Impact-Driven Strategies for Optimizing Inhaled Therapy Adherence in COPD: The OPTIMO Delphi Consensus

Introduction: Medication adherence is an important challenge in the management of COPD, with poor adherence negatively impacting symptom control, disease progression, and healthcare resource utilization. Objetives: This study aimed to achieve multidisciplinary consensus on practical, prioritized interventions for improving adherence and clinical results in stable COPD treatment. Material and methods: A modified Delphi study was carried out by a panel of COPD management experts to evaluate suboptimal adherence. The Delphi questionnaire, completed in two rounds, comprised 84 statements across six domains: non-adherence, its impact, contributing factors, assessment methods, improvement strategies, and prioritization. Agreement was rated using a 9-point Likert scale and consensus considered as ≥70% agreement. Results: Seventy-three multidisciplinary experts completed the questionnaire, reaching consensus on 74 of 84 statements. The panel identified high-impact, easy-to-implement interventions, culminating in a practical decalogue for optimizing inhalation therapy. Two key strategies were emphasized: simplifying and unifying inhalation regimens, and empowering patients. While all adherence assessment tools were considered useful, only digital and automated methods were deemed feasible in routine practice. Treatment optimization was also associated with reducing inhalation frequency by using long-acting molecules, and tailoring device selection to patient capacity. Conclusion: The resulting decalogue provides structured expert guidance for healthcare professionals, highlighting once-daily dosing, simplified devices, and patient engagement as the interventions considered most likely to improve adherence in COPD.