Management of the COPD Patient with Comorbidities: An Experts Recommendation Document

Jesús Recio Iglesias,¹ Jesús Díez-Manglano,² Francisco López García,³ José Antonio Díaz Peromingo,⁴ Pere Almagro,⁵ José Manuel Varela Aguilar<sup>6,7

1</sup>Internal Medicine Department, Quironsalud Valencia Hospital, Valencia, Valencian Community, Spain; ²Internal Medicine Department, Royo Villanova Hospital, Zaragoza, Aragon, Spain; ³Internal Medicine Department General University Hospital of Elche, Alicante, Valencian Community, Spain; ⁴Internal Medicine Department, University Clinical Hospital of Santiago de Compostela, a Coruña, Galicia, Spain; ⁵Internal Medicine Department, Mútua Terrassa University Hospital, Terrassa, Barcelona, Catalonia, Spain; ⁶Internal Medicine Department, University Hospital Virgen del Rocío, Seville, Andalusia, Spain; ⁷CIBER of Epidemiology and Public Health, Madrid, Community of Madrid, Spain

Correspondence: Jesús Recio Iglesias
Internal Medicine Department, Quironsalud Valencia Hospital, Avenida Blasco Ibañez 14, Valencia, Valencian Community 46010, Spain
Tel +34 963690600
Fax +34 961041646
Email 28581jri@gmail.com

Background: Chronic obstructive pulmonary disease (COPD) is associated with multiple comorbidities, which impact negatively on patients and are often underdiagnosed, thus lacking a proper management due to the absence of clear guidelines.
Purpose: To elaborate expert recommendations aimed to help healthcare professionals to provide the right care for treating COPD patients with comorbidities.
Methods: A modified RAND-UCLA appropriateness method consisting of nominal groups to draw up consensus recommendations (6 Spanish experts) and 2-Delphi rounds to validate them (23 Spanish experts) was performed.
Results: A panel of Spanish internal medicine experts reached consensus on 73 recommendations and 81 conclusions on the clinical consequences of the presence of comorbidities. In general, the experts reached consensus on the issues raised with regard to cardiovascular comorbidity and metabolic disorders. Consensus was reached on the use of selective serotonin reuptake inhibitors in cases of depression and the usefulness of referring patients with anxiety to respiratory rehabilitation programmes. The results also showed consensus on the usefulness of investigating the quality of sleep, the treatment of pain with opioids and the evaluation of osteoporosis by lateral chest radiography.
Conclusion: This study provides conclusions and recommendations that are intended to improve the management of the complexity of patients with COPD and important comorbidities, usually excluded from clinical trials.

Keywords: chronic obstructive pulmonary disease, COPD, comorbidities, modified RAND-UCLA, Delphi technique