Frontline COPD Care in the Biologic Era: Practical Insights From APPs

Over the past decade, chronic obstructive pulmonary disease (COPD) has undergone a quiet but profound reassessment. Once viewed as a largely homogeneous condition managed primarily with inhaled bronchodilators and corticosteroids, COPD is now increasingly understood as a biologically diverse disease with multiple inflammatory drivers. This evolving perspective has challenged long-standing assumptions about treatment limitations and opened the door to more individualized approaches.

Recent years have marked a pivotal shift, with biologic therapies—long established in asthma—beginning to demonstrate meaningful benefits in carefully selected COPD populations. Approvals such as dupilumab and mepolizumab have helped redefine what is possible for patients with persistent exacerbations and inflammatory phenotypes, signaling that disease biology, rather than diagnosis alone, may guide future therapy choices.1,2 These advances have reframed COPD not as a therapeutic dead end, but as a condition ripe for precision medicine.

Against this backdrop, HCPLive convened a clinical forum led by Sarah Tomashefski, MSN, AGNP-C, FCCP, Lead Outpatient Pulmonary Advanced Practice Provider, and Director of the Pulmonary APP Fellowship program, Prisma Health, Greenville, South Carolina, focusing on how advanced practice providers (APP) and clinicians are now navigating how to translate emerging data into real-world practice. Questions around patient selection, biomarkers, safety, access, and guideline integration are shaping day-to-day decision-making. The clinical forum captured that moment of transition, reflecting a field actively recalibrating its approach to one of pulmonary medicine’s most challenging diseases.

“[The growing recognition of type 2 inflammation in COPD] opens the door past just the inhalers for a lot of us, where before it's like you get to a point with them and then they're just exacerbating. You're putting them on steroids. And it's like, well, now what do we do? We can see you again, treat you again. But you hit a limit with their treatment. So having the different biologics has definitely opened the door,” Alyssa Minute, DNP, APRN, FNP-C, Upstate Lung & Critical Care Specialists, said during the forum.

The forum explores how improved understanding of COPD heterogeneity has enabled more targeted therapeutic strategies, particularly through biologics aimed at type 2 inflammation. Participants detailed the importance of combining biomarkers such as eosinophil counts with clinical indicators like exacerbation history to identify patients most likely to benefit, while cautioning against indiscriminate use.

In addition to reviewing efficacy and safety considerations, the discussion highlighted practical challenges including reimbursement, workflow integration, and clinician education. Throughout, the conversation reinforced a central theme: the future of COPD management lies not in replacing existing therapies, but in layering precision-based options onto a foundation of optimized standard care.

“I know that there's this big push now for precision medicine. And I feel like just having biomarkers available to help kind of dictate the right tool for the right job is helpful and kind of meeting those new standards for a patient to - obviously, everyone should have individualized care, but it just helps kind of hone in even further [to find the] right tool for a job,” another attendee said.

References

1. Dupixent® (dupilumab) Approved in the U.S. as the First-ever Biologic Medicine for Patients with COPD. Regeneron Pharmaceuticals, Inc. September 27, 2024. https://www.globenewswire.com/news-release/2024/09/27/2954552/0/en/Dupixent-dupilumab-Approved-in-the-U-S-as-the-First-ever-Biologic-Medicine-for-Patients-with-COPD.html.

2. Johnson V. FDA Approves Mepolizumab for Eosinophilic COPD. News release. Article. HCPLive. https://www.hcplive.com/view/personalized-copd-treatment-lessons-biologic-trials-clinical-practice