MeiLan K. Han, MD, MS

Panelists discuss the ongoing challenge of engaging patients, providers, and families in understanding the long-term risks of frequent oral corticosteroid use in chronic obstructive pulmonary disease (COPD), emphasizing the importance of clear communication about serious adverse effects—including mental health and cardiovascular risks—and the role of electronic medical records in early intervention; they note that patients often feel well between exacerbations and may undervalue steroid-sparing strategies, so personalized education focusing on preventing future harm is key, and express optimism that new biologics offer promising options to reduce exacerbations and steroid dependence, highlighting the evolving, hopeful landscape of COPD care.

Panelists discuss the introduction of 2 biologics for patients with chronic obstructive pulmonary disease (COPD) with high blood eosinophils and frequent exacerbations as a major advancement, highlighting their ability to reduce exacerbations and steroid use; they note differences in dosing schedules, inflammatory markers, and patient preferences that influence therapy choice, emphasize the role of shared decision-making amid cost and insurance challenges, and acknowledge that trial and error may be needed to personalize treatment while calling for more research to optimize biologic use.

Panelists discuss the importance of early identification of patients with chronic obstructive pulmonary disease (COPD) at risk for exacerbations through targeted clinical questioning about recent hospitalizations, emergency visits, and steroid or antibiotic use, noting that many patients underreport or misunderstand exacerbations; they emphasize patient education, improved communication across multiple providers, and the integration of electronic medical records and patient portals as key strategies to enhance monitoring, ensure timely treatment escalation, and ultimately reduce exacerbation frequency and severity.

Panelists discuss common barriers to timely escalation of chronic obstructive pulmonary disease (COPD) treatment, including infrequent follow-up visits, fragmented care across multiple providers, and delayed communication of exacerbations or hospitalizations, as well as therapeutic inertia stemming from competing clinical priorities and insufficient patient education; they emphasize the need for integrated, proactive strategies such as shared electronic medical records, rapid posthospitalization follow-up, care coordination, and enhanced patient engagement to overcome these challenges and optimize treatment adjustments.

Panelists discuss the critical factors guiding therapy escalation in chronic obstructive pulmonary disease (COPD), emphasizing thorough evaluation of symptoms, exacerbation history, and medication adherence; they highlight the foundational role of standard inhaled therapies and nonpharmacologic interventions like pulmonary rehabilitation and smoking cessation, while noting that newer treatments, including biologics, are reserved for patients with persistent exacerbations despite optimized care, with decisions shaped by shared decision-making and personalized considerations such as inhaler technique and delivery method to improve outcomes and quality of life.

Panelists discuss the nuanced relationship between chronic obstructive pulmonary disease (COPD) and asthma through the lens of type 2 inflammation, emphasizing that while both diseases share inflammatory pathways and a treatable trait, they remain distinct conditions with differing manifestations and treatment responses; they highlight that asthma-COPD overlap affects 15% to 20% of patients, but type 2 inflammation is a separate COPD subtype rather than evidence of dual diagnosis, underscoring the importance of precise phenotyping to guide personalized treatment strategies that balance efficacy, safety, and patient-specific factors.

Panelists discuss the prevalence and complexity of type 2 inflammation in chronic obstructive pulmonary disease (COPD), noting that blood eosinophil counts—using thresholds of 150 to 300 cells/µL—identify roughly 30% to 50% of patients with this phenotype, while emphasizing that not all elevated eosinophil cases reflect true type 2 inflammation; they highlight additional markers like allergen sensitization and immunoglobulin E (IgE), the association of type 2 inflammation with increased symptoms and exacerbations, and the ongoing need for refined phenotyping and targeted therapies to address the heterogeneity of COPD inflammation.

Panelists discuss the emerging recognition of type 2 inflammation in a subset of patients with chronic obstructive pulmonary disease (COPD) , highlighting differences from asthma in eosinophil thresholds and therapeutic responses, the roles of key cytokines IL-4, IL-13, and IL-5 in driving airway inflammation and remodeling, and the promise and challenges of targeting these pathways with biologics to improve outcomes while emphasizing the need for further research to understand the distinct inflammatory mechanisms in COPD.

Panelists discuss the variability of blood eosinophil counts in chronic obstructive pulmonary disease (COPD), emphasizing the impact of factors such as corticosteroid use, infections, comorbidities, and smoking on their interpretation, and highlight the importance of considering these influences and monitoring trends over time to guide personalized treatment decisions effectively.

Panelists highlight that while blood eosinophil counts are valuable for guiding chronic obstructive pulmonary disease (COPD) treatment, real-world challenges like fluctuating levels, incomplete symptom tracking, and fragmented care hinder their consistent use, underscoring the need for better data integration and clinician education.

Panelists discuss the growing role of blood eosinophils as a key biomarker in chronic obstructive pulmonary disease (COPD) management, highlighting their utility in guiding inhaled corticosteroid and biologic therapy decisions, the benefits of tracking longitudinal trends to improve accuracy, and the potential for integrating emerging biomarkers like FeNO to further personalize treatment despite current limitations.

Panelists discuss the future of chronic obstructive pulmonary disease (COPD) management, emphasizing the need for long-term data on newly approved therapies, the development of refined biomarkers like FeNO and imaging tools to guide precision treatment, and the potential for earlier intervention with biologics—all aimed at advancing personalized care and altering the disease trajectory in high-risk patients.

