Published: June 6, 2025
By: Anthony Calabro, MA

Chronic obstructive pulmonary disease (COPD) remains a leading cause of morbidity and mortality worldwide, with projections estimating nearly 600 million cases by 2050—a 23% increase from 2020 levels¹. Recent research has expanded our understanding of COPD’s heterogeneity, leading to more precise phenotyping and individualized approaches to diagnosis and treatment. This update highlights major advances in etiology, diagnostic frameworks, pharmacologic and nonpharmacologic treatment, and interdisciplinary models of care.

While tobacco smoking remains the most significant risk factor for COPD globally, an increasing body of evidence highlights additional contributors, including environmental exposures and genetic predisposition. For instance, alpha-1 antitrypsin deficiency (AATD) accounts for approximately 1% to 5% of COPD cases². Furthermore, chronic exposure to indoor air pollutants, particularly from biomass fuel combustion, continues to drive disease prevalence in low- and middle-income countries³.

Emerging research had shed light on the role of epigenetic modifications, such as DNA methylation and histone acetylation, in mediating inflammation and tissue remodeling in COPD. These insights are paving the way for novel diagnostic biomarkers and therapeutic targets. A 2023 review identified several genes involved in oxidative stress response and immune regulation whose expression is epigenetically altered in COPD⁴.

The 2025 Global Initiative for Chronic Obstructive Lung Disease (GOLD) report reaffirms the importance of spirometry as the diagnostic gold standard, defining airflow limitation as a post-bronchodilator FEV₁/FVC ratio < 0.70⁵. However, there is increasing recognition that spirometry alone may miss individuals with significant disease burden. New multidimensional diagnostic frameworks incorporating respiratory symptoms, computer tomography (CT) imaging, and exacerbation history are emerging as more accurate predictors of poor outcomes⁶.

Screening asymptomatic individuals is currently not recommended. While early detection of COPD has the potential to reduce disease burden and delay progression, current evidence does not support the routine use of screening tests in individuals without symptoms. The U.S. Preventive Services Task Force (USPSTF) reaffirmed its stance in its 2022 recommendation, concluding that the net benefit of screening asymptomatic adults using spirometry is negligible to none. Specifically, the Task Force emphasized that although spirometry can detect airflow obstruction, there is insufficient evidence that such detection in the absence of clinical symptoms translates into improved health outcomes, such as reduced mortality, fewer exacerbations, or enhanced quality of life⁷.

The concern is that screening may lead to overdiagnosis, overtreatment, and unnecessary patient anxiety—especially considering that many mild cases might never progress or cause significant morbidity. Furthermore, pharmacologic treatments have not demonstrated benefit in asymptomatic patients, and the benefits of lifestyle interventions like smoking cessation are already widely promoted, independent of COPD diagnosis⁷.

Several studies and professional societies continue to debate whether there is a subset of high-risk individuals—such as long-term smokers older than 40 years of age—for whom targeted case-finding might be appropriate. However, at present, the USPSTF supports a case-finding approach over population-wide screening: clinicians should remain vigilant for symptoms such as chronic cough, dyspnea, or sputum production and assess for COPD when clinical suspicion is raised⁷.

Pharmacologic therapies
The FDA’s recent approval of biologics and dual-mechanism inhalers marks a new era in COPD treatment. In 2023, dupilumab—an IL-4 and IL-13 inhibitor—became the first biologic approved for COPD with type 2 inflammation. In patients with eosinophil counts ≥ 300 cells/μL, dupilumab reduced exacerbations by 30% to 34% compared with placebo⁸.

Ensifentrine, a dual phosphodiesterase 3 and 4 inhibitor FDA approved in 2024, has demonstrated improvements in both lung function and symptom burden across Phase 3 trials. Its bronchodilator and anti-inflammatory properties make it a compelling option for patients who remain symptomatic despite traditional inhaler therapy⁹.

Another investigational agent, itepekimab—an IL-33 monoclonal antibody—has produced mixed results. In one Phase 3 trial, it reduced exacerbation rates by 27%, but a companion trial failed to replicate these findings, raising concerns about its future clinical utility¹⁰.

Beyond inhaled agents, glucagon-like peptide-1 receptor agonists (GLP-1 RAs), traditionally used for diabetes and obesity, are gaining interest. A retrospective study published in 2024 found that GLP-1 RAs were associated with improved respiratory symptoms and reduced hospitalizations among patients with comorbid COPD and obesity, although prospective trials are needed¹¹.

