Lopez-Campos, Jose LuisAlcazar-Navarrete, BernardinoRiesco-Miranda, Juan AntonioCosio, Borja Gde-Torres, Juan PCelli, BartolomeJimenez-Ruiz, Carlos ACasanova-Macario, Ciro2023-02-092023-02-092020-07-27López-Campos JL, Alcázar Navarrete B, Riesco Miranda JA, Cosío BG, de-Torres JP, Celli B, et al. A Delphi Consensus Document on the Use of Single-Inhaler Fixed-Dose Triple Therapies in COPD Patients. Int J Chron Obstruct Pulmon Dis. 2020 Jul 27;15:1801-1811.http://hdl.handle.net/10668/16204Despite the evidence provided by clinical trials, there are some uncertainties and controversies regarding the use of triple inhaled therapy. With the aim of evaluating clinical practice in specialized respiratory units, a Delphi consensus document was implemented on the use of single-inhaler fixed-dose triple therapies after 1 year of use in Spain. A scientific committee of COPD experts defined a thematic index, guided a systematic literature review and helped design the Delphi questionnaire. This was sent to the other 45 COPD experts between April and June 2019. Agreement/disagreement on 58 statements was tested in two rounds using a Likert scale. Replies were classified as a consensus when ≥80% of the panelists agreed; a majority when a degree of agreement of ≥66% was reached; and divergence if agreement was After two rounds, 44.44% of the statements reached consensus, 14.81% reached majority and 40.74% were divergent. Panelists agreed that escalating from double bronchodilation should be phenotype-based and aim to prevent exacerbations but not for improving symptoms. The addition of an antimuscarinic to inhaled corticosteroids combinations achieves improvement in lung function, symptoms and exacerbation prevention. Main safety concerns included the increased risk of pneumonia as compared to bronchodilator therapies, with similar cardiovascular effects. There was no consensus agreement on patient type response based on blood eosinophil counts or obstruction severity. The low degree of consensus among panelists may reflect the complexity of severe COPD management. The information provided here may be useful to clinicians implementing personalized medicine for COPD patients.enAttribution-NonCommercial 4.0 Internationalhttp://creativecommons.org/licenses/by-nc/4.0/Delphi consensusLABA/ICSLABA/LAMAbronchodilator agentschronic obstructive pulmonary diseaseinhaled corticosteroidsstatementstriple therapyAdministration, InhalationAdrenal Cortex HormonesAdrenergic beta-2 Receptor AgonistsBronchodilator AgentsConsensusDrug CombinationsHumansMuscarinic AntagonistsNebulizers and VaporizersPulmonary Disease, Chronic ObstructiveSpainresearch article32884252open accessEnfermedad Pulmonar Obstructiva CrónicaPacientesFenotipoNeumoníaCorticoesteroidesSangreNebulizadores y vaporizadoresBroncodilatadoresPulmónEosinófilos10.2147/COPD.S2588181178-2005PMC7435744https://www.dovepress.com/getfile.php?fileID=60007https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7435744/pdf