{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T13:45:53Z","timestamp":1792158353556,"version":"4.4.0"},"reference-count":0,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T00:00:00Z","timestamp":1792108800000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"Abstract<\/jats:title>\n \n Rationale<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Objectives<\/jats:title>\n To formulate a new, expert-based consensus definition of severe COPD and a minimal set of diagnostics and characteristics to be assessed in the work-up of these patients.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n 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. Sixty-seven (round 1) and 20 (round 2) statements were tested in seven domains: (A) the need for a definition, (B) symptoms, (C) functional impairment, (D) quality of life, (E) physiological impairment, (F) framework definition, and (G) risk factors. Consensus was defined as\u2009\u2265\u200975% agreement.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Consensus was reached for 46 (69%) statements in round 1 and 15 (75%) in round 2. Among patients with confirmed COPD, severe COPD was defined as: (1) persistent symptoms, functional impairment, or severely reduced quality of life; (2) despite optimal treatment and not due to comorbidities; and (3) 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: (1) assessment of patient-reported outcomes for symptoms, quality of life, anxiety and depression; (2) assessment of exacerbation frequency and severity; (3) comprehensive diagnostic testing, including lung function testing, blood gas analysis, imaging, cardiac assessment, and exercise-tolerance testing; and (4) assessment of risk factors for more severe and progressive disease.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Using expert consensus, we devised an internationally-supported, proposed definition and work-up for \u2018severe COPD\u2019, accounting for disease heterogeneity. 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.<\/jats:p>\n <\/jats:sec>","DOI":"10.1093\/annalsats\/aaoag305","type":"journal-article","created":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T09:51:05Z","timestamp":1792144265000},"source":"Crossref","is-referenced-by-count":0,"title":["A Proposed Consensus Definition of Severe COPD: a modified Delphi Study"],"prefix":"10.1093","author":[{"given":"Mireille C","family":"Melles","sequence":"first","affiliation":[{"name":"University of Groningen, Groningen, the Netherlands; Department of Respiratory Diseases, STZ Centre of Excellence for Asthma, COPD & Respiratory Allergy, Franciscus Hospital University of Groningen, University Medical Center Groningen, department of Pulmonary Diseases and Tuberculosis, Groningen, the Netherlands; Groningen Research Institute of Asthma and COPD (GRIAC), , Rotterdam, the","place":["Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marlies","family":"van Dijk","sequence":"additional","affiliation":[{"name":"University of Groningen University of Groningen, University Medical Center Groningen, department of Pulmonary Diseases and Tuberculosis, Groningen, the Netherlands; Groningen Research Institute of Asthma and COPD (GRIAC), , Groningen, the","place":["Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marieke L","family":"Duiverman","sequence":"additional","affiliation":[{"name":"University of Groningen University of Groningen, University Medical Center Groningen, department of Pulmonary Diseases and Tuberculosis, Groningen, the Netherlands; Groningen Research Institute of Asthma and COPD (GRIAC), , Groningen, the","place":["Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frits M E","family":"Franssen","sequence":"additional","affiliation":[{"name":"Maastricht University Medical Center Department of Research & Development, Ciro, Horn, the Netherlands; Department of Respiratory Medicine, , Maastricht, the","place":["Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Merel E","family":"Hellemons","sequence":"additional","affiliation":[{"name":"Erasmus University Medical Center Department of Respiratory Medicine and Transplantation Institute, , Rotterdam, the","place":["Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daisy J A","family":"Janssen","sequence":"additional","affiliation":[{"name":"Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands Department of Research & Development, Ciro, Horn, the Netherlands; Department of Health Services Research and Department of Family Medicine, ; Department of Expertise and Treatment, Proteion, Horn, the","place":["Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pascale M G A","family":"Lubbers-van Tuyn","sequence":"additional","affiliation":[{"name":"Longfonds , Amersfoort, the","place":["Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dirk-Jan","family":"Slebos","sequence":"additional","affiliation":[{"name":"University of Groningen University of Groningen, University Medical Center Groningen, department of Pulmonary Diseases and Tuberculosis, Groningen, the Netherlands; Groningen Research Institute of Asthma and COPD (GRIAC), , Groningen, the","place":["Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alvar","family":"Agust\u00ed","sequence":"additional","affiliation":[{"name":"Barcelona, Spain; FCRB-IDIBAPS, Barcelona, Spain; CIBERES Medicine Department, University of Barcelona, Barcelona, Spain; Respiratory Institute, Clinic Barcelona, , Madrid,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Selim M","family":"Arcasoy","sequence":"additional","affiliation":[{"name":"Columbia University Irving Medical Center, New York-Presbyterian Hospital , New York,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Surya P","family":"Bhatt","sequence":"additional","affiliation":[{"name":"University of Alabama at