Abstract Introduction Evolving evidence supports the use of interventions beyond inhaled pharmacotherapy in chronic obstructive pulmonary disease (COPD), including pulmonary rehabilitation (PR), long-term non-invasive ventilation (LTNIV), lung volume reduction (LVR) and biologic therapies. However, clinician attitudes, access to services and system-level barriers influence their clinical adoption. This study explored current practices, perceptions, and future challenges in the management of moderate to severe COPD among respiratory consultants in the Republic of Ireland (ROI). Methods A custom, structured online survey was distributed to respiratory consultants practicing in the ROI via the Irish Thoracic Society contact list and professional messaging groups between December 2024 and February 2025. The survey, developed in accordance with CHERRIES guidelines, assessed consultant demographics, access to COPD-related services, and perceptions of evidence, access, and implementation barriers relating to PR, LTNIV, LVR and biologic therapies. Quantitative data were analysed descriptively. Results Thirty-seven responses were received (25% response rate); 36 were eligible and 35 completed the survey (completion rate 97%). Only 9 of 30 respondents (30%) reported adequate access to PR, and 9 of 29 (31%) had access to a dedicated COPD multidisciplinary team (MDT). Ten of 29 (34%) infrequently or never considered LTNIV for eligible patients despite 21 of 27 (78%) rating the supporting evidence for reducing hospitalisations as moderate or high. Sixteen of 27 (59%) infrequently or never considered LVR despite 22 of 25 (88%) perceiving moderate or high evidence for quality-of-life benefit. Awareness and confidence regarding biologic therapies were variable, with 11 of 24 (46%) were uncertain about the evidence for tezepelumab. 17 of 18 (94%) cited the absence of drug reimbursement as a major barrier to future integration of biologics into COPD care. Other key challenges included the lack of dedicated MDTs and administrative burden. Conclusion This national survey highlights limited access to PR and COPD MDTs, underutilisation of LTNIV and LVR despite recognition of their benefits, and considerable uncertainty and infrastructural barriers regarding the emerging role of biologics in COPD management in the ROI. Addressing these system-level limitations through national pathways, improved MDT infrastructure, and reimbursement frameworks will be critical to optimising COPD care and facilitating the integration of advanced and precision-based therapies. This abstract is funded by: None
Lim et al. (Fri,) studied this question.