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Conversely, it was thought that relatively healthy participants without underlying disease are likely to be current smokers

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With the deeper understanding of the inflammatory mechanisms of COPD, it has been found that neutrophilic inflammation is the most common type of inflammation, but 20% to 40% of patients also belong to the type 2 inflammatory endotype, characterized by elevated eosinophils (EOS) ( The differences in eosinophil counts may determine different responses to inhaled corticosteroid (ICS) therapy ( post hoc analysis showed that ICS-containing regimens had little to no effect when blood eosinophil count was less than 100 cells/L, and thus this threshold could be used to identify patients with a low likelihood of benefit from treatment with ICS ( The pathogenesis of patients with COPD is complex, and although it is currently recommended that group E patients with blood eosinophil count 300/L should be treated with the triple therapy of ICS + LAMA + LABA, some patients are still poorly controlled after the triple therapy [1]

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