COPD is a heterogenous and progressive disease, driven by distinct chronic immune processes. In a round table discussion, leading respiratory experts discussed 
<ol style="margin-top:8px; margin-bottom:11px">
 <li style="margin-top:8px; margin-bottom:11px; margin-left:8px"><a href="https://pro.campus.sanofi/copd/articles/a-video-series-on-round-table-discussions-featuring-experts-current-unmet-needs-for-patients-with-copd" style="color:#0563c1; text-decoration:underline">What are the current unmet needs for patients with COPD?</a></li>
 <li style="margin-top:8px; margin-bottom:11px; margin-left:8px"><a href="https://pro.campus.sanofi/copd/articles/a-video-series-on-round-table-discussions-featuring-experts-different-inflammatory-pathways-in-copd-impacting-disease-pathobiology-and-progression" style="color:#0563c1; text-decoration:underline">How do different inflammatory pathways in COPD impact disease pathobiology and progression?</a></li>
 <li style="margin-top:8px; margin-bottom:11px; margin-left:8px">Biomarkers to guide COPD management. </li>
</ol>
&nbsp;
The round table was chaired by Professor Paola Rogliani of the University of Rome, Italy. Other respiratory experts on the panel were:
Dr. MeiLan Han, Professor of pulmonary critical care medicine at the University of Michigan, Ann Arbor, MI, USA.
Dr. Marc Miravitlles, a chest physician from the Hospital Universitari Vall d’Hebron, Barcelona, Spain.
<h2 style="margin-bottom: 11px;">Biomarkers to guide COPD management</h2>
Check out the video below to gain valuable insights on this topic from the respiratory experts

The article "Biomarkers to guide COPD management" features insights from a round table discussion involving leading respiratory experts. It focuses on chronic obstructive pulmonary disease (COPD), a heterogeneous and progressive condition. The experts discuss the risk factors for frequent exacerbation, use of blood eosinophil count (EOS) as a biomarker in COPD, and the association of EOS with type 2 inflammation.

CHRONIC-OBSTRUCTIVE-PULMONARY-DISEASE-(COPD)

A video series on round table discussions featuring experts: Biomarkers to guide COPD management

In this video, Dr. Miravitlles discusses the biomarkers to guide COPD management, followed by a panel discussion with other experts.
<h3 style="margin-top: 8px; margin-bottom: 11px;">Risk factors for frequent exacerbation</h3>
Dr. Miravitlles started his talk by highlighting that patients with frequent exacerbations are the most challenging and also those having the worst prognosis. Therefore, one of the aims of therapy in COPD is to prevent exacerbations. He explained that to understand the frequent exacerbator phenotype, we need to know the characteristics of these patients. “It is not restricted to very severe patients,” he added. 
Patients who have a history of frequent exacerbations are those likely to suffer frequent exacerbations in the future. 
Other risk factors for frequent exacerbations include:1

Dr. Miravitlles highlighted that the characteristics to identify the frequent exacerbator phenotype in COPD and those requiring more intensive treatment are patients who had more frequent exacerbations or severe exacerbations that resulted in hospital admission, in the past. Furthermore, patients with frequent exacerbations exhibit different mechanisms for exacerbations and are required to be treated differently.

<h3 style="margin-top: 8px; margin-bottom: 11px;">Blood eosinophil count (EOS) as a biomarker in COPD: GOLD scientific committee findings</h3>
Dr. Miravitlles emphasized that there is a need for biomarkers in COPD to guide the practicing clinicians about the first choice of treatment for each type of exacerbation. He further added, “Blood eosinophils (EOS) are a good biomarker to identify COPD patients with a predominant type 2 inflammation.” 
Read more about <a href="https://pro.campus.sanofi/copd/articles/blood-eosinophils-as-a-biomarker-in-patients-with-copd" style="color:#0563c1; text-decoration:underline">blood eosinophils as a biomarker in patients with COPD</a>
<h4 style="margin-top: 8px; margin-bottom: 11px;">Prediction of benefits from inhaled corticosteroids (ICS)</h4>
Blood eosinophil count (BEC [EOS]) should be combined with exacerbation history to predict ICS effects.3 Dr. Miravitlles explained that there are several clinical trials which have demonstrated the use of BEC (EOS) to predict the effects of ICS in preventing exacerbations, particularly when combined with exacerbation history. However, relationship between BEC (EOS) and ICS effects is continuous,3 and there is no clear threshold for BEC (EOS). Thresholds of &lt;100 cells/μL and ≥300 cells/μL help to identify individuals with the lowest and greatest, respectively, likelihood of ICS benefit.3 
Dr. Miravitlles cautioned that if BEC (EOS) is &lt;100 cells/µL, there is almost no effect of ICS and their long-term use can result in more side effects. “In contrast, patients with BEC (EOS) ≥300 cells/µL respond very well to ICS and have a significant reduction in the risk of exacerbations”, he added.

