COPD: real-world evidence on single-inhaler triple therapy and the emergence of biologic therapy
Year: 2026
Type: article
Abstract: Chronic obstructive pulmonary disease (COPD) remains a leading cause of morbidity and mortality worldwide. Despite major pharmacological advances, a substantial gap persists between guideline recommendations and routine clinical practice, particularly after exacerbations. This narrative review summarizes current evidence supporting personalized pharmacological escalation in COPD, focusing on single-inhaler triple therapy (SITT) and the emergence of biologic therapy. SITT, combining an inhaled corticosteroid, a long-acting β 2 -agonist and a long-acting muscarinic antagonist, is now the preferred inhaled strategy for patients requiring ICS-containing triple therapy. Real-world studies indicate that, compared with multiple-inhaler triple therapy, SITT is associated with better adherence and persistence, lower exacerbation rates and improved clinical outcomes, although observational findings require cautious causal interpretation. In parallel, COPD has entered the era of targeted biologic therapy. Dupilumab was the first biologic approved for COPD, following the BOREAS and NOTUS trials in patients with chronic bronchitis, blood eosinophils ≥300 cells/µL and persistent exacerbations despite triple therapy. Mepolizumab has more recently provided robust phase 3 evidence in eosinophilic COPD through the MATINEE trial. Early real-world dupilumab studies further suggest potential effectiveness in selected patients under-represented in pivotal trials, including those with advanced age, severe airflow limitation, oxygen dependence or high mucus burden. Beyond canonical type 2 pathways, IL-33 inhibition with tozorakimab may further broaden targeted treatment to COPD phenotypes without a clear eosinophilic signature. Integrating these advances within a treatable-traits framework may help optimize patient selection, close post-exacerbation therapeutic gaps, and align pharmacological escalation with comorbidity management, adherence, inhaler technique and rehabilitation needs.
Source: Frontiers in Pharmacology
Institutions: University of Trieste, Azienda Ospedaliera Santa Maria Degli Angeli, Azienda sanitaria universitaria Friuli Centrale, Ruhrlandklinik, Essen University Hospital, University of Duisburg-Essen, Azienda Ospedaliera Ospedale Civile di Legnano, Aziende Socio Sanitarie Territoriale Ovest Milanese, Manchester Academic Health Science Centre, University of Manchester, Manchester University NHS Foundation Trust, NIHR Manchester Biomedical Research Centre, Northern Care Alliance NHS Foundation Trust, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Shantou Central Hospital, Ospedale di Cattinara, University of Padua
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,801
OpenAlex ID: W7223329883