ALA Spokesperson and professor at Baylor College of Medicine.

Francesca Polverino, MD, PhD

COPD is not a complex disease, Polverino explains. It's only complex to treat because of limited understanding.

The Practical Hurdles in COPD Detection, with Francesca Polverino, MD, PhD

 is heterogeneous and often laden with confounding symptoms and severe comorbidities. But that doesn’t mean it’s a complicated disease — its treatment is complicated because of our clinical shortcomings.

In the second segment of an interview with 

2025 Global Initiative for Chronic Obstructive Lung Disease (GOLD) International COPD Conference

 in Philadelphia, PA, this week, Francesca Polverino, MD, PhD, professor of pulmonary medicine at Baylor College of Medicine discussed the issue of practical limitations in refining the diagnosis, treatment, maintenance, and monitoring of COPD.

“We call COPD a complex disease because we don't understand it,” Polverino said. “But COPD is not a complex disease. We make it complex because we don't understand that all these phenotypes or endotypes that we observe in the clinic are all different diseases with different pathologies that should be treated all in different ways. And this is the importance of the biomarkers.”

 and utility; she also noted that there’s a lack of understanding around the disease’s clinical drivers and manifestations at the primary care level. She stressed that non-smokers and younger patients are being missed at the frontline because of common misconceptions around COPD risk.

“Usually when we get a patient [from primary care] after an exacerbation, that patient has been through a couple of rounds of oral corticosteroids already, which is a problem for the pulmonologist,” Polverino said.

Another recurring issue is the patient’s lack of urgency to get a diagnosis and initiate care — not always due to the common stigma associated with COPD, but sometimes because the disease is a slow burn.

Polverino has high expectations for COPD advancement in the coming decade. She believes Th1 inflammation-based biomarkers that correlate with the majority of patients with COPD — versus the more specific eosinophil biomarker — will emerge in research. The introduction of targeted therapies like dupilumab and mepolizumab have already shifted the perception of COPD from “untreatable” to potentially alterable. An influx of biomarkers may raise the bar for treatment even higher.

“We’re going to have radiology and radiomics to be used as a valid biomarker in COPD, together with other [new biomarkers] like CC16, and we are going to start paying attention to milder stages of the disease,” she said. “We are going to start including these people more in our trials, as well as non-smoking patients.”

Polverino F, Kunzmann K. Eosinophils, CC16, and the Role of COPD Biomarkers, with Francesca Polverino, MD, PhD. 

. Published online November 14, 2025. https://www.hcplive.com/view/eosinophils-cc16-copd-biomarkers-francesca-polverino-md-phd

Terzikhan N, Verhamme KM, Hofman A, Stricker BH, Brusselle GG, Lahousse L. Prevalence and incidence of COPD in smokers and non-smokers: the Rotterdam Study. Eur J Epidemiol. 2016;31(8):785-792. doi:10.1007/s10654-016-0132-z

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Polverino stresses the need for prospective analysis to validate CC16 and mucus plugs as viable biomarkers for COPD status.

Eosinophils, CC16, and the Role of COPD Biomarkers, with Francesca Polverino, MD, PhD

It's a common misconception that there are no biomarkers available to determine 

 disease status. Both blood eosinophils and fraction exhaled nitric oxide (FeNO) serve as viable, if not each slightly limited, biomarkers in COPD. The real issue is the lack of clinical investigation into more potential biomarkers — an impasse that can delay the development of targeted therapies to treat COPD.

 in Philadelphia, PA, this week, Francesca Polverino, MD, PhD, professor of pulmonary medicine at Baylor College of Medicine, reviewed her session presentation on clinical markers of COPD that dictate therapeutic strategy. As Polverino explained, the simplistic measures of COPD type and status are currently robust: blood eosinophils, spirometry-based tests like forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV

), FeNO , and radiomics help determine a patients’ classification and severity of COPD at any point of assessment.

But a lack of investigation into more promising biomarkers like mucus plugs and club cell protein (CC16) — both of which may help determine a patient’s true response to diverse therapy strategies — stalls targeted therapy development.