<h4 style="margin-bottom: 11px;">Type 2 inflammation</h4>
Dr. Miravitlles emphasized, “It is clear that there is some relationship between BEC (EOS) and markers of type 2 inflammation.” He further highlighted that the relationship is not perfect, but the relationship between BEC (EOS) and eosinophils in the lower airways is significant.

Learn more about type inflammation in COPD from <a href="https://pro.campus.sanofi/copd/articles/decoding-type-2-inflammation-in-copd-an-expert-perspective" style="color:#0563c1; text-decoration:underline">decoding type 2 inflammation in COPD: An expert’s perspective</a>
<h4 style="margin-bottom: 11px;">Future risk of exacerbations/disease progression</h4>
In younger individuals without COPD, higher BEC (EOS) are associated with increased risk of decline of forced expiratory volume in 1 second and development of COPD.3 “So, it is an important biomarker to identify these risks in a wider population”, Dr. Miravitlles pointed out.
BEC (EOS) cannot be used as a standalone biomarker of future risk without considering exacerbation risk and ICS use.3
Dr. Miravitlles summarized his discussion by saying, “We have an easy-to-use biomarker to identify a particular subgroup of patients who are more likely to respond to some types of drugs, such as ICS and this biomarker can be accessed at all levels of healthcare, even in primary care.” 
<h3 style="margin-bottom: 11px;">Panel discussion</h3>
Dr. Miravitlles’s presentation was followed by individual perspectives of the panel of experts on biomarkers to guide COPD management.
Dr. Rogliani opened the panel discussion by highlighting the need for more biomarkers in the future to characterize patients with chronic obstructive diseases. She further added that BEC (EOS) is easy to use and easy to detect, but we will need a more precise way to detect it, which is still confined to research settings. 
She concluded by saying, “BEC (EOS) is a useful biomarker, and it is helpful to manage patients in daily practice in our daily routine.”
Dr. Han emphasized that the cut offs for BEC (EOS) of 300 cells/µL for initial use of triple therapy and 100 cells/µL for escalating therapy in patients who are continuing to exacerbate on current therapy, provided in the GOLD document are sort of guideposts. She thought that the data for eosinophil-guided ICS, specifically for eosinophils &lt;100 cells/µL was on the weaker side, whereas benefits appear stronger as the eosinophil levels go higher. 
She stated, “In an ideal world we would be using sputum eosinophils, but that’s a challenging biomarker to get outside of our research setting.” “There is a potential for other biomarkers in the future,” she further pointed out.
Dr. Miravitlles added his thoughts, “BEC (EOS) is not a perfect biomarker, but is good enough to be used in clinical practice.” He further emphasized that with the evidence available at present, it is good enough in clinical practice for specialists and general practitioners.

The article "Biomarkers to guide COPD management" features insights from a round table discussion involving leading respiratory experts. It focuses on chronic obstructive pulmonary disease (COPD), a heterogeneous and progressive condition. The experts discuss the risk factors for frequent exacerbation, use of blood eosinophil count (EOS) as a biomarker in COPD, and the association of EOS with type 2 inflammation.

