Airway inflammation in COPD: progress to precision medicine

Area of Science:

• Pulmonary Medicine
• Immunology
• Genetics

Background:

• Chronic obstructive pulmonary disease (COPD) is a major global health issue with increasing prevalence.
• Airway inflammation is central to COPD pathogenesis and progression, yet anti-inflammatory therapies are not standard first-line treatments.
• COPD exhibits heterogeneous inflammatory phenotypes, including neutrophil-associated, eosinophil-associated, and autoimmune patterns.

Purpose of the Study:

• To review current and future biomarker strategies for assessing airway inflammation in COPD.
• To explore how these biomarkers can facilitate precision medicine approaches in COPD.
• To investigate the role of host-environment interactions in driving COPD airway inflammation.

Main Methods:

• Review of existing literature on COPD inflammation and biomarkers.
• Analysis of different COPD inflammatory phenotypes and their clinical implications.
• Discussion of the efficacy of current and emerging anti-inflammatory therapies, including biologics.

Main Results:

• Neutrophil-associated inflammation with inflammasome activation and T1/T17 immunity is the most common COPD phenotype.
• Eosinophilic inflammation (T2-mediated) is present in a minority of COPD patients, responding better to corticosteroids.
• Anti-interleukin-5 biologics show limited efficacy in COPD compared to severe asthma, suggesting other inflammatory drivers.
• Neutrophilic inflammation may be linked to bacterial colonization and dysbiosis.
• Autoimmunity is observed in more severe COPD cases.

Conclusions:

• Biomarkers are crucial for identifying COPD inflammatory phenotypes and enabling targeted anti-inflammatory strategies.
• Precision medicine in COPD requires a deeper understanding of inflammation drivers, including host-environment interactions.
• Current biological therapies targeting T2 inflammation have limited success in COPD, highlighting the need for novel approaches for neutrophilic inflammation.