It is time to further expand research in tailoring self-management of COPD exacerbations!

We are grateful to the editors of the European Respiratory Journal for the opportunity to respond to the letter to the editor by S. Ramakrishnan and M. Bafadhel, whom we thank for their thoughtful remarks about our COPE-III self-management trial [1]. Whereas our study did not show a significant difference in the number of COPD exacerbation days per year, the results showed that exacerbation action plans for COPD patients with comorbidities, embedded in a patient-tailored self-management intervention, reduced the duration of COPD exacerbations and the risk of respiratory-related hospitalisation, without increasing all-cause mortality [1]. In our study, we did not phenotype COPD exacerbations by airway eosinophilic inflammation prior to randomisation. Tailoring self-treatment by adding exacerbation phenotyping could be explored. Evidence on phenotyping effects, an accurate tool to identify eosinophilic exacerbations, and a validated cut-off point are needed before eosinophils can be used in practice. http://bit.ly/2L4b6SR