Revolutionizing Asthma and COPD Care: Entering the Precision Medicine Frontier
Imagine a world where treatments for chronic lung conditions like asthma and COPD are no longer a guessing game, but instead tailored perfectly to each patient's unique biology. That's the exciting reality unfolding in pulmonary medicine today—and it's happening faster than ever. But here's where it gets controversial: Are we truly ready to ditch the old 'one-size-fits-all' approach, or could this personalized revolution leave some patients behind? Let's dive into the insights from the CHEST 2025 Annual Meeting, where experts gathered to celebrate 90 years of progress while peering boldly into the future.
The CHEST 2025 conference, hosted by the American College of CHEST Physicians in Chicago, Illinois, marked a pivotal 90th anniversary for this global gathering of top pulmonary specialists. As outlined in the event agenda, it wasn't just a retrospective on the past—it was a forward-looking celebration of the next decade's medical breakthroughs. Looking ahead to CHEST's 100th anniversary in 2035, experts like Nicola A. Hanania, MD, MS, suggest that the last decade's innovations might rival the entire previous 90 years. Precision medicine, which customizes treatments based on individual genetic, environmental, and lifestyle factors, is becoming the norm for asthma and COPD. Ongoing research into disease mechanisms, severity levels, and how patients respond to therapies has refined how we start treatments, ensuring they're more effective and patient-centered.
In a chat with HCPLive, Hanania—a professor of medicine and director of the Asthma Clinical Research Center at Baylor College of Medicine—shared highlights from CHEST 2025. She covered the meeting's key takeaways, the growing importance of biomarkers in guiding treatments, and the need to prioritize patients' own goals from the outset of care.
What stood out to you as a major shift in pulmonary care at CHEST 2025?
Let's begin with asthma, where targeted therapies—particularly biologics—took center stage in multiple sessions. Clinicians are buzzing with questions like: When should I begin a biologic treatment? How do I pick the right one? And which patients are the best candidates? We explored clinical trial data on new biologics' effectiveness. For instance, in one session, speakers like myself dissected biologic selection based on patient traits—think age, symptom patterns, or co-existing conditions. With six approved biologics for asthma, real-world evidence is piling up, making choices tricky. That's why discussions emphasized biomarkers to guide selections, alongside patient characteristics and comorbidities.
And this is the part most people miss: I also delved into 'remission' in asthma, a concept gaining traction. When patients on biologics experience minimal symptoms, stable lung function, and no flare-ups or oral steroid needs, we ask: Is this true remission? Can we stop or reduce the biologic? In my talk, I outlined potential definitions for clinical remission, such as no exacerbations, normalized symptoms, stable lungs, and avoiding oral steroids. I reviewed existing data across biologics but teased what's coming next. If remission is achieved, could we discontinue controller therapies or space out biologic doses? Studies are scarce, but some suggest tapering might be feasible for patients in remission—though we lack a cure, so full discontinuation isn't advisable yet. I ended by posing questions for future research: Establishing a universal remission definition, incorporating imaging or other biomarkers beyond just symptoms and lung tests. This area is bursting with potential, with more unknowns than answers, but it's thrilling—ushering in the Precision Medicine Era where asthma isn't treated as a blanket condition.
But here's where it gets controversial: Could pushing for remission lead to overconfidence in tapering treatments, risking setbacks for patients? What if remission definitions vary wildly, causing inconsistent care across doctors?
What's the current landscape of COPD care following CHEST 2025?
COPD is trailing behind asthma a bit, but catching up. We now have biologics approved for specific COPD subgroups, like those with high eosinophil levels (type 2 COPD). I delivered three presentations on COPD interventions.
First, on the MATINEE study, which evaluated mepolizumab in COPD patients with frequent exacerbations. This post-hoc analysis of a New England Journal of Medicine trial examined oral steroid use over two years, revealing that biologics can cut the need for these potent drugs.
Second, I shared findings on patient-reported outcomes with dupilumab, another biologic. Symptoms matter hugely in COPD, as do exacerbations. Our study analyzed secondary outcomes like symptoms via tools such as the St. George's Respiratory Questionnaire (SGRQ), showing dupilumab improved breathlessness and overall well-being over a year, beyond just reducing flare-ups in trials like NOTUS and BOREAS.
