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Inhaled corticosteroids (ICS) are widely used to treat patients with chronic obstructive pulmonary disease (COPD). Their main impact is to reduce the risk of exacerbations; in contrast to long-acting bronchodilators their effects on symptoms and lung function are small and insufficient to use as a guide of treatment efficacy. As a result, ICS are applied in a “risk-directed” fashion, with treatment directed at patients deemed to be at risk of exacerbations because of a past history of events, and/or poor lung function 1. A better, more precise strategy would be to apply treatment in a targeted fashion according to a biomarker indicating the likelihood that corticosteroid treatment will have a positive effect on the outcome of interest ( i.e. reduction in exacerbations or decline in lung function). Blood eosinophil count can identify eosinophilic airway inflammation, a “treatable trait” of COPD
Pavord et al. (2016) studied this question.