COPD is a heterogenous and progressive disease, driven by distinct chronic immune processes. In a round table discussion, leading respiratory experts discussed 
<ol style="margin-top:8px; margin-bottom:11px">
 <li style="margin-top:8px; margin-bottom:11px; margin-left:8px"><a href="https://pro.campus.sanofi/copd/articles/a-video-series-on-round-table-discussions-featuring-experts-current-unmet-needs-for-patients-with-copd" style="color:#0563c1; text-decoration:underline">What are the current unmet needs for patients with COPD?</a></li>
 <li style="margin-top:8px; margin-bottom:11px; margin-left:8px">How do different inflammatory pathways in COPD impact disease pathobiology and progression?</li>
 <li style="margin-top:8px; margin-bottom:11px; margin-left:8px"><a href="https://pro.campus.sanofi/copd/articles/a-video-series-on-round-table-discussions-featuring-experts-biomarkers-to-guide-copd-management">Biomarkers to guide COPD management. </a></li>
</ol>
&nbsp;
The round table was chaired by Professor Paola Rogliani of the University of Rome, Italy. Other experts on the panel were:
Dr. MeiLan Han, Professor of Pulmonary Critical Care Medicine at the University of Michigan, Ann Arbor, MI, USA.
Dr. Marc Miravitlles, a chest physician from the Hospital Universitari Vall d’Hebron, Barcelona, Spain.
<h2 style="margin-bottom: 8px;">How do different inflammatory pathways in COPD impact disease pathobiology and progression?</h2>
Watch the video below to gain insights on this topic from the respiratory experts.

The article "How do different inflammatory pathways in COPD impact disease pathobiology and progression?" features insights from a round table discussion involving leading respiratory experts. It focuses on chronic obstructive pulmonary disease (COPD), a heterogeneous and progressive condition. The experts delved into the inflammatory processes in COPD, particularly type 2 pathway and its associated endotype, emphasizing the importance of identifying patients by endotypes.

A video series on round table discussions featuring experts: Different inflammatory pathways in COPD impacting disease pathobiology and progression

In this video, Dr. Han provides answers to a pertinent question from Prof. Rogliani, “How do different inflammatory endotypes of COPD impact disease pathogenesis and progression?”
<h3 style="margin-bottom: 8px;">COPD is a heterogenous disease</h3>
COPD is the end-result of complex, cumulative and dynamic gene-environment interactions over the lifetime that can damage the lungs and/or alter their normal developmental or aging processes.1
<h3 class="Default" style="margin-bottom: 8px;">Inflammatory processes in COPD</h3>
Dr. Han remarked that traditionally, it is believed that COPD is driven by neutrophilic inflammation. COPD is typically associated with increased macrophages in peripheral airways, lung parenchyma and pulmonary vessels, along with activated neutrophils and lymphocytes.1 Neutrophils stimulate mucus hypersecretion and generate further oxidative stress, which can perpetuate inflammation.2
Airway damage following exposure to cigarette smoke and pollutants leads to an&nbsp;epithelial alarmins-mediated pro-inflammatory cascade, involving key cytokines such as IL-33, IL-25 and thymic stromal lymphopoietin (TSLP).3 Altered barrier function resulting from airway damage also predisposes the airway to infection, further amplifying the type 1 inflammatory cascade.3

<h3>Type 2 pathway in COPD</h3>
Dr. Han highlighted, “In recent years, we've begun to better appreciate another inflammatory pathway that can be important in some patients with COPD, which is type 2 inflammation.”
Listen to an expert’s perspective on <a href="https://pro.campus.sanofi/copd/articles/decoding-type-2-inflammation-in-copd-an-expert-perspective" style="color:#0563c1; text-decoration:underline">Decoding Type 2 Inflammation in COPD</a>
Type 2 inflammation in COPD encompasses type 2 effector cells, including type 2 helper cells (Th2), innate lymphoid cells (ILC2), eosinophils and mast cells, as well as key cytokines such as IL-4, IL-5, and IL-13.4,5

