copd
Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide, caused primarily by smoking-related airflow obstruction and characterized by progressive dyspnea, chronic bronchitis, and exacerbations that drive hospitalizations and mortality. Despite approval of triple inhaled therapy (LABA/LAMA/ICS), exacerbation rates remain high in eosinophilic phenotypes, driving active trials in targeted biological therapies that have transformed severe asthma management.
Active trials investigate dupilumab for eosinophilic COPD (BOREAS and NOTUS trials showed reduced exacerbations), itepekimab (anti-IL-33), tezepelumab (anti-TSLP), mepolizumab for high-eosinophil COPD, phosphodiesterase-3/4 inhibitors, and novel mucolytic approaches. Disease-modifying trials targeting lung regeneration (all-trans retinoic acid, stem cell therapy) and alpha-1 antitrypsin augmentation for AATD-related COPD are also active.
COPD trials typically require post-bronchodilator FEV1/FVC <0.70 with documented history of exacerbations; blood eosinophil count ≥150 or ≥300 cells/μL is increasingly used to enrich biologic trials.