Type 2 inflammation in chronic obstructive pulmonary disease: A promising treatable trait and practice recommendations.

Background: Type 2 inflammation is a key inflammatory endotype of chronic obstructive pulmonary disease (COPD). The precise identification and targeted intervention of treatable traits related to type 2 inflammation are crucial directions in the current management of COPD. Recently, a growing body of evidence-based medical data has accumulated regarding the clinical characteristics, biomarkers, therapeutic agents, and efficacy evaluation of type 2 inflammation in COPD, providing strong support for clinical diagnosis and treatment. This clinical practice recommendation systematically reviewed the evidence-based medical literature and integrated clinical experience to present expert opinions, aiming to standardize and improve the management of type 2 inflammation in COPD. Methods: This clinical practice recommendation followed Appraisal of Guidelines for Research and Evaluation II (AGREE II) and the Reporting Items for Practice Guidelines in HealThcare (RIGHT) statement to ensure the thoroughness and transparency. Clinical questions were primarily derived from surveys among experts in the field and thorough discussion at meetings. The evidence grading levels and recommendation grades adopted in the clinical practice recommendation follow the evidence grading levels and recommendation grades established by the Oxford Centre for Evidence-Based Medicine. The expert opinions were formulated through open discussion and expert voting. Expert opinions with an agreement rate of 80 % or higher among the experts are incorporated in the clinical practice recommendation. Results: Eight clinical questions concerning diagnosis and treatment were proposed after expert discussion. In addition, fifteen specific major points of expert opinions about type 2 inflammation in COPD, involving clinical features, biomarkers, correlation with clinical outcomes, inhaled corticosteroid (ICS) treatment, biologic treatment and treatment response, were determined. Conclusions: A set of comprehensive clinical practice recommendations focusing on the treatable trait of type 2 inflammation in COPD was established, which may provide potential guidance for the precision management of COPD.