LAUSR

exacerbation is made, maximal effort should be undertaken to better characterize endotypes and identify treatable traits, instead of contemplating the correct clinical label. The current method for severity classification is determined by healthcare systems. The Rome proposal instead uses the visual analog scale for dyspnea, heart rate, respiratory rate, and C-reactive protein. The thresholds were derived from observational cohorts of hospitalized patients. However, this lacks specificity because most patients treated in the outpatient setting are also tachypneic and tachycardic and have a visual analog scale score for dyspnea greater than 5 (4), and C-reactive protein is frequently raised in patients with COPD exacerbations treated in the community (5). Furthermore, in hospitalized exacerbations from the BACE (Azithromycin for Acute Exacerbations Requiring Hospitalization) study (6), many patients would not evenmeet the criteria for a moderate event (Figure 1). Overall, the Rome proposal is a bold step forward to break the mold of our healthcare use–based definition of COPD exacerbations. More work is needed to continue to improve on this to define treatable traits of exacerbations. The CICERO (Collaboration in COPD Exacerbations) program (7) will capture all exacerbations seen in the hospital, inclusive of worsening of comorbidities, with detailed assessments to determine the above.