Birmingham Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, USA; Center for Lung Analytics and Imaging Research, , Birmingham,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Folkert","family":"Brijker","sequence":"additional","affiliation":[{"name":"Spaarne Gasthuis Department of Pulmonary Medicine, , Haarlem, the","place":["Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guy G","family":"Brusselle","sequence":"additional","affiliation":[{"name":"Erasmus University Medical Center Department of Respiratory Medicine, University Hospital Ghent, Ghent, Belgium; Department of Respiratory Medicine, , Rotterdam, the","place":["Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bartolome R","family":"Celli","sequence":"additional","affiliation":[{"name":"Director Clinical Research Foundation , Boston, Massachusetts,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurens J","family":"Ceulemans","sequence":"additional","affiliation":[{"name":"KU Leuven Respiratory Division, University Hospitals Leuven, Leuven, Belgium; Laboratory of Respiratory Diseases and Thoracic Surgery, , Leuven,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerard J","family":"Criner","sequence":"additional","affiliation":[{"name":"Temple University Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, , Philadelphia,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Dreher","sequence":"additional","affiliation":[{"name":"University Hospital Aachen Department of Pneumonology and Intensive Care Medicine, , Aachen,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonardo M","family":"Fabbri","sequence":"additional","affiliation":[{"name":"University of Ferrara Section of Respiratory Medicine, Department of Translational Medicine, , Ferrara,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Greer","sequence":"additional","affiliation":[{"name":"Hannover Medical School Department of Respiratory Medicine and Infectious Diseases, , Hannover,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas","family":"Hart","sequence":"additional","affiliation":[{"name":"King's College London Lane Fox Clinical Respiratory Physiology Research Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK; Centre for Human and Applied Physiological Sciences, ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne E","family":"Holland","sequence":"additional","affiliation":[{"name":"Alfred Health Respiratory Research@Alfred, School of Translational Medicine, Monash University, Melbourne, Australia; Institute for Breathing and Sleep, Melbourne, Australia; Department of Physiotherapy, , Melbourne,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas","family":"Hopkinson","sequence":"additional","affiliation":[{"name":"National Heart and Lung Institute, Imperial College, Royal Brompton Hospital Campus , London,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John R","family":"Hurst","sequence":"additional","affiliation":[{"name":"UCL Respiratory, University College London , London,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alvin J","family":"Ing","sequence":"additional","affiliation":[{"name":"Health and Human Sciences Macquarie University, Faculty of Medicine, , Sydney, New South Wales,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wim","family":"Janssens","sequence":"additional","affiliation":[{"name":"KU Leuven Respiratory Division, University Hospitals Leuven, Leuven, Belgium; Laboratory of Respiratory Diseases and Thoracic Surgery, , Leuven,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huib A M","family":"Kerstjens","sequence":"additional","affiliation":[{"name":"University of Groningen University of Groningen, University Medical Center Groningen, department of Pulmonary Diseases and Tuberculosis, Groningen, the Netherlands; Groningen Research Institute of Asthma and COPD (GRIAC), , Groningen, the","place":["Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janwillem W H","family":"Kocks","sequence":"additional","affiliation":[{"name":"Groningen Research Institute of Asthma and COPD (GRIAC), University of Groningen, Groningen, the Netherlands; University of Groningen, University Medical Center Groningen, department of Pulmonary Diseases and Tuberculosis General Practitioners Research Institute, Groningen, the Netherlands; Observational and Pragmatic Research Institute, Singapore, Singapore; , Groningen, the","place":["Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Coenraad F N","family":"Koegelenberg","sequence":"additional","affiliation":[{"name":"Stellenbosch University and Tygerberg Hospital Division of Pulmonology, Department of Medicine, , Cape Town,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Th\u00e9r\u00e8se S","family":"Lapperre","sequence":"additional","affiliation":[{"name":"University of Antwerp Department of Pneumology, Antwerp University Hospital, Edegem, Belgium; Laboratory of Experimental Medicine and Pediatrics, , Antwerp,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carli J","family":"Lehr","sequence":"additional","affiliation":[{"name":"Cleveland Clinic Department of Pulmonary and Critical Care Medicine, Integrated Hospital Care Institute, , Cleveland, Ohio,","place":["US"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federica","family":"Meloni","sequence":"additional","affiliation":[{"name":"University of Padova and AOPD Department of Cardio-Thoracic and Vascular Sciences, , Padua,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masamichi","family":"Mineshita","sequence":"additional","affiliation":[{"name":"St. Marianna University School of Medicine Department of Respiratory Diseases, , Kawasaki,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"Miravitlles","sequence":"additional","affiliation":[{"name":"Vall d'Hebron Barcelona Hospital Campus Pneumology Department, Hospital Universitari