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Article History

Received: 21 January 2026

Accepted: 1 September 2026

First Online: 12 September 2026

Declarations

Ethics approval and consent to participate: The study protocol was approved by the Anonymized Data Ethics Protocols and Transparency committee (PROTOCOL2361) and was registered with the HMA-EMA Catalogues of real-world data sources and studies (EUPAS1000000783). After development of the protocol, the US Food and Drug Administration approved biologics therapy for patients with a lower blood eosinophil count; we therefore extended the protocol to include a sensitivity analysis of using that threshold for definition of eosinophilic COPD. Because of sparse numbers, we additionally removed patients with physician-reported sex other than male or female. The Reporting of studies Conducted using Observational Routinely-collected Data (RECORD) checklist guided reporting (Appendix Table 9).

Consent for publication: Not applicable.

Competing interests: Christian Schnier:Reports research funding from HDRUK, paid to his institution.P Jane McDowell:Reports speaker’s honoraria from GSK and AZ; participation on advisory boards for GSK and AZ and received support for attending educational meetings from AZ and GSK.John Busby:Reports receiving research funding from AstraZeneca, paid to his institution.David Price:David B. Price has advisory board membership with AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Novartis, Viatris, Teva Pharmaceuticals; consultancy agreements with AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Novartis, Viatris, Teva Pharmaceuticals; grants and unrestricted funding for investigator-initiated studies (conducted through Observational and Pragmatic Research Institute Pte Ltd) from AstraZeneca, Chiesi, Viatris, Novartis, Regeneron Pharmaceuticals, Sanofi Genzyme, and UK National Health Service; payment for lectures/speaking engagements from AstraZeneca, Boehringer Ingelheim, Chiesi, Cipla, Inside Practice, GlaxoSmithKline, Medscape, Viatris, Novartis, Regeneron Pharmaceuticals and Sanofi Genzyme, Teva Pharmaceuticals; payment for travel/accommodation/meeting expenses from AstraZeneca, Boehringer Ingelheim, Novartis, Medscape, Teva Pharmaceuticals.; owns 74% of the social enterprise Optimum Patient Care Ltd (Australia and UK) and 92.61% of Observational and Pragmatic Research Institute Pte Ltd (Singapore); is peer reviewer for grant committees of the UK Efficacy and Mechanism Evaluation Programme, and Health Technology Assessment; and he was an expert witness for GlaxoSmithKline.Jennifer K Quint:Reports having been supported by institutional research grants from UKRI, NIHR, Health Data Research UK, BI, AZ, Insmed, and received personal fees for advisory board participation, consultancy or speaking fees from GlaxoSmithKline, BI.Aziz Sheik:Reports being co-investigator on NIHR grant and an unrelated grant to his institution from GSK.Lian G Heaney:LGH has previously participated in advisory boards and given lectures at meetings supported by Amgen, AstraZeneca, Boehringer Ingelheim, Chiesi, Circassia, Hoffmann la Roche, GlaxoSmithKline, Novartis, Theravance, Evelo Biosciences, Sanofi, and Teva; he has received grant support from MedImmune, Novartis UK, Roche/ Genentech Inc, GlaxoSmithKline, Amgen, Genentech/Hoffman la Roche, Astra Zeneca, MedImmune, Glaxo Smith Kline, Aerocrine and Vitalograph; he has received sponsorship for attending international scientific meetings from AstraZeneca, Boehringer Ingelheim, Chiesi, GSK and Napp Pharmaceuticals; he has also taken part in asthma clinical trials sponsored by AstraZeneca, Boehringer Ingelheim, Hoffmann la Roche, and GlaxoSmithKline for which his institution received remuneration; he was the Academic Lead for the Medical Research Council Stratified Medicine UK Consortium in Severe Asthma which involved industrial partnerships with a number of pharmaceutical companies including Amgen, AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Hoffmann la Roche, and Janssen.