Panelists discuss the evolving role of newly approved chronic obstructive pulmonary disease (COPD) therapies—such as ensifentrine, mepolizumab, and dupilumab—in addressing persistent symptoms and frequent exacerbations despite standard care, highlighting their targeted use based on patient profiles, the practical challenges of integration into clinical practice, and the importance of education, shared decision-making, and personalized care to optimize outcomes in moderate to severe COPD.

Panelists discuss the impact of newly approved therapies for chronic obstructive pulmonary disease (COPD)—such as ensifentrine, mepolizumab, and dupilumab—highlighting their diverse mechanisms and potential to personalize treatment for patients with persistent symptoms or type 2 inflammation, while emphasizing the importance of guideline integration, clinician education, and collaboration across care teams to ensure timely and effective adoption in clinical practice.

Panelists discuss how chronic obstructive pulmonary disease (COPD) management is evolving with personalized therapies, nonpharmacological care, and advanced treatments. Early diagnosis, adherence, and innovation offer hope for improved outcomes and quality of life.

Panelists discuss how key nonpharmacological interventions include vaccinations to prevent infections, pulmonary rehabilitation to improve function, and lung cancer screening for high-risk patients to enable early detection.

Panelists discuss how individualized chronic obstructive pulmonary disease (COPD) maintenance therapy considers symptom severity, exacerbation risk, and eosinophil levels. Dupilumab and ensifentrine require adherence to prescribed dosing for efficacy and safety.

Panelists discuss how the ENHANCE trials assessed ensifentrine in patients with chronic obstructive pulmonary disease (COPD) with moderate-to-severe airflow obstruction and a history of exacerbations. Outcomes showed improved lung function and reduced exacerbations. Clinically, ensifentrine may be used as monotherapy or an add-on, addressing diverse patient needs.

Panelists discuss how the BOREAS and NOTUS phase 3 trials demonstrated that dupilumab significantly reduced exacerbations, improved lung function, and enhanced quality of life in patients with uncontrolled chronic obstructive pulmonary disease (COPD), particularly those with elevated eosinophil counts, highlighting its potential in targeted therapy.

Panelists discuss how ensifentrine is a nebulized inhaled therapy, a small molecule inhibitor of PDE3 and PDE4, and is compelling because there are very few adverse effects. There are also compelling results from studies that show bronchial dilatation and exacerbation reduction.

Panelists discuss how monitoring blood eosinophil counts is crucial for assessing inflammation in asthma and chronic obstructive pulmonary disease (COPD). It guides treatment decisions by identifying patients who may benefit from corticosteroids or biologics.

Panelists discuss how the coexistence of heart disease and chronic obstructive pulmonary disease (COPD) requires careful management as these conditions significantly impact each other. In stable COPD, cardiovascular complications are a leading cause of mortality, whereas acute exacerbations can worsen heart function. Key treatable traits in COPD-associated pulmonary hypertension include hypoxemia, inflammation, and right ventricular dysfunction. Management focuses on optimizing respiratory and cardiac function through appropriate medication selection, oxygen therapy when indicated, and careful monitoring of both conditions to prevent deterioration.

Panelists discuss how dysbiosis of the lung microbiome can exacerbate chronic obstructive pulmonary disease (COPD) through increased inflammation and altered immune responses. In contrast, chest CT imaging is indicated for patients with severe COPD, suspected comorbidities, surgical planning, or unexplained symptoms despite standard treatment. These factors highlight the complexity of COPD management.

Panelists discuss the initial thought that postbronchodilator spirometry would help differentiate chronic obstructive pulmonary disease (COPD) from asthma. However, postbronchodilator spirometry adds time and effort, as well as exposing a patient to short-term medication that may have adverse effects. Guidelines favor a fixed ratio of forced expiratory volume in the first second to forced vital capacity (FEV1/FVC; < 0.7) because of the ratio’s simplicity and is independent of other reference values.

Panelists discuss how chronic obstructive pulmonary disease (COPD) management follows a stepwise approach, beginning with bronchodilators (typically short-acting β2-agonists/long-acting β2-agonists) and progressing to combination therapy with long-acting muscarinic antagonists/inhaled corticosteroids based on symptom severity. Current unmet needs include more targeted anti-inflammatory treatments, better biomarkers for phenotyping, and therapies to halt disease progression, particularly for those who don’t respond well to conventional treatments.

Panelists discuss how, despite being preventable and treatable, chronic obstructive pulmonary disease (COPD) has emerged as a major global health challenge due to widespread exposure to risk factors, particularly tobacco smoke, which remains the primary cause despite declining smoking rates in some regions. Early environmental exposures play a crucial role—workplace pollutants, air pollution, and secondhand smoke can damage developing lungs, whereas genetic factors like α1-antitrypsin deficiency increase susceptibility.

Panelists discuss current statistics indicating that COPD is one of the top three leading causes of death worldwide, with high morbidity and mortality rates, particularly in individuals over 40 years of age, and a growing global burden due to risk factors like smoking and air pollution.

Panelists discuss major risk factors for COPD development, including smoking, long-term exposure to environmental pollutants, and genetics, while noting that a history of asthma, early bronchitis, respiratory infections, and sex (with higher prevalence in men) may also influence disease onset and progression.

Panelists discuss COPD as a chronic inflammatory lung disease characterized by persistent airflow limitation, typically diagnosed through spirometry, and highlight common respiratory symptoms including chronic cough, sputum production, and dyspnea.