Vall d'Hebron; Vall d'Hebron Institut de Recerca (VHIR), , Barcelona,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kris","family":"Mooren","sequence":"additional","affiliation":[{"name":"Spaarne Gasthuis Department of Pulmonary Medicine, , Haarlem, The","place":["Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Parameswaran K","family":"Nair","sequence":"additional","affiliation":[{"name":"McMaster University Firestone Institute for Respiratory Health, St Joseph's Healthcare Hamilton, Hamilton, Canada; Department of Medicine, Division of Respirology, , Hamilton,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hugo G","family":"de Oliveira","sequence":"additional","affiliation":[{"name":"Universidade Federal do Rio Grande do Sul (UFRGS) Pulmonology Service, Hospital de Cl\u00ednicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Medical School, , Porto Alegre,","place":["Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hilary","family":"Pinnock","sequence":"additional","affiliation":[{"name":"Usher Institute, The University of Edinburgh , Edinburgh,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabio","family":"Pitta","sequence":"additional","affiliation":[{"name":"Universidade Estadual de Londrina Departamento de Fisioterapia, Laborat\u00f3rio de Pesquisa em Fisioterapia Respirat\u00f3ria (LFIP), , Londrina, Brasil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudio","family":"Rabec","sequence":"additional","affiliation":[{"name":"Lausanne University Hospital Division of Pulmonary Diseases, Department of Medicine, , Lausanne,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas","family":"Roche","sequence":"additional","affiliation":[{"name":"H\u00f4pital et Institut Cochin Service de Pneumologie, Assistance Publique-H\u00f4pitaux de Paris Centre, Universit\u00e9 Paris Cit\u00e9, , Paris,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard E K","family":"Russell","sequence":"additional","affiliation":[{"name":"King's College London King's Centre for Lung Health, Peter Gorer Department of Immunobiology, , London,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sami O","family":"Simons","sequence":"additional","affiliation":[{"name":"Maastricht University Department of Respiratory Medicine, NUTRIM Institute of Nutrition and Translational Research in Metabolism, , Maastricht, the","place":["Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dave","family":"Singh","sequence":"additional","affiliation":[{"name":"Manchester University NHS Foundation Trust, Manchester, UK; Medicines Evaluation Unit Division of Immunology, Immunity to Infection and Respiratory Medicine, The University of Manchester, Manchester, UK; North West Lung Centre, , Wythenshawe, Greater Manchester,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daiana","family":"Stolz","sequence":"additional","affiliation":[{"name":"University of Freiburg Clinic of Respiratory Medicine, Faculty of Medicine, , Freiburg,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00f8rgen","family":"Vestbo","sequence":"additional","affiliation":[{"name":"The University of Manchester Division of Immunology, Immunity to Infection and Respiratory Medicine, , Manchester,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claus F","family":"Vogelmeier","sequence":"additional","affiliation":[{"name":"University of Marburg, Baldingerstrasse, Marburg Department of Medicine, Pulmonary, and Critical Care Medicine, German Center for Lung Research (DZL), , 35033, Marburg,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robin","family":"Vos","sequence":"additional","affiliation":[{"name":"KU Leuven Respiratory Division, University Hospitals Leuven, Leuven, Belgium; Laboratory of Respiratory Diseases and Thoracic Surgery, , Leuven,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wolfram","family":"Windisch","sequence":"additional","affiliation":[{"name":"University Witten\/Herdecke Department of Pneumology, Kliniken der Stadt K\u00f6ln gGmbH, , Cologne,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily F A","family":"van \u2019t Wout","sequence":"additional","affiliation":[{"name":"Leiden University Medical Center Department of Pulmonology, , Leiden, The","place":["Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes C C M","family":"in \u2019t Veen","sequence":"additional","affiliation":[{"name":"Franciscus Hospital Department of Respiratory Diseases, STZ Centre of Excellence for Asthma, COPD & Respiratory Allergy, , Rotterdam, the","place":["Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pieter-Paul W","family":"Hekking","sequence":"additional","affiliation":[{"name":"University of Amsterdam Department of Respiratory Diseases, STZ Centre of Excellence for Asthma, COPD & Respiratory Allergy, Franciscus Hospital, Rotterdam, the Netherlands; Department of Respiratory Medicine, Academic Medical Centre, , Amsterdam, the","place":["Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,10,16]]},"container-title":["Annals of the American Thoracic Society"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/annalsats\/advance-article-pdf\/doi\/10.1093\/annalsats\/aaoag305\/72033005\/aaoag305.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/annalsats\/advance-article-pdf\/doi\/10.1093\/annalsats\/aaoag305\/72033005\/aaoag305.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T12:52:18Z","timestamp":1792155138000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/annalsats\/advance-article\/doi\/10.1093\/annalsats\/aaoag305\/8930781"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,16]]},"references-count":0,"URL":"https:\/\/doi.org\/10.1093\/annalsats\/aaoag305","relation":{},"ISSN":["2325-6621"],"issn-type":[{"value":"2325-6621","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,16]]},"article-number":"aaoag305"}}