Diego J. Maselli Caceres, MD 

Prioritizing Long-Term Control and Steroid Reduction in COPD

Engaging patients in understanding the importance of long-term COPD control and the risks of frequent oral corticosteroid use remains a significant challenge. It is critical to inform not only patients but also health care providers and families about the serious consequences of repeated steroid exposure, including increased exacerbations, hospitalizations, and even mortality. Beyond well-known adverse effects like weight gain, osteoporosis, and diabetes, steroids are also linked to mental health issues such as depression and anxiety, as well as cardiovascular risks. Effective communication strategies, including leveraging electronic medical records to flag exacerbations early, may enable timely interventions and better patient outcomes.

A major difficulty lies in patients who feel well between exacerbations and therefore may not perceive the need for intensified treatment or steroid-sparing therapies. Many patients appreciate the immediate relief steroids provide during flare-ups, making it harder to convey the cumulative harm of repeated short courses over time. Personalizing education by discussing patients’ own experiences with steroid adverse effects—such as skin thinning or blood sugar issues—and framing treatment as prevention of future complications can help increase awareness. Emphasizing the goal of avoiding long-term damage may motivate patients to adhere more closely to maintenance therapies.

In closing, the panel expressed optimism about recent advances in COPD treatment, particularly the availability of new biologics that reduce exacerbations and steroid use. Although personalized approaches are still evolving, these therapies offer hope for patients who have struggled with frequent flare-ups. The clinicians highlighted the rewarding nature of seeing real improvements in patient lives and emphasized the importance of ongoing research to refine treatment selection. Overall, it is an exciting era for COPD care, marked by new tools and a growing understanding of the disease’s underlying biology.

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Panelists discuss the ongoing challenge of engaging patients, providers, and families in understanding the long-term risks of frequent oral corticosteroid use in chronic obstructive pulmonary disease (COPD), emphasizing the importance of clear communication about serious adverse effects—including mental health and cardiovascular risks—and the role of electronic medical records in early intervention; they note that patients often feel well between exacerbations and may undervalue steroid-sparing strategies, so personalized education focusing on preventing future harm is key, and express optimism that new biologics offer promising options to reduce exacerbations and steroid dependence, highlighting the evolving, hopeful landscape of COPD care.

Selecting a Biologic in COPD Management

The introduction of 2 biologics for patients with COPD with high blood eosinophils and frequent exacerbations marks an exciting advancement in treatment. Both therapies have demonstrated reductions in exacerbation risk and the need for oral steroids, which is particularly important since steroids can cause serious adverse effects, especially in patients with multiple health issues. Having these biologic options provides clinicians with new tools to better manage patients who previously had limited choices, potentially improving outcomes by breaking the cycle of frequent exacerbations and steroid use.

When deciding between the 2 biologics, there are some differences to consider, although no definitive guidelines currently exist. Factors such as blood eosinophil levels, presence of certain inflammatory markers, lung function, and patient preference for dosing schedules (every 2 weeks vs every 4 weeks) may guide treatment selection. Cost and insurance coverage also play significant roles in real-world decision-making. Clinicians acknowledge that it can sometimes take trial and error to determine which biologic yields the best response for a given patient, highlighting the need for personalized approaches in the absence of clear-cut criteria.

Ultimately, shared decision-making with patients is crucial, especially when costs are comparable. Patients’ preferences about injection frequency and convenience, as well as their tolerance for potential adverse effects, should be factored in. The availability of 2 biologics offers flexibility, allowing providers to switch therapies if the first choice does not produce adequate results. This evolving landscape reflects progress in COPD care but also underscores the need for further research to better clarify the optimal use of these new treatment options.

Panelists discuss the introduction of 2 biologics for patients with chronic obstructive pulmonary disease (COPD) with high blood eosinophils and frequent exacerbations as a major advancement, highlighting their ability to reduce exacerbations and steroid use; they note differences in dosing schedules, inflammatory markers, and patient preferences that influence therapy choice, emphasize the role of shared decision-making amid cost and insurance challenges, and acknowledge that trial and error may be needed to personalize treatment while calling for more research to optimize biologic use.

