New anti‐inflammatory and remodelling drugs for unmet clinical needs in severe asthma and chronic obstructive pulmonary disease (COPD)

-agonists as bronchodilators and the introduction of inhaled corticosteroids (ICS) to reduce airway inflammation. The next revolution was the advent of inhaled combinations of long-acting bronchodilators together with inhaled corticosteroids in the same inhalation device for improved asthma control. The most recent step-change is the introduction of targeted monoclonal antibodies in patients with severe asthma and frequent exacerbations with biomarkers reflecting high levels of Type 2 (T2) inflammation. In chronic obstructive pulmonary disease (COPD), advances in bronchodilator therapy have been made, but limited advances in treating the inflammation and lung remodelling changes are present. We need new therapeutic agents for patients with a sub-optimal response to current drugs. The aim of this narrative review is to provide a summary of the potential future anti-inflammatory approaches undergoing testing for asthma and COPD rather than provide a systematic review. These approaches aim to optimize current treatment regimens and to develop novel agents against differing aspects of asthma and COPD pathophysiology. However, clinical trial results highlight our limited understanding of the biology of asthma and COPD subtypes. Furthermore, failed studies provide insight into disease pathophysiology and may indicate responder/non-responder populations. Various aspects of cytokine- and environment-activated intracellular pathways are being targeted. These include receptor agonists and antagonists and inhibitors of the Janus kinase (JAK) and Bruton tyrosine kinase (BTK) pathways for use against both stable disease and for reducing disease exacerbations or 'attacks'. New or better use of current biomarkers will provide non-invasive means of patients most likely to respond to any one specific or combination of drugs.