N, Holland AE, Hopkinson N, Hurst JR, Ing AJ, Janssens W, Kerstjens HAM, Kocks JWH, Koegelenberg CFN, Lapperre TS, Lehr CJ, Meloni F, Mineshita M, Miravitlles M, Mooren K, Nair PK, de Oliveira HG, Pinnock H, Pitta F, Rabec C, Roche N, Russell REK, Simons SO, Singh D, Stolz D, Vestbo J, Vogelmeier CF, Vos R, Windisch W, van ’t Wout EFA, in ’t Veen JCCM, Hekking P-PW.
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Fecha de publicación
Published: 16 October 2026
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