Learn more about the <a href="https://pro.campus.sanofi/copd/articles/role-of-type-2-inflammation" style="color:#0563c1; text-decoration:underline">Role of Type 2 Inflammation</a>
<h3>COPD endotype with type 2 inflammation</h3>
A subset of patients with COPD and type 2 airway inflammation has been identified, even after excluding features of asthma.4,8 The prevalence of persistently elevated blood eosinophil count (BEC [EOS]) varies between studies, depending on population characteristics and threshold definitions used for evaluation.4
Read more about <a href="https://pro.campus.sanofi/copd/articles/blood-eosinophils-as-a-biomarker-in-patients-with-copd" style="color:#0563c1; text-decoration:underline">Blood Eosinophils as a Biomarker in Patients with COPD</a>
In this context, Dr. Han discussed the ECLIPSE (Evaluation of COPD Longitudinally to Identify Predictive Surrogate End-points) cohort study, which demonstrated that 37% of patients with COPD (n=554/1483) had persistently elevated BEC (EOS) (≥2%).8

Referring to two studies in frequent exacerbators receiving triple therapy for COPD, Dr. Han pointed out that, “BEC (EOS) can be seen elevated in patients with frequent exacerbations.”

She also emphasized, “So this is actually an incredibly common finding in COPD.”
<h3>Panel discussion</h3>
Following Dr. Han’s presentation, the panel of experts put forth their opinions on the involvement of type 2 inflammation in COPD pathogenesis.&nbsp;
Dr. Rogliani pointed out that endotyping is a key to properly understanding the&nbsp;disease and how to eventually treat COPD patients.
She added that airway epithelium is the key aspect in determining the type of&nbsp;inflammatory profile a patient can exhibit because it will respond differently upon&nbsp;exposure to different stimuli such as pollution/smoking/infection, infection and&nbsp;smoking. “This will lead to a different cascade of inflammatory mediators, cytokines&nbsp;and also on cellular level such as eosinophils”, Dr. Rogliani further highlighted.
Dr. Miravitlles pointed out that the possibility of availability of biomarkers that can&nbsp;easily be used by all practicing physicians — not only specialists, but also in primary&nbsp;care — to identify patients with different endotypes, can help to move from bench to&nbsp;bedside (i.e. to move from the research arena to the clinical practice).&nbsp;
For more information, please read <a href="https://pro.campus.sanofi/copd/articles/a-review-of-the-clinical-implications-of-eosinophil-stability-and-predictive-capability-in-copd" style="color:#0563c1; text-decoration:underline">A review of the clinical implications of eosinophil stability and predictive capability in COPD</a>
Dr. Rogliani agreed that it could be a good start to characterize the patient&nbsp;differently from the standpoint of inflammatory profile.
Dr. Han added that blood eosinophils are there for clinicians right now. She&nbsp;highlighted that patients really benefit clinically from steroids, but it is terrible that&nbsp;chronic use of steroids is associated with long term harms. Further, she added,&nbsp;“There is subset of patients which does have type 2 inflammation. We need to find&nbsp;better ways of identifying such patients because they really would benefit from&nbsp;targeted therapies.”
Dr. Rogliani concluded this topic by saying, “Identification of the right patient is the&nbsp;key in order to better treat and better approach COPD patients.”

The article "How do different inflammatory pathways in COPD impact disease pathobiology and progression?" features insights from a round table discussion involving leading respiratory experts. It focuses on chronic obstructive pulmonary disease (COPD), a heterogeneous and progressive condition. The experts delved into the inflammatory processes in COPD, particularly type 2 pathway and its associated endotype, emphasizing the importance of identifying patients by endotypes.

COPD is a heterogenous and progressive disease, driven by distinct chronic immune processes. In a round table discussion, leading respiratory experts discussed 
<ol style="margin-top:8px; margin-bottom:11px">
 <li style="margin-top:8px; margin-bottom:11px; margin-left:8px">What are the current unmet needs for patients with COPD?</li>
 <li style="margin-top:8px; margin-bottom:11px; margin-left:8px"><a href="https://pro.campus.sanofi/copd/articles/a-video-series-on-round-table-discussions-featuring-experts-different-inflammatory-pathways-in-copd-impacting-disease-pathobiology-and-progression" style="color:#0563c1; text-decoration:underline">How do different inflammatory pathways in COPD impact disease pathobiology and progression?</a></li>
 <li style="margin-top:8px; margin-bottom:11px; margin-left:8px"><a href="https://pro.campus.sanofi/global/copd/articles/a-video-series-on-round-table-discussions-featuring-experts-biomarkers-to-guide-copd-management">Biomarkers to guide COPD management. </a></li>
</ol>
&nbsp;
The round table was chaired by Professor Paola Rogliani of the University of Rome, Italy. Other respiratory experts on the panel were:
<ul>
 <li style="margin-top: 8px; margin-bottom: 11px;">Dr. MeiLan Han, Professor of Pulmonary Critical Care Medicine at the University of Michigan, Ann Arbor, MI, USA.</li>
 <li style="margin-top: 8px; margin-bottom: 11px;">Dr. Marc Miravitlles, a chest physician from the Hospital Universitari Vall d’Hebron, Barcelona, Spain.</li>
</ul>
<h2 style="margin-top: 8px; margin-bottom: 11px;"><a>What are the current unmet needs for patients with COPD?</a></h2>
Watch the video below to gain insights on this topic from the respiratory experts

