Gerard Criner, MD, is chair and professor of thoracic medicine and surgery at Lewis Katz School of Medicine at Temple University and director of the Temple Lung Center.

Gerard Criner, MD

Gerard Criner, MD, spells out GOLD improvements, from interventions like smoking cessation and pulmonary rehabilitation to the heightened importance of spirometry for diagnosis.

Going for GOLD: Updated COPD Guidelines with Dr. Gerard Criner

Chronic obstructive pulmonary disease (COPD) remains a major public health challenge, affecting over 14 million adults in the U.S.—with many more likely undiagnosed—and ranking as the sixth leading cause of death nationally and fourth globally. As of 2024, more than half of diagnosed U.S. patients are women, with higher prevalence seen in rural areas, and while tobacco smoking accounts for over 70% of COPD cases in high-income countries, household air pollution and occupational exposures drive a significant burden worldwide. 

Earlier this year, the GOLD (Global Initiative for Obstructive Lung Disease) guidelines, developed by a global panel of leading experts, were updated to optimize COPD diagnosis, management, and care strategies in clinical practice, including new emphases on cardiovascular disease and pulmonary hypertension in COPD.

Returning for another episode of Lungcast is Gerard Criner, MD, of Temple University, a foremost COPD expert who serves on the GOLD Board of Directors and GOLD Science Committee. In this episode, he outlines the improvements to the guidelines, from interventions like smoking cessation and pulmonary rehabilitation to the heightened importance of spirometry for diagnosis.

"The major goal of of gold is basically distill whatever information we have from clinical trials and the best epidemiologic path of physiologic evidence that we have, and make it clinically relevant for someone who's seeing patients [so] that they can adopt those recommendations," Criner said.

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

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Going for GOLD: Updated COPD Guidelines with Gerard Criner, MD

Mepolizumab Reduces Exacerbation Risk, Healthcare Resource Utilization in COPD

Use of mepolizumab as an add-on treatment to optimal triple therapy may help prevent severe exacerbations and reduce subsequent healthcare burden in patients with 

chronic obstructive pulmonary disease (COPD)

, according to data from the phase 3 MATINEE trial presented at 

the American Thoracic Society (ATS) International Conference 2025

“Patients with COPD who are plagued by frequent moderate or severe exacerbations may have type 2 inflammation,” Gerard Criner, MD, chair and professor of thoracic medicine and surgery at Lewis Katz School of Medicine at Temple University and director of the Temple Lung Center, explained to 

. “In patients who continue to exacerbate despite maximal inhaled therapy with long acting bronchodilators and inhaled steroids, that presents an opportunity to have more robust, targeted treatments that selectively target type 2 inflammation.”

A humanized monoclonal antibody specifically targeting interleukin-5, a central cytokine in type 2 inflammation, mepolizumab’s use in COPD was explored in the randomized, double-blind, parallel-group MATINEE trial. It enrolled patients ≥ 40 years of age with COPD, blood eosinophil counts ≥300 cells/µL at screening, and a history of exacerbations despite receiving optimal inhaled triple therapy, defined as dual long-acting bronchodilators plus inhaled corticosteroid.

Participants were randomly assigned in a 1:1 ratio to mepolizumab 100 mg administered subcutaneously every 4 weeks for 52-104 weeks or placebo, in addition to optimal inhaled triple therapy. The secondary analysis presented at ATS reports the time to first severe exacerbation (requiring hospitalization ≥24 hours or resulting in death) and to first exacerbation leading to emergency department (ED) visit and/or hospitalization, alongside the annualized rates and proportions of patients experiencing ≥1 of such exacerbations, and post hoc patient-reported HCRU, all up to Week 104.

A total of 804 patients were randomized and treated, including 403 to mepolizumab and 401 to placebo. Results showed numerically lower proportions of mepolizumab-treated patients versus placebo experienced ≥1 severe exacerbation (11% vs 15%) and ≥1 exacerbation requiring ED visit and/or hospitalization (14% vs 18%) by Week 104. With mepolizumab, compared with placebo, the annualized rate of severe exacerbations was 34% lower, alongside a 35% lower rate in exacerbations requiring ED visit and/or hospitalization (rate ratio [RR], 0.66; 95% CI, 0.43-1.01 and RR, 0.65; 95% CI, 0.43-0.96, respectively).

Investigators noted the risk of experiencing a first severe exacerbation over 104 weeks was 26% lower with mepolizumab versus placebo (hazard ratio [HR], 0.74; 95% CI, 0.50-1.08), alongside a 27% lower risk of a first exacerbation leading to ED visit and/or hospitalization (HR, 0.73; 95% CI, 0.51-1.04).

