Updates in COPD Management: From Inflammatory Pathways to Targeted Therapies

Abstract

Background

Chronic obstructive pulmonary disease (COPD) is a heterogeneous respiratory disorder driven by neutrophilic and eosinophilic inflammation, structural changes, and airflow limitation. Shared pathophysiology makes cardiovascular disease a prevalent COPD comorbidity, necessitating an integrated cardiopulmonary assessment. Screening questionnaires may aid early COPD detection. CT imaging can supplement spirometry to characterise structural changes. Recent advances have shifted COPD management toward phenotype-directed approaches that incorporate novel biomarkers and emerging targeted therapies.

Methods

This narrative review summarises recent advances in COPD management. Relevant literature was identified through database searches focusing on COPD guidelines, randomised controlled trials, systematic reviews, and emerging therapies.

Results

Current management emphasises smoking and e-cigarette cessation, vaccination against respiratory pathogens, and early recognition of disease phenotypes. Blood eosinophils and other biomarkers correlate with corticosteroid responsiveness. Dual long-acting bronchodilator therapy (LABA/LAMA) remains foundational for maintenance treatment, while triple therapy (ICS/LABA/LAMA) reduces exacerbations in patients with recurrent exacerbations and eosinophilic inflammation. Advances in targeted therapies include biologics such as dupilumab and mepolizumab that improve outcomes in patients with eosinophilic COPD. Phosphodiesterase inhibitors provide additional therapeutic options including ensifentrine, which combines bronchodilator and anti-inflammatory effects, and roflumilast, which reduces frequent exacerbations and chronic bronchitis. Emerging therapies that target inflammatory pathways including tezepelumab, and IL-33 inhibitors such as astegolimab, itepekimab, and tozorakimab, are under investigation.

Conclusion

COPD management is evolving toward precision medicine, guided by inflammatory phenotypes, biomarkers, and individualised risk profiles. Continued investigation into targeted biologics, anti-inflammatory agents, and incorporating biomarkers into clinical practice may improve outcomes and reduce disease burden.