Lastly, I presented on ensifentrine, a nebulized PDE3 and PDE4 inhibitor—not a biologic. Trials demonstrated better lung function, fewer exacerbations, and eased symptoms, especially shortness of breath. In a post-hoc look at patients without flare-ups in six months, we found reduced dyspnea even without exacerbations, highlighting that breathlessness and flare-ups don't always overlap.
You mentioned biomarkers' role in prescribing, especially for targeted therapies, and new head-to-head trial data. Why keep testing?
Biomarkers are key, and with emerging head-to-head comparisons of biologics, the data reinforces their necessity.
How often and urgently should we test for biomarkers before starting severe airway disorder treatments?
We have fewer biomarkers than in other medical fields, but blood eosinophil count is a standout for both asthma and COPD. In asthma, it's crucial for a large group, predicting exacerbation risk and response to steroids. In COPD, it's vital for a subset, endorsed by GOLD guidelines for forecasting flare-ups, lung decline, and hospitalizations. It also predicts steroid responsiveness.
In asthma, composite biomarkers—combining blood eosinophils with exhaled nitric oxide (FeNO)—offer stronger predictions. CHEST featured data on this, suggesting single markers may not suffice.
For COPD, FeNO is promising but variable (affected by smoking), while eosinophils remain reliable. Other biomarkers are being explored, though not prominently at CHEST.
CT imaging biomarkers are emerging too, costly but potentially precise for classifying patients. They're not clinic-ready yet, but research is promising.
How do patient-reported outcomes shape future research priorities?
Patients must stay front and center. For pricey, long-term biologics, their buy-in through shared decision-making is essential—guidelines urge it. Clinicians might lean toward the 'best' therapy, but patients' views matter. In my practice, we discuss expectations, address concerns, and involve caregivers in COPD for cognitive issues.
Inhaler choice is huge—we have four delivery systems, and not all suit every patient. Patient outcomes go beyond lung function metrics; questionnaires like asthma control tests and COPD assessment tests gauge subjective well-being. FEV1 (forced expiratory volume in one second) measures airway obstruction but misses the full picture. Now, we're eyeing small airway function—how it contributes to disease and how to test it. A CHEST session explored this, noting current therapies often overlook small airways, while newer ones like biologics or targeted inhalers might help. This shift encourages holistic care.
Any final thoughts from CHEST 2025?
After 31 years, I realize we're never 'done'—more innovation awaits. In asthma and COPD, we're breaking free from narrow views, embracing phenotypes, endotypes, mechanisms, biomarkers, and patient outcomes once overlooked.
What do you think? Is precision medicine the ultimate game-changer for lung diseases, or does it risk complicating care for busy clinicians? Could biomarkers democratize treatment access, or widen disparities for those without testing? Share your views in the comments—we'd love to hear your take! Join thousands of clinicians with HCPLive for the latest on therapies, trials, and insights—subscribe today.
References
Sciurba FC, Criner GJ, Christenson SA, et al. Mepolizumab to Prevent Exacerbations of COPD with an Eosinophilic Phenotype. N Engl J Med. 2025;392(17):1710-1720. doi:10.1056/NEJMoa2413181
Kunzmann K. Dupilumab Lessens COPD Exacerbation Impact, with Nicola Hanania, MD, MS. HCPLive. Published online October 21, 2025. https://www.hcplive.com/view/dupilumab-lessens-copd-exacerbation-impact-nicola-hanania
Anzueto A, Barjaktarevic IZ, Siler TM, et al. Ensifentrine, a Novel Phosphodiesterase 3 and 4 Inhibitor for the Treatment of Chronic Obstructive Pulmonary Disease: Randomized, Double-Blind, Placebo-controlled, Multicenter Phase III Trials (the ENHANCE Trials). Am J Respir Crit Care Med. 2023;208(4):406-416. doi:10.1164/rccm.202306-0944OC
Kunzmann K. Dupilumab Bests Omalizumab in Airway Improvement for Patients with CRSwNP and Asthma. HCPLive. Published online October 22, 2025. https://www.hcplive.com/view/dupilumab-bests-omalizumab-airway-improvement-patients-crswnp-asthma
Kunzmann K. Clinical and Patient Definitions of Acute COPD Exacerbation Recovery Differ Greatly. HCPLive. Published online October 20, 2025. https://www.hcplive.com/view/clinical-patient-definitions-acute-copd-exacerbation-recovery-differ-greatly
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