Optimizing COPD Care in Belgium: A Multidisciplinary Expert Consensus on Cardiopulmonary Risk Management

Introduction: Chronic obstructive pulmonary disease (COPD) represents a major health and economic challenge in Belgium, affecting approximately 800,000 individuals, half of whom remain undiagnosed. Beyond respiratory morbidity, COPD patients face substantial cardiopulmonary (CP) risk-encompassing severe exacerbations and cardiovascular (CV) events-that is often under-recognized and insufficiently addressed due to limited clinical awareness, fragmented care, and the absence of national guidance. Methods: A multidisciplinary Belgian taskforce (general practitioners, pulmonologists, cardiologists, pharmacists, epidemiologists) convened through structured workshops and iterative consensus-building to develop a pragmatic, evidence-informed care pathway. The recommendations focus on COPD patients with at least one moderate or severe exacerbation, who are at heightened CP risk. Results: This consensus introduces an integrated, stepwise framework that positions CP risk as a central component of COPD management after exacerbation and operationalizes it across primary care, hospitalization, and post-exacerbation follow-up. Core elements include systematic and proactive CP risk identification in primary care, standardized diagnostic workups during hospitalization, and multidisciplinary discharge planning. Pharmacological strategies combine eosinophil-guided inhaler therapy with guideline-directed CV treatment, while non-pharmacological measures reinforce smoking cessation, vaccination, physical activity, and pulmonary rehabilitation. Clear referral thresholds between primary care, pulmonology, and cardiology are defined, supported by patient education and digital monitoring tools. Conclusion: This Belgian consensus complements international guidelines by consolidating fragmented recommendations into coherent, actionable algorithms that bridge gaps in routine practice. Its contribution lies in translating emerging evidence into structured, real-world pathways that integrate respiratory and cardiac care. Adoption of this framework may help reduce exacerbations, improve CV outcomes, and support multidisciplinary COPD care in Belgium.