The 2023 “ABE” GOLD treatment guidelines focus mainly on exacerbation risk to determine pharmacological treatment strategies, independent of spirometric value. 

Since launching as the first fixed-dose combinations of an ICS and a LABA, GSK’s Advair and AstraZeneca’s Symbicort have been widely adopted in COPD. However, generic competition in Europe, and more recently in the US, marks the end of this successful history. Lawmakers and regulators have imposed measures to combat the high prices of inhalers by challenging inhaler patents in the Orange Book and urging price cuts. Inhaler makers GSK, AstraZeneca, and Boehringer Ingelheim will join the $35 co-pay club as pressure grows.  

On 27 September 2024, Sanofi and Regeneron’s Dupixent became the first biologic to receive approval in the US for treating COPD patients with high eosinophils, based on positive data from the Phase III NOTUS and BOREAS studies. Meanwhile, ongoing studies are evaluating AstraZeneca’s Fasenra and GSK’s Nucala in individuals with high eosinophils. IL-33 inhibitors represent a novel class of therapies being developed specifically for COPD and address upstream inflammatory signaling across multiple pathways.