In a roundtable chaired by Professor Paola Rogliani, Dr. Marc Miravitlles highlighted the need for personalized COPD therapies, improved diagnostics, and greater awareness of non-smoking risk factors to better manage exacerbations and disease progression.

RESPIRATORY

A video series on round table discussions featuring experts: Current unmet needs for patients with COPD

In this video, Dr. Miravitlles discusses the current unmet needs in patients with COPD, followed by a panel discussion with other experts.
<h3 style="margin-top: 8px; margin-bottom: 11px;"><a>How Global Initiative for Chronic Obstructive Lung Disease (GOLD) defines chronic obstructive pulmonary disease (COPD)?</a></h3>
COPD is a heterogeneous lung condition characterized by chronic respiratory symptoms (dyspnea, cough, expectoration and/or exacerbations) due to abnormalities of the airways (bronchitis, bronchiolitis) and/or alveoli (emphysema) that cause persistent, often progressive, airflow obstruction.1
According to Dr.&nbsp;Miravitlles, “Despite airflow obstruction in all patients with COPD, they may have very different types of disease.”
<h3 style="margin-top: 8px; margin-bottom: 11px;"><a>Global burden of COPD</a></h3>
COPD is a leading cause of morbidity and mortality.2 Global burden of COPD continues to increase.2 COPD is currently the third leading cause of death worldwide and the seventh leading cause of poor health and disability.3 
Smoking is the leading risk factor for the development of COPD.4,5 Dr. Miravitlles highlighted, “Cigarette smoking is the leading cause of COPD in most developed countries — in the United States, in Europe, Japan and around the world.” However, 25%–45% of people with COPD in the United States and other developed countries reportedly have never smoked.4 In low- and middle-income countries, up to 70% of cases of COPD are non-smokers.6 
Second-hand smoke exposure has been implicated as a potential risk factor for the development of COPD in non-smokers.5 Non-smoking risk factors may include indoor4 and outdoor air pollution and infections.6
<h3 style="margin-top: 8px; margin-bottom: 11px;"><a>COPD exacerbations&nbsp;</a></h3>
<h4 style="margin-top: 8px; margin-bottom: 11px;"><a>Incidence and prevalence</a></h4>
Studies have shown that exacerbations are common among patients with COPD.7,8,9&nbsp;
Dr. Miravitlles noted, “More than one-half of patients with moderate-to-severe COPD experience exacerbations.”