Structuring Patient Visits to Ensure Timely COPD Management

Effective management of COPD requires early identification of patients at risk for exacerbations, which can be life-threatening. To achieve this, clinic visits are structured around targeted, probing questions that quickly assess recent exacerbation history. Asking about hospitalizations, emergency department visits, unscheduled doctor visits, and recent use of steroids or antibiotics helps uncover both major and minor flare-ups. Many patients may not recognize or report these events unless specifically asked, so these questions are essential to flag high-risk patients. Early identification allows clinicians to intervene sooner and break the cycle of repeated exacerbations and hospitalizations.

Another challenge is that patients often underestimate or do not fully understand what qualifies as an exacerbation, especially when symptoms are mild or treated outside of specialist care. Educating patients to report any flare-up, even those managed at urgent care or with a short course of steroids, improves communication and ensures timely adjustment of treatment. This is particularly important because many patients receive care from multiple providers and may not volunteer information unless prompted. Continuity of care is further complicated when events occur outside the primary health care system, making it difficult for specialists to stay informed.

Integration of electronic medical records across institutions is becoming a valuable tool to bridge communication gaps. Access to comprehensive records enables providers to see hospital admissions, prescriptions, and clinical notes even if care occurred elsewhere. This data allows for real-time monitoring of exacerbations and better risk stratification. Additionally, encouraging patients to use patient portals to report flare-ups or hospitalizations fosters ongoing engagement. Together, these strategies help clinicians recognize early signs of worsening disease and escalate therapy appropriately to improve patient outcomes.

Panelists discuss the importance of early identification of patients with chronic obstructive pulmonary disease (COPD) at risk for exacerbations through targeted clinical questioning about recent hospitalizations, emergency visits, and steroid or antibiotic use, noting that many patients underreport or misunderstand exacerbations; they emphasize patient education, improved communication across multiple providers, and the integration of electronic medical records and patient portals as key strategies to enhance monitoring, ensure timely treatment escalation, and ultimately reduce exacerbation frequency and severity.

Addressing Barriers to COPD Treatment Escalation and the Importance of Continuity of Care

One of the most common barriers to timely escalation of COPD treatment is the infrequency of patient follow-up visits. Many patients are seen every 3 to 6 months, or even annually if considered stable, which can delay recognition of worsening symptoms or exacerbations. Additionally, patients often receive care from multiple providers and health systems, leading to fragmented communication. Hospitalizations or emergency visits may not be promptly communicated back to the primary COPD specialist, and patients themselves may not always report these events. This lack of timely information creates challenges in adjusting treatment plans effectively and quickly.

Therapeutic inertia also plays a significant role in delayed treatment escalation. Clinicians may continue with familiar management approaches and may not reassess or intensify therapy promptly, especially during busy clinic visits where many competing priorities exist. Patient education can sometimes be insufficient, and many patients lack clear action plans for managing exacerbations or understanding when to seek care. Without frequent monitoring or active engagement, worsening symptoms and risks can be missed, prolonging suboptimal control and increasing the chance of future exacerbations.

To overcome these barriers, a more integrated and proactive approach is necessary. This includes improving communication between specialists, primary care providers, hospitalists, and emergency departments through shared electronic medical records and coordinated care pathways. Implementing rapid posthospitalization follow-up clinics and using dedicated care coordinators or COPD navigators can help ensure patients receive timely reassessment and support. Encouraging patient education about exacerbation management and the importance of informing their care team about hospital visits is also crucial. Together, these strategies can help reduce delays in therapy escalation, improve symptom control, and ultimately decrease exacerbation frequency and severity.

Panelists discuss common barriers to timely escalation of chronic obstructive pulmonary disease (COPD) treatment, including infrequent follow-up visits, fragmented care across multiple providers, and delayed communication of exacerbations or hospitalizations, as well as therapeutic inertia stemming from competing clinical priorities and insufficient patient education; they emphasize the need for integrated, proactive strategies such as shared electronic medical records, rapid posthospitalization follow-up, care coordination, and enhanced patient engagement to overcome these challenges and optimize treatment adjustments.

Diego J. Maselli Caceres, MD

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