Advances in the treatment of chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is optimally managed through a comprehensive, individualized, and adaptable treatment approach. This review summarizes current and emerging strategies in COPD care, emphasizing both pharmacologic and non-pharmacologic interventions aimed at relieving symptoms, reducing exacerbations, and improving quality of life. Long-acting bronchodilators remain the cornerstone of pharmacologic therapy, with combination long-acting β-agonists (LABA) and long-acting muscarinic antagonist (LAMA) therapy preferred as initial treatment for most patients with persistent dyspnea or exercise intolerance. Inhaled corticosteroids (ICS) are recommended for select patient phenotypes, particularly individuals with frequent exacerbations or elevated blood eosinophil levels. Triple therapy (LABA+LAMA+ICS) demonstrates significant benefits in reducing exacerbations and may provide mortality benefits in appropriately selected patients. Personalized treatment strategies guided by exacerbation history, blood eosinophil counts, and symptom burden have become central to contemporary COPD management. Novel biologic therapies targeting type 2 inflammation, including dupilumab and mepolizumab, have demonstrated efficacy in reducing exacerbations in patients with eosinophilic phenotypes who remain symptomatic despite optimized triple inhaler therapy. Bronchoscopic interventions, particularly endobronchial valve placement for lung volume reduction, offer meaningful improvements in lung function and quality of life for carefully selected patients. Despite these advances, significant challenges persist, especially in resource-limited settings. Barriers include limited access to guideline-recommended therapies, difficulties in managing comorbidities, inadequate implementation of pulmonary rehabilitation programs, and broader health system constraints continue to impact optimal disease management.