An Updated Definition and Severity Classification of Chronic Obstructive Pulmonary Disease Exacerbations: The Rome Proposal

The current definition of a chronic obstructive pulmonary disease (COPD) exacerbation (ECOPD) is based solely on worsening respiratory symptoms, with severity classified post hoc by the healthcare resource used to treat the event, which may vary among practitioners and healthcare systems. These shortcomings support a need to revise the ECOPD definition and severity classification to one that is useful at time of patient contact. To achieve this, an expert panel used a modified Delphi method of five rounds of questions generated by a thorough review of the literature, supplemented by virtual discussions. For the 80 identified questions, the agreement level was rated using a Likert scale from 0 (strongly disagree) to 9 (strongly agree). Consensus was defined a priori as a median score ≥7 (strong agreement). The proposed definition states: "In a patient with COPD, an exacerbation is an event characterized by dyspnea and/or cough and sputum that worsens over ≤14 days, that may be accompanied by tachypnea and/or tachycardia, often associated with increased local and systemic inflammation caused by airway infection, pollution, or other insult to the airways." Three severity categories (mild, moderate, or severe) were defined using integration of six clinically measurable variables: intensity of dyspnea, oxygen saturation, respiratory rate, heart rate, C-reactive protein, and, if indicated, arterial blood gases. In conclusion, by incorporating measurable clinical and laboratory variables at the time of exacerbation, the Rome proposal for an updated definition of ECOPD could help standardize care and outcomes for clinicians and researchers alike.