COPD

In this video, Prof Dr Thérèse Lapperre, pneumonologist at the University Hospital Antwerp shares the most important takeaways from the 2025 annual ERS meeting in the field of Chronic Obstructive Pulmonary Disease (COPD)

At ERS 2025, considerable attention was focused on the role of biological therapies in COPD, an area that has experienced rapid development over the past few years. Several drugs are showing promising results in reducing exacerbations, especially in patients with eosinophilic COPD and frequent exacerbations. Dupilumab has demonstrated significant benefits in this group, with post hoc analyses from the BOREAS and NOTUS trials suggesting that the number needed to treat to reduce exacerbations is only three.¹ Similarly, mepolizumab has shown consistent positive effects, with pooled analyses of three trials indicating a 21% percent in exacerbation rates.² Finally, a newer biologic agent, astegolimab, targeting the IL-33 pathway via the ST2 receptor, has also produced encouraging results in the ALIENTO trial, showing a 15% reduction in exacerbations in patients with moderate-to-severe COPD.³ Further subgroup analyses of this trial will be important to identify which phenotypes derive the greatest benefit from this treatment modality

Alongside these clinical trial data, a study from Copenhagen took a closer look at the characteristics of patients hospitalised for severe COPD exacerbations. When followed up and reassessed, a large proportion of patients were found to be poorly adherent to inhaled therapies, with about half not taking medications regularly and around one in five making critical errors in inhaler technique. Many patients also had comorbidities such as bronchiectasis that required targeted management. In the end, only about one-third of the patients could truly be classified as having severe COPD once treatable traits were corrected. In contrast, the majority had modifiable issues contributing to poor outcomes.⁴ These findings stress the importance of comprehensive evaluation before considering escalation to biological treatment. Biomarker analysis in these patients also revealed that over 40% of them had elevated levels of blood eosinophils or FeNO, indicating that a significant subgroup may benefit most from targeted therapies.

Beyond clinical trials, real-world data are increasingly important. In this respect, evidence from asthma registries presented at ERS confirms that patients with both asthma and COPD respond less favorably to biologics than those with asthma alone. Several countries are currently working to establish registries to better track outcomes and define key parameters for assessing response and stability in patients receiving biologics.