Identification, assessment, and management of cardiopulmonary risk in patients with COPD: a modified Delphi Consensus in low-middle income countries

Cardiovascular disease is major determinant of morbidity and mortality in chronic obstructive pulmonary disease (COPD), yet cardiopulmonary risk remains underrecognized and insufficiently addressed, particularly in low- and middle-income countries (LMICs). We developed a multidisciplinary consensus to provide practical recommendations for the identification, assessment, and management of cardiopulmonary risk in COPD, adapted to healthcare systems in emerging countries. A modified Delphi process was conducted by a six-member steering committee and a multidisciplinary panel of 21 experts in pulmonology, cardiology and internal medicine. Clinical questions were developed from unmet needs in COPD care and informed by a systematic literature review of studies published between January 2020 and September 2025. Recommendations were graded according to the Scottish Intercollegiate Guidelines Network (SIGN) methodology and refined through two Delphi rounds with consensus defined as ≥80% agreement. Thirteen recommendations achieved consensus, including 12 (92.3%) with very strong consensus (≥90% agreement) and one (7.7%) with strong consensus (80-90% agreement). The recommendations address three clinical domains: identification and assessment of respiratory and cardiovascular comorbidities, targeted diagnostic testing, and implementation of evidence-based pharmacological and non-pharmacological interventions. This modified Delphi consensus provides a practical framework to support systematic cardiopulmonary risk assessment and individualized management of COPD. Although developed for Mexico, its resource-sensitive approach may facilitate implementation across Latin America and other low- and middle-income countries facing similar healthcare challenges.