Non-pharmacologic interventions
Pulmonary rehabilitation remains foundational in COPD care. Innovations in remote delivery models, including tele-rehabilitation and app-based coaching, have expanded access and engagement. Smoking cessation, physical activity promotion, and vaccination remain essential components of disease management¹².

There is growing consensus that a multidisciplinary team (MDT) approach significantly enhances outcomes in COPD care. In a 2020 study, patients managed in rural settings by MDTs—including physicians, nurses, pharmacists, respiratory therapists, dietitians, and psychologists—showed improved symptom control, higher smoking cessation rates, and a 50% reduction in hospitalization rates compared to usual care¹³.

The 2025 GOLD update emphasizes personalized treatment based on biomarkers, such as blood eosinophil counts, and clinical phenotypes, such as frequent exacerbators. This tailored strategy necessitates close collaboration across specialties to optimize treatment adherence, monitor disease progression, and adjust therapy accordingly¹⁴.

Between 2020 and 2025, the field of COPD has seen meaningful progress—from a deeper understanding of disease pathogenesis to the approval of new therapies that target inflammatory endotypes. Diagnosis is evolving beyond spirometry to include imaging and symptom-based assessment. While universal screening remains unsupported, strategic case-finding and multidisciplinary management models are improving patient outcomes. Clinicians should stay abreast of these developments and incorporate personalized strategies to deliver high-quality COPD care.

1. GBD 2021 Chronic Respiratory Disease Collaborators. Global burden of chronic obstructive pulmonary disease and forecast to 2050: a modelling study. JAMA Netw Open. 2023;6(12):e2346598. doi:10.1001/jamanetworkopen.2023.46598
2. Chronic obstructive pulmonary disease (COPD) - Etiology. BMJ Best Practice. https://bestpractice.bmj.com/topics/en-us/7/aetiology
3. Salvi SS, Barnes PJ. Chronic obstructive pulmonary disease in non-smokers. Lancet. 2009;374(9691):733-743.
4. Vucic EA, Chari R, Thu KL, et al. DNA methylation is globally disrupted and associated with expression changes in chronic obstructive pulmonary disease small airways. Am J Respir Cell Mol Biol. 2014;50(5):912-922.
5. Global Initiative for Chronic Obstructive Lung Disease (GOLD). 2025 GOLD Report. https://goldcopd.org/2025-gold-report
6. Bhatt SP, Washko GR, Martinez FJ. Beyond obstruction—a milestone in COPD diagnosis. JAMA. 2025;329(20):2025–2026. doi:10.1001/jama.2025.0725
7. Siu AL; US Preventive Services Task Force. Screening for Chronic Obstructive Pulmonary Disease: US Preventive Services Task Force Recommendation Statement. JAMA. 2022;328(17):1730–1736. doi:10.1001/jama.2022.19788
8. Rabe KF, Martinez FJ, Ferguson GT, et al. Dupilumab in type 2 inflammation-associated COPD. N Engl J Med. 2023;389(3):209–220.
9. Hanania NA, Criner GJ, Tarasevych SP, et al. Ensifentrine as a novel treatment in COPD: results from the ENHANCE trials. Chest. 2024;165(1):123–134.
10. Regeneron dashes Wall Street’s hopes as COPD treatment trial suffers a failure. MarketWatch. https://www.marketwatch.com/story/regeneron-dashes-wall-streets-hopes-as-copd-treatment-trial-suffers-a-failure-1ffb6016
11. Buse JB, Polonsky WH, Garber AJ. GLP-1 receptor agonists and COPD: emerging evidence. Lancet Respir Med. 2024;12(3):145–147.
12. The most exciting new advances in managing COPD. TIME. https://time.com/6903546/copd-treatment-advances/
13. Rollins G, Garcia A, Davis L, et al. Improving chronic obstructive pulmonary disease (COPD) symptoms using a multidisciplinary team approach. J Am Board Fam Med. 2020;33(6):978–984.
14. ASHP Midyear: 2025 GOLD report updates highlight cardiovascular risks, new therapies for COPD patients. Pharmacy Times. https://www.pharmacytimes.com/view/ashp-midyear-2025-gold-report-updates-highlight-cardiovascular-risks-new-therapies-for-copd-patients