Emerging treatment options for chronic obstructive pulmonary disease: a look into 2026 and beyond

INTRODUCTION: As a leading cause of worldwide mortality, chronic obstructive pulmonary disease (COPD) is progressive and irreversible, leading to significant challenges with disease management and treatment. This is further complicated by the heterogenous nature of COPD, which is represented by the multiple endotypes that have variable responses to available treatments, thereby negating the one-size-fits-all approach. While recent clinical studies describe the effectiveness of existing therapies, further investigation is required to align COPD endotypes with the appropriate treatment options. AREAS COVERED: In this review, we discuss the known biomarkers pertaining to both direct and indirect measures of the inflammatory milieu and structural abnormalities in COPD. Combined use of conventional anti-inflammatory and bronchodilator treatments provide some symptomatic relief by reducing exacerbation frequency, however, for some patients, long-term corticosteroid use can increase the risk developing pneumonia and subsequent mortality. Biologics are at the forefront of emerging therapies for COPD, which shifts the target from widespread airway inflammation to pinpoint precise inflammatory markers involved in pathophysiological mechanisms of COPD. EXPERT OPINION: Identifying reliable airway-derived biomarkers in COPD will drive the development of therapies that can facilitate a precision medicine approach for patients with COPD.