“I think [CC16] is next in line,” Polverino said. “All we need is a clinical trial in which CC16 is used prospectively…I think it’s going to be probably the most powerful biomarker in COPD, just because it relates to all patients with COPD, not just a subset of [type 2] COPD patients like eosinophils.”

Polverino referenced very recently published analysis from her and a team of colleagues showing a correlation between lowered CC16 levels and accelerated lung function decline and progression of emphysema. The findings even showed the biomarker’s ability to determine pediatric disease progression: children with lowered levels had correlative obstructive physiology and early small airway impairment.

There has been ample early data supporting the potential of CC16 and mucus plugs in determining COPD status; Polverino wants to see that potential be finally met.

Rojas-Quintero J, Faner R, Chiu CY, et al. Maternal Smoking and CC-16: Implications for Lung Development and COPD Across the Lifespan. Am J Respir Crit Care Med. Published online October 7, 2025. doi:10.1164/rccm.202504-0854OC

Lugugo N. Dupilumab Reduces Mucus Burden in Uncontrolled Asthma, with Njira Lugogo, MD. 

. Published October 22, 2025. https://www.hcplive.com/view/dupilumab-reduces-mucus-burden-uncontrolled-asthma-njira-lugogo-md

ATS 2025, with Harold P. Wimmer and Francesca Polverino, MD, PhD

, host Albert Rizzo, MD, Chief Medical Officer of the American Lung Association (ALA) speaks to several important topics in the field of pulmonology on-site at the 

American Thoracic Society (ATS) 2025 International Conference

The episode features 2 interviews, including one with Harold P. Wimmer, CEO of the ALA, and another with Francesca Polverino, MD, PhD, spokesperson for the ALA and Lester and Sue Smith Professor in the Pulmonary and Critical Care Division at the Baylor College of Medicine. The 2 leaders in the respiratory health space explored current challenges, advancements, and collaborations driving the field of pulmonology forward.

Harold P. Wimmer outlined the organization’s mission and strategic initiatives within the broader landscape of pulmonary health. Wimmer emphasizes the immense value of attending ATS, citing the opportunity to engage with emerging science, observe the latest technologies, and interact with ALA-supported investigators presenting at the meeting.

Wimmer highlighted the ALA’s research portfolio, which includes the Awards and Grants Program and the Airways Clinical Research Centers (ACRC) Network. Notably, 45 ALA-affiliated researchers presented at this year’s ATS conference—a record number reflecting the Association’s growing influence in advancing respiratory science.

Wimmer touched on the importance of cross-organizational collaboration, highlighting recent meetings with leadership from ATS and the American College of Chest Physicians. As the respiratory field faces threats such as proposed National Institutes of Health (NIH) and Centers for Disease Control and Prevention (CDC) budget cuts and potential rollbacks to Environmental Protection Agency (EPA) air quality regulations, Wimmer stressed the need for a unified voice across scientific, clinical, and advocacy communities.

In the second half of the episode, Polverino was asked to discuss emerging topics in chronic obstructive pulmonary disease (COPD) research and care presented at the ATS meeting. Polverino identified several key areas of interest among the pulmonary research community, noting an ongoing debate in the COPD field around diagnostic criteria, specifically whether airflow obstruction should remain the cornerstone of diagnosis.

Many investigators are now calling for broader inclusion criteria that account for symptomatic patients without spirometric evidence of obstruction, based on radiologic or biomarker findings. This could expand the definition of COPD and better capture individuals with early or atypical disease.

Polverino also discussed the growing focus on type 2 inflammation as a treatable trait in COPD. With recent positive results from different trials, there is increasing momentum to identify patient subgroups—particularly those with blood eosinophilia—who may benefit from targeted biologic therapies. However, Polverino cautioned that this remains only one component of a heterogeneous disease and more comprehensive approaches are needed.

Lungcast is a monthly respiratory news podcast series hosted by Albert Rizzo, MD, chief medical officer of the ALA, and produced by 

This special episode of Lungcast features Harold P. Wimmer, CEO of the ALA, and Francesca Polverino, MD, PhD, an ALA spokesperson.

Francesca Polverino, MD, PhD

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