From GOLD to Ground Level: Navigating Biologic Use in COPD Care

Over the past decade, asthma and chronic obstructive pulmonary disease (COPD) management has undergone a steady but profound transformation, driven by deeper insight into disease heterogeneity and inflammatory pathways. What were once treated as largely uniform conditions managed through stepwise inhaler escalation are now understood as biologically diverse diseases requiring more individualized strategies. This shift has been fueled by advances in biomarker science, growing recognition of steroid-related harm, and the emergence of targeted biologic therapies capable of altering disease trajectories rather than simply relieving symptoms.

These new biologics, namely dupilumab in 2024 and mepolizumab in 2025, have begun to revolutionize the field of COPD, particularly eosinophilic COPD. With a growing variety of options, clinicians increasingly face nuanced decisions around patient selection, timing of initiation, response assessment, and long-term management—particularly as biologic options expand beyond asthma into select COPD populations. These developments have prompted a reexamination of long-standing treatment paradigms and renewed focus on outcomes such as exacerbation prevention, steroid reduction, and quality of life.

A clinical forum convened by HCPLive and led by MeiLan K. Han, MD, MS, Henry Sewall Professor of Medicine, Professor of Internal Medicine and Section Head, Division of Pulmonary and Critical Care Medicine, University of Michigan Medical School, gathered expert perspectives to examine how these evolving tools are being integrated into real-world practice. Against a backdrop of rapid therapeutic progress, the discussion reflects a field in transition as clinicians adapt to a new era of precision-driven care for asthma and COPD.

Throughout the discussion, Han and the other participants stepped back to reflect on how biologics have reshaped the management of severe asthma, shifting care away from reactive symptom control toward proactive, inflammation-targeted intervention. They discussed how lessons learned with biologic management of asthma will need to be applied for COPD, with an emphasis on identifying appropriate candidates using clinical history and biomarkers, reassessing traditional definitions of disease severity, and recognizing the cumulative burden of exacerbations and chronic oral corticosteroid exposure. They also highlighted practical considerations such as timing of initiation, expectations for response, and strategies for evaluating effectiveness over time. Furthermore, more research and understanding about the overlap and differences between phenotypes across COPD and asthma is needed.

“My general take on it is that there are certain aspects that are the same, and it does appear that there are some drugs that are same, but there's many aspects to it. I think it is probably doing a little bit of a disservice to overgeneralize and to say, yeah, it's type 2 inflammation in COPD… I think there's a lot more nuance about what the triggers are, because if it wasn't, then the drugs would work exactly the same, right?” Han said.

Bringing biologics into COPD comes with its own challenges, especially in such as historically heterogeneous and undertreated population. Integration into regular practice depends on careful patient selection, realistic outcome measures, and shared decision-making. Across both diseases, barriers such as access, insurance requirements, and workflow integration were acknowledged, alongside the growing need for clinician education as biologic therapies become a more routine component of chronic airway disease management. Despite these barriers, Han and other panelists remain excited about the future of COPD treatment.

“It's definitely exciting to maybe have something that would work not just in type 2 patients, but in everybody else. Because we've had a lot of carryover drugs from asthma, but it's kind of nice to see something that might be COPD specific,” Han commented on the potential of IL-33 targeting therapies for COPD.