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María Merino,1 Teresa Martín Lorenzo,1 Paulina Maravilla-Herrera,1 Julio Ancochea,2– 4 José Tomás Gómez Sáenz,5 Nicole Hass,6 Jesús Molina,7 Germán Peces-Barba,8 Marta Trapero-Bertran,9 Juan Antonio Trigueros Carrero,10 Álvaro Hidalgo-Vega11 1Health Outcomes Research, Weber, Madrid, Spain; 2Pulmonology Service, La Princesa University Hospital - IIS-Princesa, Madrid, Spain; 3Faculty of Medicine, Universidad Autónoma de Madrid, Madrid, Spain; 4Respiratory Diseases Networking Biomedical Research Centre - CIBERES, Carlos III Institute of Health - ISCIII, Madrid, Spain; 5Nájera Health Centre, Nájera, La Rioja, Spain; 6Chronic Obstructive Pulmonary Disease Patient and Family Association - APEPOC, Pontevedra, Spain; 7Francia Health Centre, Fuenlabrada, Madrid, Spain; 8Pulmonology Service, Fundación Jiménez Díaz University Hospital, Madrid, Spain; 9Basic Sciences Department, University Institute for Patient Care, Universitat Internacional de Catalunya, Barcelona, Spain; 10Menasalbas Health Centre, Mensalbas, Toledo, Spain; 11Department of Economic Analysis and Finances, Universidad de Castilla-La Mancha, Toledo, SpainCorrespondence: María Merino, Health Outcomes Research, Weber, Calle Moreto 17, 5° Dcha, Madrid, 28014, Spain, Tel +34 91 639 38 24, Fax +34 91 634 6643, Email maria.merino@weber.org.esPurpose: To define a set of proposals that would improve the current management of chronic obstructive pulmonary disease (COPD) within the Spanish National Healthcare System (SNHS) from a comprehensive multidisciplinary perspective and to assess the impact of its implementation from clinical, healthcare, economic, and social perspectives.Patients and Methods: A group of 20 stakeholders related to COPD (healthcare professionals, patients, and informal caregivers, among others) participated in an online Delphi process to agree on a set of 15 proposals that would improve the current management of COPD within the SNHS in four areas: diagnosis, risk stratification

Juan Antonio Riesco,1,2 Bernardino Alcázar,3 Juan Antonio Trigueros,4 Anna Campuzano,5 Joselín Pérez,5 José Luis Lorenzo5 1Pulmonology Department, Hospital San Pedro de Alcántara, 2Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Cáceres, 3Pulmonology Department, Hospital La Loja, Granada, 4Centro de Salud de Menasalvas, Toledo, 5Grupo Ferrer Internacional, Barcelona, Spain Purpose: Smoking can affect both the phenotypic expression of COPD and factors such as disease severity, quality of life, and comorbidities. Our objective was to evaluate if the impact of active smoking on these factors varies according to the disease phenotype. Patients and methods: This was a Spanish, observational, cross-sectional, multicenter study of patients with a diagnosis of COPD. Smoking rates were described among four different phenotypes (non-exacerbators, asthma-COPD overlap syndrome [ACOS], exacerbators with emphysema, and exacerbators with chronic bronchitis), and correlated with disease severity (body mass index, obstruction, dyspnea and exacerbations [BODEx] index and dyspnea grade), quality of life according to the COPD assessment test (CAT), and presence of comorbidities, according to phenotypic expression. Results: In total, 1,610 patients were recruited, of whom 46.70% were classified as non-exacerbators, 14.53% as ACOS, 16.37% as exacerbators with emphysema, and 22.40% as exacerbators with chronic bronchitis. Smokers were predominant in the latter 2 groups (58.91% and 57.67%, respectively, P=0.03). Active smoking was significantly associated with better quality of life and a higher dyspnea grade, although differences were observed depending on clinical phenotype. Conclusion: Active smoking is more common among exacerbator phenotypes and appears to affect quality of life and dyspnea grade differently, depending on the clinical expression of the disease. Keywords: COPD, phenotyp