Breaking new ground biologic in COPD: Beyond the usual puff

Wong Chee Kuan
University Malaya Medical Centre, Kuala Lumpur, Malaysia

This presentation underscores the evolution of COPD management into the era of precision medicine, focusing on the emerging role of biologic therapies. Traditionally reliant on bronchodilators and inhaled corticosteroids, COPD treatment is now shifting toward individualized care based on phenotypes and endotypes—particularly the presence of eosinophilic inflammation.

COPD is increasingly recognized as a heterogeneous disease with distinct inflammatory profiles. Biologic therapies targeting type 2 (Th2) inflammation have shown promise, especially in patients with elevated blood eosinophil counts. The most significant advancement is the FDA approval of dupilumab, an anti-IL-4/IL-13 monoclonal antibody, for COPD patients with type 2 inflammation. It has demonstrated significant reductions in exacerbation rates and improvements in lung function in phase 3 trials.

Other biologics under investigation include anti-IL-5 agents like mepolizumab and benralizumab, which target eosinophilic inflammation, and anti-alarmins such as itepekimab, astegolimab, tozorakimab and tezepelumab, which interfere with epithelial-derived cytokines like IL-33 and TSLP. While some of these agents have shown encouraging results, others remain in the exploratory phase, particularly for patients with non-eosinophilic or neutrophilic COPD.

Biomarkers such as blood eosinophil count, FeNO, and mucus scoring techniques (CT-based and bronchoscopic) are becoming essential tools in identifying candidates for biologic therapy. This biologic revolution signals a departure from standard inhaler-based regimens, offering a new frontier in COPD management where therapy is matched to inflammatory phenotype—marking a bold step forward in precision respiratory medicine.