In an era of groundbreaking advancements, the landscape of respiratory medicine is being transformed, particularly in managing asthma and chronic obstructive pulmonary disease (COPD). The shift from one-size-fits-all treatment strategies—primarily relying on inhaled therapies—to personalized care approaches informed by detailed disease profiles and biomarker insights, is changing patient outcomes like never before.

Biologic therapies are at the forefront of this revolution. The introduction of medications such as dupilumab (Dupixent), benralizumab (Fasenra), and the game-changing tezepelumab (Tezspire) has raised the bar for effective asthma interventions. Notably, tezepelumab’s approval in 2021 marked a significant milestone as the first biologic for severe asthma that doesn't restrict treatment based on eosinophil counts, giving clinicians the ability to customize therapies according to each patient's unique condition. This evolution is also fostering strengthened collaboration between allergists and pulmonologists, emphasizing the importance of early patient identification to enhance treatment outcomes and reduce steroid dependency.

COPD, historically regarded as a stubborn disease to manage, is finally embracing similar innovation. The recent 2024 FDA approval of dupilumab for eosinophilic COPD is heralding a new era in biologic therapy for patients who have long been managed primarily on a symptom-driven basis. As the distinctions between asthma and COPD continue to blur, there’s a growing imperative for clinicians to reassess traditional treatment protocols.

A recent clinical forum hosted by HCPLive, featuring a panel of expert pulmonologists and allergists led by Dr. Joseph Khabbaza of the Cleveland Clinic, delved into these transformative changes in respiratory care. The panel underscored how biologics are becoming crucial to modern asthma management, especially for patients with type 2 inflammation. The newfound emphasis on biomarkers such as eosinophils and FeNO signifies a paradigm shift in treatment strategies.

Interestingly, pulmonologists are taking the reins on biologic management, indicating a trend toward diminished reliance on allergists as comfort with these therapies grows. There's also a movement towards initiating biologics earlier in treatment to lower the cumulative burden of steroids and stave off long-term complications, despite hurdles posed by payer criteria.

One panelist confidently stated, "If my patient has needed steroids more than twice in a six-month span, I’m moving faster to initiate biologics. I’ve seen the detrimental long-term effects of steroids, and I refuse to let anyone suffer through that. I’m quick to act on biologic treatments in those cases."

COPD strategies are beginning to embrace these same principles as well, recognizing that certain patients with type 2 inflammation could significantly benefit from biologic options. However, the journey is far from over. The panelists acknowledged the need for more long-acting biologics, refined patient phenotyping, and expanded eligibility definitions, particularly in the COPD demographic.

As Dr. Khabbaza poignantly remarked at the close of the discussion, "Asthma and COPD have dramatically evolved recently. With enhanced understanding of eosinophils and type 2 inflammation, we now have myriad pathways and treatment options to support these patients better. Our goals are to minimize the reliance on prednisone and reduce exacerbations. Achieving these objectives will be beneficial across the entire healthcare system."