Patient-reported HCRU resulting from exacerbations by Week 104 was similar in mepolizumab- and placebo-treated patients, as evidenced by the number of exacerbations requiring ED visits (11% vs 15%), urgent care/outpatient clinic visits (6% vs 6%), general ward admissions (12% vs 12%), and intensive care admissions (5% vs 4%). Mepolizumab-treated patients experienced lower mean resource utilization per exacerbation in ED visits, urgent care/outpatient clinic visits, and days in intensive care.

“I think that if this drug receives approval, this extends our knowledge into how type two inflammation affects patients with COPD and the long term benefits of this treatment, regardless if they have chronic bronchitis or emphysema,” Criner said.

Editors’ note: Criner has relevant disclosures with APREO, AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Pfizer, Pulmonx, Sanofi, and 

Criner GJ, Watz H, Sciurba FC, et al. Mepolizumab in Patients with COPD: Results from the MATINEE Phase III Randomized Controlled Trial [abstract]. Am J Respir Crit Care Med 2025;211:A5238. 

https://doi.org/10.1164/ajrccm.2025.211.Abstracts.A5238

Gerard Criner, MD, reviews findings from a secondary analysis of the phase 3 MATINEE trial of mepolizumab and looks ahead to the potential significance of the drug, if approved.

AIRFLOW-3 Data for Lung Denervation in COPD, with Gerard Criner, MD

New trial data are shedding light on the potential impact of targeted lung denervation on 

Findings from the AIRFLOW-3 clinical trial were presented at 

 by Gerard Criner, MD, chair and professor of thoracic medicine and surgery at Lewis Katz School of Medicine at Temple University and director of the Temple Lung Center.

The randomized, double-blind, sham-controlled study enrolled patients with symptomatic COPD (CAT ≥10) with moderate to very severe airflow obstruction (GOLD stage II-IV: 25% ≤ FEV1 ≤ 80% predicted, FEV1/FVC<0.70) and GOLD E status (≥2 moderate or ≥1 severe exacerbation in the prior 12 months) despite optimal medical therapy. The primary endpoint was a time-to-first event comparison of the probability of subjects having a moderate or severe exacerbation, between the treatment arm who received targeted lung denervation and optimal medical therapy and the sham control arm who received optimal medical therapy.

“There's been some preliminary clinical trials done outside the US that show the target of lung denervation in patients with COPD could have a significant effect, about 20% reduction in exacerbation severe enough to cause hospitalization,” Criner explained to 

. “That was the rationale for why AIRFLOW-3 was designed with exacerbations as an end point in a patient group that had exacerbations in the past, either frequent, moderate or severe and were highly symptomatic with COPD assessment test scores that are greater than 10.”

A total of 388 patients at 32 clinical sites across the US, EU, and UK were randomized in a 1:1 ratio to the treatment and sham control arms of the trial. Patients were 67.8 (standard deviation [SD], 7.1) years of age, ex-smokers with a 46.7 (SD, 22.0) pack-year smoking history, and 41.0 (SD, 11.8) post bronchodilator FEV1% pred. Their SGRQ-C and CAT scores were 62.5 (SD, 17.0) and 23.6 (SD, 6.3), respectively. More than 90% of patients were on triple therapy at baseline and through 1 year of follow up, and 42% of patients had prior-year COPD hospitalization(s).

Findings presented at ATS showed AIRFLOW-3 did not meet its primary endpoint for moderate or severe exacerbations, with no significant difference observed between the treatment and sham control groups. Despite this, Criner highlights key physiologic findings demonstrating positive impacts of targeted lung denervation.

At 1 year, the sham arm exhibited a statistical decline in lung function, including a decrease in FEV1 and FVC, and worsening of gas trapping, as indicated by an increase in RV, whereas both were stable in the treatment arm. Additionally, results showed the treatment arm exhibited a statistically significant improvement in dyspnea at 1 year compared to sham, leading to the identification of a subgroup of targeted lung denervation treatment responders corresponding to an airway predominant phenotype that demonstrated clinically and statistically significant improvements in lung function and exacerbation frequency and severity.

“That's the subgroup that we're going to examine in an additional AIRFLOW-4 randomized control trial,” Criner said.

Criner GJ, Slebos DJ, Sue RD, et al. Results From Airflow-3: Randomized, Double Blind, Sham Controlled Study of Targeted Lung Denervation in Patients With COPD [abstract]. 

https://doi.org/10.1164/ajrccm.2025.211.Abstracts.A3112

Criner reviews findings from AIRFLOW-3 and describes the subgroup of targeted lung denervation treatment responders being targeted in AIRFLOW-4.

Gerard Criner, MD

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