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. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/).

中文翻译：

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慢性阻塞性肺疾病恶化的更新定义和严重性分类：罗马提案。

目前对慢性阻塞性肺病 (COPD) 恶化 (ECOPD) 的定义仅基于呼吸道症状的恶化，其严重程度由用于治疗该事件的医疗资源进行事后分类，这可能因从业者和医疗保健系统而异。这些缺点支持将 ECOPD 定义和严重性分类修改为在与患者接触时有用的定义。为实现这一目标，专家小组使用了改进的德尔菲法，该方法由对文献进行彻底审查产生的五轮问题组成，并辅以虚拟讨论。对于确定的 80 个问题，一致性水平使用李克特量表从 0（非常不同意）到 9（非常同意）进行评级。共识被预先定义为中位得分≥7（强一致）。提议的定义指出：“