After decades in which COPD care meant inhaled bronchodilators and corticosteroids alone, the disease has entered a new therapeutic era with its first biologics and its first novel inhaled mechanism in a generation.
Dupilumab (anti-IL-4 receptor alpha) became the first biologic approved for COPD in 2024, on the strength of the BOREAS and NOTUS Phase 3 trials, which showed roughly a 30% reduction in exacerbations in patients with COPD and type 2 inflammation (elevated blood eosinophils), plus improved lung function and quality of life. Mepolizumab (anti-IL-5) followed: the MATINEE trial demonstrated benefit in eosinophilic COPD, adding a second biologic option. Separately, ensifentrine (Ohtuvayre), a first-in-class inhaled dual PDE3/PDE4 inhibitor that combines bronchodilator and anti-inflammatory effects, was approved in 2024 as maintenance therapy — the first genuinely new inhaled mechanism for COPD in decades.
These build on the foundation of long-acting bronchodilators (LABA/LAMA), with inhaled corticosteroids reserved largely for eosinophilic patients and frequent exacerbators, and triple therapy for those who remain symptomatic.
Further reading: dupilumab BOREAS and NOTUS (Bhatt et al., NEJM 2023 and 2024); mepolizumab MATINEE; ensifentrine ENHANCE trials and 2024 approval.