ANTES B+ Clinical Trial

Inclusion Criteria: * Female or male * 40-80 yrs. of age * Current/former smokers ≥10 pack-year * Diagnosis of COPD according to GOLD 2023 (post-bronchodilator(BD) FEV1/FVC\<0.7 in the appropriate clinical context) with FEV1 post-BD 30-70% of the reference value * B+ phenotype * CAT≥10 despite being on LABA-LAMA for ≥3 months, and * 1 moderate ECOPD in the previous year (treated with a short course of oral steroids and/or antibiotics), and * ≥150 blood Eos/ μL (as determined by a single Eos measurement in the previous 12 months available in the medical record of the patient) * A signed and dated written informed consent prior to study participation. Exclusion Criteria: * GOLD E (≥2 moderate or 1 severe ECOPD in the previous year) * ICS treatment (or oral steroid for whatever reason) during the last 8 weeks (10) * ECOPD during the last 8 weeks * Current diagnosis of asthma or documented history of asthma in the medical record of the patient according to the 2023 Global Initiative for Asthma (GINA) guidelines or other accepted guidelines * Other concomitant respiratory disease (e.g., bronchiectasis, lung fibrosis, lung neoplasm) * Use of domiciliary long-term oxygen therapy or non-invasive ventilation * Alpha-1 antitrypsin deficiency * Unstable or life-threatening cardiac disease, including: * Myocardial infarction or unstable angina in the last 6 months * Unstable or life-threatening cardiac arrhythmia requiring intervention in the last 3 months. * New York Heart Association (NYHA) Class IV Heart failure. * Participation on Pulmonary Rehabilitation Program within 4 weeks prior to Screening or subjects who plan to enter the acute phase of a Pulmonary Rehabilitation Program during the study. * Long term antibiotic therapy (antibiotics are allowed for the short-term treatment of an exacerbation or for short term treatment of other acute infections during the study). * Systemic, oral, parenteral corticosteroids used for COPD and/or other diseases in the 8 weeks before entering in the study (oral/systemic corticosteroids may be used to treat COPD exacerbations during the study). * Active neoplasm * Life expectancy \< 1 yr. * Current participation in other RCTs (randomized clinical trial) * Non-compliance: subjects at risk of non-compliance, or unable to comply with the study procedures. * Any disease, disability, or geographic location that would limit compliance for scheduled visits. * Known allergy to Trelegy® components (vilanterol, umeclidinium and/or fluticasone furoate) or inability to use the Ellipta® device. * Women who are pregnant or lactating or are planning to become pregnant during the study.