The article in response to critiques by Gan et al., Calzetta et al., and Poor on Ensifentrine trials for COPD, Anzueto et al. defend the diverse trial design, aligning with real-world therapy. They address exacerbation endpoints, asserting substantial effects across meaningful subgroups in independent phase 3 trials. Arguing for nebulized delivery, they highlight Ensifentrine's evidence-backed effectiveness in improving FEV1, quality of life, and reducing exacerbations in GOLD Group B COPD.