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

Naomi Michotte,1,2 Fabian Demeure,3 Julien Guiot,4,5 Sander Trenson,6 Michiel JEGW Vanfleteren,7 Lies Lahousse,8,9 Jo Raskin,10,11 Didier Cataldo,4,12 Thérèse Lapperre,13,14 Eric Marchand,15– 17 Mathias Leys,18 Wim Janssens,19 Marie Bruyneel,20,21 Lowie EGW Vanfleteren,22,23 Eef Vanderhelst,1,2 Pieter Goeminne,24 Stefan Teughels,25 Muriel Lins,26 Inès Van Rossem,27 Rudi Peché28 1Department of Respiratory Medicine, Universitair Ziekenhuis Brussel, Brussels, Belgium; 2Lung Research Unit, Vitality Research Group, Vrije Universiteit Brussel, Brussels, Belgium; 3Department of Cardiology, CHU UCL Namur, Yvoir, Belgium; 4Department of Respiratory Medicine, CHU Liège, Liège, Belgium; 5Faculty of Medicine, University of Liège, Liège, Belgium; 6Department of Cardiology, AZ Sint-Jan, Bruges, Belgium; 7Department of Respiratory Medicine, Sint-Josefskliniek, Izegem, Belgium; 8Department of Bioanalysis, Ghent University, Gent, Belgium; 9Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands; 10Department of Pulmonology and Thoracic Oncology, Antwerp University Hospital, Edegem, Belgium; 11Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; 12Laboratory of Tumours and Development, University of Liège, Liège, Belgium; 13Department of Respiratory Medicine, Antwerp University Hospital, Antwerp, Belgium; 14Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp, Belgium; 15Department of Respiratory Medicine, CHU-UCL Namur, Yvoir, Belgium; 16Institute of Experimental and Clinical Research, UCLouvain, Brussels, Belgium; 17Namur Research Institute for Life Sciences (NARILIS), University of Namur, Namur, Belgium; 18Department of Respiratory Medicine, AZ Groeninge, Kortrijk, Belgium; 19Department of Respiratory Medicine, University Hospital of Leuven, Leuven, Belgium; 20Department of Respiratory Medicine, CHU Saint-Pierre, Brussels, Belgium; 21Department of Respiratory Medicine, CHU Brugmann, Brussels, Belgium; 22Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium; 23Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; 24Department of Respiratory Medicine, VITAZ Hospitals, Sint-Niklaas, Belgium; 25Domus Medica, Antwerp, Belgium; 26Department of Respiratory Medicine, AZ Sint-Maarten, Mechelen, Belgium; 27Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel, Brussels, Belgium; 28Department of Respiratory Medicine, Humani Network, CHU Charleroi, Charleroi, BelgiumCorrespondence: Naomi Michotte, Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, Jette, 1090, Belgium, Tel +3224776841, Email naomi.michotte@uzbrussel.beIntroduction: 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.Keywords: cardiovascular diseases, chronic obstructive pulmonary disease, comorbidity, exacerbations, patient discharge, practice guidelines