Bridging the Knowledge Gap: Transforming COPD Management Through Lessons from Asthma

Advances in asthma immunopathology and the integration of biologic therapies have reshaped clinical practice, and in turn have impacted diagnosis, phenotyping, monitoring, and care organization. Given the persistent burden of chronic obstructive pulmonary disease (COPD), transferring these strategies may facilitate the implementation of precision medicine in COPD. The BRIDGE project, an educational initiative involving seven pulmonologists, aimed to identify key learnings from asthma that could support the incorporation of immunological insights and biologics into the management of COPD.

The expert panel conducted a structured review of current approaches to severe asthma, including biomarker-guided diagnosis, endotyping, treatment evaluation frameworks, and specialized clinical pathways. Through consensus-based discussions, the group analyzed which elements were adaptable to COPD and proposed recommendations to support their implementation.

Experts agreed that several core principles of asthma management could significantly improve COPD care. Comprehensive phenotyping, supported by biomarkers such as blood eosinophils, FeNO, and IgE, along with computed tomography (CT) imaging to characterize mucus plugging and emphysema, was identified as essential. Treatment optimization should shift toward quantifiable therapeutic objectives, emphasizing exacerbations, corticosteroid use, dyspnea, and physical activity. Structured follow-up must rely on objective exacerbation recording, rescue medication use, lung function, and functional capacity. Organizational improvements should mirror the asthma model, including the development of specialized units, decentralization of biologic administration, and enhanced, multidisciplinary coordination. The remaining gaps include the need for standardized CT protocols, consensus definitions of uncontrolled exacerbator phenotypes, and a national registry to generate real-world evidence on biologics.

Experience gained from biologic therapy in asthma provides a robust framework for advancing precision medicine in COPD. Adopting rigorous diagnostic, therapeutic, and organizational strategies will facilitate the effective introduction of biologics and improve outcomes for patients with uncontrolled COPD despite conventional therapies.