New COPD Treatments Shift Focus From Symptoms to Survival

FLORENCE, Italy — Exacerbations remain one of the major unresolved challenges in the management of chronic obstructive pulmonary disease (COPD), despite the introduction of new therapies. However, recent advancements have shifted the treatment focus from controlling symptoms to significantly reducing the mortality rate. This pivotal change was discussed at the 23rd European Congress of Internal Medicine (ECIM) 2025, held from March 5 to 8.

In 2019, COPD was responsible for 3.3 million deaths and 74.4 million disability-adjusted life years globally. Exacerbations are the leading cause of COPD-related deaths, with mortality rates reaching 50% within 3.6 years after hospital admission, and the risk for mortality increases with each subsequent exacerbation, experts said at a meeting in Tuscany.

COPD is also a major financial burden on healthcare systems, accounting for 6% of Europe’s annual healthcare budget for respiratory diseases. Of this, COPD represents approximately 56% of the expenditure, with half of these costs arising from acute exacerbations. Additionally, the factors that increase the risk for exacerbations are closely linked to those that lead to poor outcomes, creating a vicious cycle of worsening health.

New Treatments

Sergio Harari, MD, chief of the Department of Medicine and director of the Division of Pneumology and of Internal Medicine at San Giuseppe Hospital, Milan, Italy, discussed advancements in COPD management during his session “What’s New in COPD?”

He highlighted emerging treatment strategies aimed at addressing exacerbations, which remain significant challenges. These patients visit general practitioners, emergency departments, and consultants more frequently than others.

Monoclonal antibodies, which have been successful in treating asthma, have been explored for the treatment of COPD.

While triple therapy — which includes long-acting beta agonists, long-acting muscarinic antagonists, and inhaled corticosteroids — has been effective in reducing exacerbations and improving quality of life, challenges remain. Approximately 20% of patients still experience moderate to severe exacerbations within a year of starting treatment.

Who comprises this 20%? According to the available data, eosinophilic inflammation is a key factor in this group, affecting 20%-37% of patients. However, studies on three molecules — benralizumab, mepolizumab, and astegolimab — have not reported positive outcomes.

“By contrast, dupilumab has demonstrated significant reductions in moderate and severe exacerbations, along with improved lung function compared to placebo in specific patient populations,” Harari explained to Univadis Italy, a Medscape Network platform. As a result, dupilumab has been included in the most recent update of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) report.

Several other targeted therapies are under investigation, all designed to act on specific molecular pathways and tailored to selected patient populations.

Beyond drug treatments, several non-pharmacological approaches are being explored, including:

• Endoscopic interventions, such as endobronchial valves
• Targeted pulmonary denervation, using radiofrequency ablation of the vagus nerve’s bronchial branch
• Pulmonary rehabilitation, which has shown effectiveness even when conducted at home

Additionally, early-stage regenerative medicine research is opening new possibilities for COPD treatment.

“With drugs targeting precise molecular mechanisms, a new important chapter in COPD therapy has begun,” said Harari. “It is a long and complex path, but the direction of research is correct and opens important perspectives for new molecules.”

GOLD: Reflections and Updates

Filippo Pieralli, MD, internal medicine specialist and head of the Intermediate Care Unit of the University Hospital Careggi in Florence, Italy, discussed the latest updates from the GOLD 2025 report.

“This document includes new information about the medications discussed in this session, but there are additional points that merit further consideration,” he stated, highlighting the ongoing challenges in accurately diagnosing and classifying the disease.

Currently, approximately 30% of patients are misdiagnosed. “The correct diagnosis is fundamental to understand who really suffers from COPD,” stated Mark Cranston, MBBS, FRCP, chair of the session and consultant in internal medicine at Cambridge University Hospital, Cambridge, England, in an interview with Univadis Italy.

In the United Kingdom, many services related to respiratory health and COPD are managed by nurses who collaborate closely with general practitioners and hospitals.

A key focus of the discussion was the importance of managing exacerbations, particularly in vulnerable patients. Experts reiterated that the number and severity of exacerbations play a critical role in guiding treatment decisions.

The role of eosinophil count in managing COPD was a hot topic in the session. The GOLD 2025 report emphasizes that current data are insufficient to recommend the use of peripheral blood eosinophil counts to predict exacerbation risks on an individual basis.

The importance of vaccinations was also stressed, urging that patients with COPD should adhere to local guidelines and receive recommended vaccinations against influenza, severe acute respiratory syndrome coronavirus 2, pneumococcus, and others.

Additionally, a significant shift in treatment focus was discussed, from reducing acute exacerbations to decreasing mortality rates in patients with COPD.

“Respiratory syndromes are highly complex, and it is important to treat them by moving from an approach dedicated to a single organ to a more holistic one,” Pieralli concluded. “This aligns with the internist’s perspective, as we approach patients with multiple, overlapping symptoms in an integrated way.”

Cristina Ferrario, a molecular biologist by training, holds a master’s degree in communication and health from the University of Milan, Milan, and in cancer genetics from the University of Pavia, Pavia, Italy. After conducting research in molecular oncology, she has been involved in scientific journalism and medical writing for over 20 years.

The experts interviewed declared no conflicts of interest related to the topics discussed.

This story was translated from Univadis Italy using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.