Biologics and biomarkers have reshaped asthma and chronic obstructive pulmonary disease (COPD) management, especially for patients with type 2 (T2) inflammation, but clinicians still struggle to apply them consistently in real-world practice. At a 2025 HCP Live forum, pulmonologists emphasized that blood eosinophils and FeNO are the most actionable biomarkers to help choose between agents targeting IgE, IL-5, IL-4/IL-13, or TSLP, but their use is limited by variability in testing, reimbursement, and the need to interpret results in the context of symptoms, exacerbation history, comorbidities, and inhaler optimization. Biologics have reduced the need for chronic steroids in severe asthma, but selecting the “right” biologic often remains empirical rather than strictly algorithmic.
In COPD, the panel noted that 30% to 40% of patients show evidence of T2 inflammation, creating an opportunity for targeted therapy. The 2024 approval of dupilumab for eosinophilic COPD was singled out as a proof point that blocking IL-4/IL-13 can deliver clinically meaningful lung and symptom gains in the right phenotype, helping move COPD closer to asthma-style precision care. Long-acting options are attractive to patients but introduce follow-up and monitoring challenges. Overall, the clinicians agreed that the future of airway disease care lies in balancing precision (biomarker-guided, phenotype-driven) with practicality (what can be done in clinic).
Reference: Campbell P. Biologics and Biomarkers in 2025: Evolving Strategies for Asthma and COPD. HCP Live. Published August 5, 2025. Accessed October 31, 2025. https://www.hcplive.com/view/biologics-and-biomarkers-in-2025-evolving-strategies-for-asthma-and-copd
