From Guidelines to the Clinic: Applying Precision Medicine in COPD and Asthma

Over the last decade, the management of chronic obstructive pulmonary disease (COPD) and asthma has evolved from generalized treatment algorithms to precision-based strategies supported by advances in phenotyping, biomarker testing, and targeted biologics. While inhaled corticosteroids and bronchodilators remain foundational, the emergence of agents such as mepolizumab, benralizumab, dupilumab, and tezepelumab has transformed care for patients with severe or uncontrolled disease. These therapies, designed to modulate key inflammatory pathways like IL-5, IL-4/IL-13, and TSLP, have enabled clinicians to achieve greater reductions in exacerbations and symptom burden, even among patients who historically responded poorly to standard regimens. Updated GOLD and GINA guidelines reflect this paradigm shift, emphasizing individualized treatment plans based on phenotypic and endotypic traits.

This evolution is particularly meaningful for patients with high disease burden, where past options often offered limited improvement in quality of life. Expanded biologic indications for COPD, alongside asthma-specific advancements, are bridging historical gaps in care and bringing precision medicine closer to everyday practice. The growing use of digital monitoring, treatable trait assessment, and targeted interventions signals a new era in airway disease management—one where the combination of biologics, advanced diagnostics, and proactive patient engagement offers the potential for sustained control and fewer disease-related setbacks.

At a recent clinical forum convened by HCPLive in Atlanta, Georgia, a group of pulmonologists, led by Surya Bhatt, MD, Professor of Medicine - Pulmonary, Allergy, & Critical Care Medicine, and Director, Center for Lung Analytics and Imaging Research (CLAIR), University of Alabama at Birmingham, gathered to discuss how these developments are changing clinical management of COPD and asthma.

The forum emphasized that COPD and asthma remain major contributors to morbidity and mortality, but advances in phenotyping and targeted biologics have transformed the treatment landscape. Furthermore, clinical guidelines are shifting toward individualized therapy based on treatable traits rather than a one-size-fits-all approach.

"I think many times it's hard to tell [how much overlap patients with COPD have with asthma]. And then there's also this concept of treatable trait, where if you have an endotype, it doesn't matter what that respiratory disease is, you probably treat them the same. I personally am a believer in labels because it matters for prognosis. And then [there are] nuances. Like you can't give a LABA alone in asthma... and then also, LAMA may be better as standalone in COPD than in asthma. So there's some nuances to treatment," Bhatt said.

Looking forward, newer biologics and combination inhalers are reducing exacerbations and improving quality of life, especially in severe and refractory cases. Implementation challenges persist, including patient adherence, education gaps, and equitable access to advanced therapies. Altogether, the future of care is moving toward precision medicine, leveraging biomarkers, digital health, and tailored treatment algorithms.

"I don't have as much experience with biologics... so my takeaway [from the panel] is I need to try and advocate so that we can do phenotyping in our office. I've just been going on symptom improvement as opposed to rechecking biomarkers to make sure my drugs are doing what I think they should be doing," a panelist said. "I like the fact that there is data showing 2 years, 4 years out, that there's still that reduction in exacerbation [with mepolizumab]. So that helps me feel better about trying to talk my patients into trying the biologic therapies and the benefits that they will get from that."