The Practical Hurdles in COPD Detection, with Francesca Polverino, MD, PhD

COPD is heterogeneous and often laden with confounding symptoms and severe comorbidities. But that doesn’t mean it’s a complicated disease — its treatment is complicated because of our clinical shortcomings.

In the second segment of an interview with HCPLive at the 2025 Global Initiative for Chronic Obstructive Lung Disease (GOLD) International COPD Conference in Philadelphia, PA, this week, Francesca Polverino, MD, PhD, professor of pulmonary medicine at Baylor College of Medicine discussed the issue of practical limitations in refining the diagnosis, treatment, maintenance, and monitoring of COPD.

“We call COPD a complex disease because we don't understand it,” Polverino said. “But COPD is not a complex disease. We make it complex because we don't understand that all these phenotypes or endotypes that we observe in the clinic are all different diseases with different pathologies that should be treated all in different ways. And this is the importance of the biomarkers.”

Polverino previously discussed the shortcomings in COPD biomarker research and utility; she also noted that there’s a lack of understanding around the disease’s clinical drivers and manifestations at the primary care level. She stressed that non-smokers and younger patients are being missed at the frontline because of common misconceptions around COPD risk.

“Usually when we get a patient [from primary care] after an exacerbation, that patient has been through a couple of rounds of oral corticosteroids already, which is a problem for the pulmonologist,” Polverino said.

Another recurring issue is the patient’s lack of urgency to get a diagnosis and initiate care — not always due to the common stigma associated with COPD, but sometimes because the disease is a slow burn.

Polverino has high expectations for COPD advancement in the coming decade. She believes Th1 inflammation-based biomarkers that correlate with the majority of patients with COPD — versus the more specific eosinophil biomarker — will emerge in research. The introduction of targeted therapies like dupilumab and mepolizumab have already shifted the perception of COPD from “untreatable” to potentially alterable. An influx of biomarkers may raise the bar for treatment even higher.

“We’re going to have radiology and radiomics to be used as a valid biomarker in COPD, together with other [new biomarkers] like CC16, and we are going to start paying attention to milder stages of the disease,” she said. “We are going to start including these people more in our trials, as well as non-smoking patients.”

References

1. Polverino F, Kunzmann K. Eosinophils, CC16, and the Role of COPD Biomarkers, with Francesca Polverino, MD, PhD. HCPLive. Published online November 14, 2025. https://www.hcplive.com/view/eosinophils-cc16-copd-biomarkers-francesca-polverino-md-phd
2. Terzikhan N, Verhamme KM, Hofman A, Stricker BH, Brusselle GG, Lahousse L. Prevalence and incidence of COPD in smokers and non-smokers: the Rotterdam Study. Eur J Epidemiol. 2016;31(8):785-792. doi:10.1007/s10654-016-0132-z