Results of voting for which criteria should contribute to the definition

Potential criteria for inclusionSurvey 2#Survey 3
calculated ranking
(1=most important)
Survey 4+
% agreement
Mean score% agree
Change in sputum volume and/or colour1.5493296
Increased cough1.64891100
New/increased haemoptysis1.8679892
Increased shortness of breath (parent/patient perceived)1.54100392
Increased respiratory rate2.1464
Increased chest discomfort/chest pain2.0775
Malaise, tiredness, fatigue or lethargy2.1468792
Decreased activity2.54NA
Decreased exercise tolerance2.1471
Temperature >38°C1.9682984
Anorexia or weight loss2.50NA
Change in physical examination of the chest2.29NA
Increased crepitations/crackles2.2168
Increased wheeze2.43NA
New radiographic changes indicative of a pulmonary infection2.18755
Decrease in pulmonary function of ≥10% from a previously recorded value (FEV1 % pred or FVC % pred)2.11754
Raised C-reactive protein2.79NA
Prolonged erythrocyte sedimentation rate3.39NA
Raised white cell count3.00NA
Raised neutrophil count2.96NA
Physician decision to change treatment because of perceived change in condition  692

FEV1: forced expiratory volume in 1 s; FVC: forced vital capacity; NA: neither agree nor disagree. #: in Survey 2, participants (n=28) indicated whether each item should be included in the definition of pulmonary exacerbations (1=strongly agree; 5=strongly disagree). The mean score and the percentage of respondents who agreed are shown. : items which were considered positively in Survey 2 were ranked in Survey 3 (n=25 participants); “physician decision to treat” was added to the list for ranking. We present the calculated rank score from all participants. +: in Survey 4 (n=25 participants), the final wording for included items was agreed. The items included in the final definition are in italics.