Joseph Khabbaza, MD 

Managing Moderate to Severe COPD: Integrating New Therapies Into Practice

The recent introduction of new therapies for COPD, including ensifentrine, mepolizumab, and dupilumab, marks an important step forward in addressing unmet clinical needs. While existing inhaled therapies—such as dual bronchodilators and triple therapy—have been effective for many, a significant subset of patients continues to experience persistent symptoms and frequent exacerbations. These newer agents offer targeted options for patients who remain symptomatic despite standard care, helping to improve quality of life and reduce the risk of hospitalizations.

In clinical practice, these therapies are being gradually integrated based on patient profiles. Ensifentrine, a nebulized PDE4 inhibitor, is considered for patients with ongoing dyspnea despite triple inhaler therapy, while biologics like dupilumab and mepolizumab are being used in patients with a history of exacerbations and evidence of type 2 inflammation, particularly elevated blood eosinophil levels. Incorporating these treatments, however, presents challenges—including navigating insurance coverage, managing drug administration routes, and ensuring that patients understand the purpose and expectations of their new regimens.

Ultimately, effective integration of these therapies requires robust patient and provider education. With options like nebulized medications and injectable biologics now available, personalized care has become even more critical. Shared decision-making, caregiver involvement, and support from nurse educators or respiratory therapists can help ensure treatment success. As more real-world data emerge and clinical experience grows, these therapies hold the promise to significantly shift the management of moderate to severe COPD toward more tailored, outcomes-focused care.

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Panelists discuss the evolving role of newly approved chronic obstructive pulmonary disease (COPD) therapies—such as ensifentrine, mepolizumab, and dupilumab—in addressing persistent symptoms and frequent exacerbations despite standard care, highlighting their targeted use based on patient profiles, the practical challenges of integration into clinical practice, and the importance of education, shared decision-making, and personalized care to optimize outcomes in moderate to severe COPD.

New Horizons in COPD: Recent Approvals and GOLD Guideline Updates

The introduction of newly approved therapies for COPD marks a significant milestone in respiratory care. After a long period with few novel options, the approvals of treatments like ensifentrine, mepolizumab, and dupilumab offer clinicians new tools to better manage patients, especially those who continue to struggle despite standard therapies. These agents work through different mechanisms—some improving bronchodilation and others targeting type 2 inflammation—allowing for a more tailored approach based on individual patient characteristics such as symptom severity or eosinophil count.

With these advances, there’s growing emphasis on precision medicine in COPD. Guidelines like the GOLD report have already incorporated ensifentrine and dupilumab into their treatment algorithms, which helps provide clearer direction for clinicians and may accelerate the adoption of these therapies in practice. While these medications aren’t appropriate for every patient, they hold particular promise for individuals with frequent exacerbations or persistent symptoms despite maximal inhaled therapy. Their inclusion in widely respected guidelines lends credibility and urgency to their consideration in appropriate cases.

Ultimately, adoption of these newer agents will depend not only on guideline inclusion but also on education, clinician comfort, and real-world experience. As pulmonologists gain familiarity with prescribing these therapies and begin to see their impact outside of clinical trials, wider implementation is likely. Close collaboration between specialists and primary care providers will be crucial to ensure that patients most likely to benefit are identified early and treated appropriately. As the field moves forward, the goal remains the same: improving outcomes for patients with COPD through more individualized and effective treatment strategies.

Panelists discuss the impact of newly approved therapies for chronic obstructive pulmonary disease (COPD)—such as ensifentrine, mepolizumab, and dupilumab—highlighting their diverse mechanisms and potential to personalize treatment for patients with persistent symptoms or type 2 inflammation, while emphasizing the importance of guideline integration, clinician education, and collaboration across care teams to ensure timely and effective adoption in clinical practice.

Joseph Khabbaza, MD

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