Over the past decade, management of airway disease has shifted from treating asthma and chronic obstructive pulmonary disease (COPD) as rigidly separate entities to recognizing a spectrum with overlapping phenotypes, especially in patients with eosinophilic inflammation. This reframing aligns with a surge of biologics targeting type 2 pathways—some with indications spanning both conditions—opening options for patients poorly served by inhaler-only regimens. Experts note that many patients with “COPD” likely have unrecognized antecedent asthma and persistent eosinophilia, reinforcing a continuum model rather than discrete diagnoses. Environmental triggers and rising atopy further complicate the picture, underscoring the need to reassess labels and pathways as evidence evolves.
Clinically, teams must navigate a nuanced spectrum amid diverging guidelines and payer restrictions, while personalizing care to patient goals. Priorities include cohesive guidance that reflects real-world overlap, broader biomarker-driven phenotyping (eg, eosinophil-high disease), and clearer pathways to reduce steroid exposure. Panelists emphasized clinician advocacy, shared decision-making, and equity in access—particularly for underserved populations—as biologics and targeted therapies expand. Persistent gaps remain around airway remodeling and long-term disease modification. Current options (eg, limited pulmonary rehab, valves, transplant) highlight the need for research that maps biomarkers to durable outcomes and defines practical algorithms for initiating and sequencing advanced therapies.
Reference: Johnson V. Rethinking Airway Inflammation: Treating Airway Disease at the Intersection of Asthma and COPD. HCPLive. Published July 29, 2025. Accessed Spetember 8, 2025. https://www.hcplive.com/view/rethinking-airway-inflammation-treating-airway-disease-intersection-asthma-copd
