From Inhalers to Immunology: Real-World Insights on Biologics in Asthma and COPD

The past several years have marked a pivotal shift in the treatment of chronic obstructive pulmonary disease, driven by breakthroughs that began reshaping clinical practice in 2024 and continued to evolve through 2025 and into 2026. Long managed primarily with bronchodilators and inhaled steroids, chronic obstructive pulmonary disease (COPD) has entered a new era with the approval of targeted biologic therapies such as dupilumab and mepolizumab.1,2 These agents, already well established in asthma, have expanded treatment possibilities for a subset of COPD patients defined not just by symptoms, but by underlying biology—particularly type 2 inflammation and eosinophilia.

Against this backdrop, a virtual clinical forum convened by HCPLive and led by David G. Hill, MD, Director, Clinical Research, Waterbury Pulmonary Associates, brought together pulmonologists and advanced practice providers to share their experiences navigating the changing COPD and asthma landscape. The discussion centered on how frontline clinicians are identifying appropriate patients, integrating biomarkers like blood eosinophils into routine care, and balancing emerging evidence with the realities of payer access, patient adherence, and diagnostic uncertainty.

As biologics move from theory into exam rooms, the forum highlighted both optimism and restraint. Panelists described meaningful improvements in select patients—particularly those with asthma–COPD overlap or steroid-responsive disease—while acknowledging that most COPD patients still lack disease-modifying options. The dialogue underscored a broader shift underway: from treating COPD as a single entity to approaching it as a collection of phenotypes requiring individualized, biologically informed care.

Throughout the forum, clinicians emphasized how recent biologic approvals have changed the way they think about asthma and COPD, particularly for patients who fall into gray areas such as asthma–COPD overlap. Blood eosinophils, bronchodilator responsiveness, and exacerbation patterns have become critical tools for identifying candidates for therapy escalation. Dupilumab emerged as a commonly favored option due to its mechanism, safety profile, and broader labeling, while mepolizumab was viewed as beneficial for select patients with higher eosinophil counts. Despite these advances, panelists repeatedly noted that access barriers, dosing logistics, and payer restrictions often shape real-world decision-making as much as clinical factors.

“I grew up in the era of mild persistent, moderate persistent, severe persistent type [asthma]. We didn't phenotype. We kind of just went with how severe they were and the more severe, the more steroids you gave. I think that has changed. We always knew we didn't want to use too much steroids, but we really didn't have the option. I think now with newer therapies, we have ways to minimize steroid usage, not in everybody, but… much more than we used to,” Paul Strachan, MD, Director of the Stony Brook Pulmonary Hypertension Center, said during the forum.

At the same time, the discussion made clear that biologics address only a fraction of the unmet need in COPD. Most patients continue to live with neutrophilic disease, progressive emphysema, and persistent symptoms that current therapies do not adequately control. Looking ahead, participants called for better biomarkers, earlier disease intervention, and a more personalized approach modeled after advances in oncology. From the frontline perspective, the future of asthma and COPD care lies not just in new drugs, but in redefining how these complex diseases are classified, studied, and treated.

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