By: Michael S. Alvarez, DO, MPH, FCCP
Chronic Obstructive Pulmonary Disease (COPD) affects millions of people and remains one of the most common causes of breathing disorders worldwide. For decades, treatment has centered around inhalers, steroids, oxygen, and lifestyle changes. These remain essential, but now there are exciting new therapies that can target the disease in more precise ways.
Some of the biggest breakthroughs are biologic medications like Dupixent and Nucala, which have been used for asthma and are now approved for certain COPD patients. Another new medication, Ohtuvayre, is the first inhaled COPD medication to be approved in more than a decade.
The Foundation of COPD Care
The starting point for COPD treatment is usually maintenance inhalers. Dual therapy inhalers combine two types of medicines, while triple therapy adds an inhaled steroid for more complete control.
When a flare-up—also called an exacerbation—occurs, patients may need a short course of oral steroids such as prednisone, sometimes combined with antibiotics or nebulizer treatments.
But repeated steroid bursts can lead to adverse effects over time, including bone loss, weight gain, diabetes, high blood pressure, and higher infection risk. Even more concerning, the more flare-ups a patient experiences, the faster their lung function declines, which often leads to even more flare-ups. This is the dangerous cycle these new treatments aim to break.
Why Eosinophils Matter in COPD
To understand why biologics work, it helps to know about eosinophils—a type of white blood cell. They normally help fight infections, but in some COPD patients, especially those with chronic bronchitis, high eosinophil levels cause ongoing inflammation in the airways.
Eosinophil counts are measured with a simple blood test. Levels of 150 cells/μL or higher may indicate that a patient could benefit from Nucala. Levels of 300 cells/μL or higher show the strongest evidence for benefit from both Nucala and Dupixent. Patients with high eosinophil counts often have more flare-ups and may respond better to therapies that specifically target these cells.
Dupixent: A Targeted Option for High Eosinophil COPD
Dupixent has been a trusted asthma treatment for years and is now approved for certain COPD patients. It is designed for people with chronic bronchitis-type COPD, eosinophil counts of at least 300 cells/μL, and frequent flare-ups despite being on triple inhaler therapy.
It works by blocking two inflammatory proteins, IL-4 and IL-13, that drive swelling, mucus production, and airway wall thickening. For eligible patients, Dupixent can reduce flare-ups, improve lung function, and make day-to-day breathing easier.
Nucala: Expanding Access to Biologic Therapy
Nucala is another biologic that has been used in asthma for years and is now available for certain COPD patients. It can be prescribed for people with eosinophil counts of 150 cells/μL or higher, with the best results seen at 300 or more.
Nucala targets IL-5, a protein that eosinophils need to survive. By lowering eosinophil numbers, Nucala reduces inflammation in the lungs and decreases the frequency of exacerbations. This makes it an important option for patients whose COPD is driven by eosinophilic inflammation but who may not meet the higher threshold for Dupixent.
Ohtuvayre: A Dual-Action Inhaled Breakthrough
Ohtuvayre represents a major step forward as the first inhaled COPD medication approved in over a decade. It is delivered via nebulizer, allowing the medication to reach the lungs directly.
What makes Ohtuvayre unique is that it works in two ways at once. It relaxes the muscles around the airways so air can flow more freely, and it reduces inflammation to limit swelling and mucus buildup. This is achieved by blocking two enzymes, PDE3 and PDE4, that are involved in both airway tightening and inflammation.
Unlike the biologics, Ohtuvayre can be used regardless of eosinophil levels, making it an option for patients who still have daily shortness of breath despite being on standard inhalers.
Fitting These Treatments Into the COPD Care Plan
COPD care can be thought of as a ladder. The first steps are lifestyle changes—quitting smoking and exercising. Next comes medication with dual or triple inhaler therapy. When flare-ups occur, short courses of steroids and antibiotics may be necessary.
If symptoms or exacerbations persist, advanced options come into play. Dupixent is for patients with high eosinophils and frequent flare-ups. Nucala can be used at lower eosinophil counts but is most effective at higher levels. Ohtuvayre is for persistent breathlessness, no matter what the eosinophil level.
The Promise of Personalized COPD Care
These new therapies mark a shift from “one-size-fits-all” to precision medicine in COPD. By targeting the specific type of inflammation driving the disease, they can reduce flare-ups, protect lung function, and improve overall quality of life.
If you have COPD, our team of doctors at Tampa Pulmonary & Sleep Specialists can help determine whether you might benefit from Dupixent, Nucala, or Ohtuvayre. We can review your history, check your eosinophil levels, and create a plan that fits your needs.
For patients looking for even more personalized care, our Tampa Pulmonary Premium Service offers concierge-style benefits, including direct physician access, same-day or next-day appointments, and extra time to focus on your health.
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