Of 52% of patients with moderate-to-severe exacerbations in the Spanish study, 12% had 1 severe exacerbation, 8% had ≥2 moderate and/or severe exacerbations, and 9% had ≥3 moderate-to-severe exacerbations.8
<h4>Clinical impact</h4>
Dr. Miravitlles highlighted the clinical impact of COPD exacerbations, “Patients with frequent exacerbations also have an accelerated decline in lung function.”&nbsp; Moreover, exacerbations can have potentially irreversible effects on lung function. In a retrospective analysis of the 4-year, randomized, double-blind, placebo-controlled, parallel group UPLIFT® (Understanding Potential Long-term Impacts on Function with Tiotropium) trial, the annual decline in post-bronchodilator FEV1 was nearly doubled after a single moderate-to-severe exacerbation.10
For more information, please watch the video on <a href="https://pro.campus.sanofi/copd/articles/the-burden-and-risk-of-exacerbations-in-copd-according-to-dr-surya-bhatt" style="color:#0563c1; text-decoration:underline">the burden and risk of exacerbations in COPD presented by Dr. Surya Bhatt</a>, a distinguished professor of medicine at the University of Alabama at Birmingham and a COPD researcher.
An observational study conducted using data from the UK clinical practice research datalink (<a href="https://www.cprd.com/" style="color:#0563c1; text-decoration:underline">CPRD</a>) Aurum database, reported that the frequency of future exacerbations increased with increased frequency and severity of exacerbations at baseline in patients with COPD.
As emphasized by Dr. Miravitlles, “Even a single moderate exacerbation increases risk of future exacerbation events,” the adjusted incidence rate ratio for future exacerbation (vs 0 exacerbation) was 1.70 (95% CI: 1.66–1.74) with 1 moderate exacerbation according to the CPRD Aurum database study.7
Read this article to find out more about the <a href="https://pro.campus.sanofi/copd/articles/the-impact-of-exacerbations-in-copd" style="color:#0563c1; text-decoration:underline">the impact of exacerbations in COPD</a>.
The CPRD Aurum database study also reported an association between increased frequency and severity of baseline exacerbations with mortality (all cause/COPD-related/cardiovascular-related).7
<h4>Impact on quality of life</h4>
While explaining impact of exacerbations, Dr. Miravitlles further highlighted, “It’s not just lung function, patients with COPD complain of impairment in quality of life, which is even more impaired when they experience a severe exacerbation.” Exacerbations have an impact on daily activities of the patient, such as walking, sleeping, talking, and sexual life.11 Furthermore, reduced physical activity levels have been associated with an increased risk of further exacerbations and mortality.11
<div>
 <div>
 &nbsp;
 </div>
</div>

“There is a vicious circle of more symptoms, reduced activity, even more symptoms. We need to break this vicious circle by providing adequate treatment for not only acute exacerbations, but also for stable COPD”, Dr. Miravitlles pointed out.
<h3 style="margin-top: 8px; margin-bottom: 11px;"><a>COPD exacerbations despite maximal inhaled therapy</a></h3>
Dr. Miravitlles called attention to frequent exacerbations despite triple therapy with inhaled corticosteroids (ICS), long-acting muscarinic antagonist (LAMA) and long-acting β2 agonist (LABA), representing a crucial unmet need,12 “There are patients who despite optimal or maximal inhaled therapy are still experiencing exacerbations.”
Discover more about <a href="https://pro.campus.sanofi/copd/articles/understanding-and-managing-copd-exacerbations" style="color:#0563c1; text-decoration:underline">understanding and managing COPD exacerbations</a>.
In this context, Dr. Miravitlles discussed a UK study involving 43,753 patients with COPD receiving maintenance therapy. Of the overall study population, 6480 (15%) patients were frequent exacerbators, defined as those who had experienced ≥1 severe or ≥2 moderate exacerbations despite ≥3 months of continuous treatment with triple therapy in the prior 12 months.12 During the 12-month follow-up in the UK study, frequent exacerbators reported a mean of 2.55 (vs 1.19) exacerbations even after triple therapy. These patients also had a significantly higher risk of COPD-related death (5.8% vs 2.1%, P &lt;0.0001) than other maintenance therapy-treated patients. Importantly, almost one-quarter of frequent exacerbators exhibited a high blood eosinophil count&nbsp;(BEC [EOS]) (≥250 cells/µL) and ≥3 exacerbations.12
Learn more about <a href="https://pro.campus.sanofi/copd/articles/blood-eosinophils-as-a-biomarker-in-patients-with-copd" style="color:#0563c1; text-decoration:underline">blood eosinophils as a biomarker in patients with COPD</a>.
<h3 class="Default" style="margin-top: 8px;"><a>Unmet needs in COPD&nbsp;</a></h3>
In his concluding slide, Dr. Miravitlles presented the conclusions and recommendations reached by the Lancet Commission from their analysis of the current landscape of COPD.2 
COPD diagnosis relies almost exclusively on post-bronchodilator spirometry despite the heterogeneity of COPD. However, post-bronchodilator spirometry is neither sensitive for early pathological changes nor predictive of symptoms.2 As a result, COPD is often underdiagnosed or diagnosis is delayed, often until lung function is substantially impaired.2 Thus, making disease management more challenging. 
The Lancet commission put forth urgent recommendations for driving transformational change and assessing progress, acknowledging that evidence to support their proposals is currently lacking.2 
Dr. Miravitlles concluded, “so far, the guidelines recommend a kind of treatment that is quite simplistic in the sense that despite the heterogeneity of the disease, we do not have evidence to recommend a more personalized therapy. Therefore, we are still treating the majority of patients in a quite a standardized way. As a result, some patients, particularly moderate to severe, are still experiencing exacerbations despite the therapy.”
<h3 class="Default" style="margin-top: 8px; margin-bottom: 6px;"><a>Panel discussion</a></h3>
Following Dr. Miravitlles presentation, the panel of experts added their views on the current unmet needs in patients with COPD.
Dr.&nbsp;Rogliani pointed out, “Post-bronchodilation spirometry is inadequate to detect early phase of the disease, which can really have an impact in terms of the natural history of the disease.” She further added that exacerbations are very different in terms of their nature, occurrence, and management approach.
Dr.&nbsp;Han opined, “Not all COPD is related to tobacco smoke.” She added that patients may get COPD from occupational exposures, recurrent respiratory infections, asthma along with early life factors; therefore, exposure history is important from public health perspective. 
She emphasized upon, “Increasing public awareness, increasing physician awareness and trying to track and identify patients with a different idiotype and move them into clinical trials.” 
On this note, Dr.&nbsp;Rogliani highlighted the need for a different approach towards COPD.
Dr.&nbsp;Miravitlles agreed and highlighted, “We need to address different aspects of the disease, starting with the risk factors.” He also added that there is a need to pay attention to the most severe patients, who are on the so-called maximum therapy. 
Dr. Han said that good therapies are available, but the primary need is for better therapies, because patients suffering from frequent exacerbations and significant morbidity and disability, despite the currently available therapies, still there.

