New hope for lung patients: Innovative treatment changes the game in COPD

At the ERS 2025 Congress, the world’s largest annual meeting on respiratory diseases, attended by international experts, one of the hot topics in pulmonary medicine was discussed this year—the management of COPD and its exacerbations. During a special symposium, new and encouraging findings on innovative biologic drugs, including Nucala, were presented, opening the door to a new era in disease treatment.

COPD is a chronic obstructive lung disease, currently considered one of the most significant underlying diseases in the Western world. The disease is mostly caused by long-term cigarette smoking, but air pollution, exposure to harmful particles at work, and genetic predisposition can also be risk factors.

In COPD patients, the airways and lungs are progressively damaged: They become flooded with mucus, stiff, and obstructed, leading to severe breathing difficulties, chronic cough, reduced physical capacity, lower quality of life, and even death. According to the World Health Organization, COPD is one of the leading causes of death worldwide, a trend expected to worsen in the coming years.

Beyond the slow and ongoing progression of the disease, there is another danger: Exacerbation—a sudden event in which symptoms intensify dramatically. Each exacerbation can lead to hospitalization, worsen lung tissue damage, and accelerate disease progression. Patients who experience recurrent exacerbations have shorter life expectancy and much lower quality of life.

During the symposium, it was emphasized that type 2 inflammation characterizes about 40% of COPD patients. In this group, the rate of exacerbations is 74% higher, the risk of hospitalization is 64% higher, and the impact on quality of life is significant. Identifying this population is crucial because they may benefit greatly from advanced biologic treatments. The symposium also examined how the medical community treating COPD patients can be proactive to prevent exacerbations and hospitalizations in these patients.

Although the test to detect type 2 inflammation is simple (a routine blood count measuring eosinophil levels), in practice many patients are not diagnosed.

A global survey presented at the congress showed that about 40% of doctors do not perform the test regularly: Approximately 10% never perform it, and 30% perform it only once, at initial diagnosis. Moreover, a one-time test is not sufficient to identify all patients with type 2 inflammation, leading to underdiagnosis and a missed therapeutic opportunity.

At the center of the symposium, data from the MATINEE study were presented, which examined the effectiveness of Nucala (mepolizumab)—already used in asthma patients—in COPD patients with recurrent exacerbations and type 2 inflammation.

The study results showed that treatment with the drug in patients already on triple inhalation therapy (ICS+LAMA+LABA) reduced the rate of moderate-to-severe exacerbations by 21% compared to placebo.

This is a significant achievement for patients whose treatment options were previously limited. Nucala treatment joins another biologic, Dupixent, which has recently demonstrated the ability to reduce exacerbations in COPD patients with a type 2 inflammation component. Thus, Nucala joins dupilumab, another drug already proven effective in reducing exacerbations in COPD patients suffering from type 2 inflammation.

Given the high burden of disease, mortality, and economic impact of COPD exacerbations, numerous phase 2 and 3 studies are ongoing on various molecules to treat COPD patients with recurrent exacerbations. Unlike the MATINEE study, which demonstrated Nucala’s effectiveness, five studies on three different molecules were presented at the symposium and were summarized as negative, meaning they failed to show a reduction in exacerbation frequency in COPD patients who received them.

COPD exacerbations are not only a medical problem—they also represent a huge economic and social challenge. They involve repeated hospitalizations, sick days, reduced functioning, and a heavy burden on healthcare systems. Therefore, any advancement in treatment, especially one that prevents exacerbations, could change the game.

The main conclusion from the symposium is that the future lies in a proactive approach: Early identification of patients with type 2 inflammation, continuous monitoring of their blood tests, and personalized biologic therapy. This approach can reduce life-threatening events, improve patients’ quality of life, and even extend their lifespan.

The data presented at the ERS 2025 Congress represent a significant milestone in improving COPD treatment. While there is still a long way to go, Nucala and Dupixent mark a new and optimistic era in which a broad population of patients who have needed it for many years can receive effective, tailored treatment.