In a roundtable chaired by Professor Paola Rogliani, Dr. Marc Miravitlles highlighted the need for personalized COPD therapies, improved diagnostics, and greater awareness of non-smoking risk factors to better manage exacerbations and disease progression.

What if you could identify higher-risk patients?&nbsp;&nbsp;
A deeper look at the inflammation behind exacerbations could ignite new thinking in COPD. Look for blood eosinophils, a biomarker of COPD with Type 2 Inflammation, which may help you identify those patients at increased risk of exacerbations.
Watch the video below to better understand exacerbations in COPD and better identify patients at risk.&nbsp;&nbsp;&nbsp;

Understanding type 2 inflammation may help shed light on why some patients continue to exacerbate. Watch this video to learn how.

One minute to ignite new thinking in COPD

Ignite new thinking in COPD -&nbsp;COPD, chronic obstructive pulmonary disease
In patients with COPD, exacerbations may :&nbsp;
<ul>
 <li>Increase the risk of another&nbsp;1</li>
 <li>Accelerate lung function decline&nbsp;2</li>
 <li>Increase morbidity and mortality risk&nbsp;1,3-6</li>
</ul>
Different types of chronic inflammation have an important role in COPD&nbsp;7-15 
 Type 2 inflammation and beyond type 2 inflammation 
 Identifying COPD patients with type 2 inflammation may help determine those at increased risk of exacerbations 16 
 Look for blood eosinophils, a biomarker of COPD with type 2 inflammation 17,18, a, b 
 EOS ≥ 300 cells/ μL à 32% increased risk of COPD exacerbations 16a,b 
 Understanding type 2 inflammation in COPD may shed light on why some patients continue to experience exacerbations
a Results from an observational analysis of 1553 patients with GOLD spirometry grade 2-4 COPD evaluating the relationship between blood eosinophil count and COPD exacerbation risk. b Stratified analysis confirmed that increased exacerbation risk was driven by subjects with a history of frequent exacerbations, defined as ≥2 exacerbations per year.

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Understanding type 2 inflammation may help shed light on why some patients continue to exacerbate. Watch this video to learn how.

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