EVOLVING PERSPECTIVES IN COPD: EMERGING THERAPIES AND FUTURE DIRECTIONS

Background: Chronic inflammation, airway remodelling, and irreversible airflow limitation are the main causes of Chronic Obstructive Pulmonary Disease (COPD), which continues to be a major cause of morbidity and mortality globally. The management of COPD remains difficult because of the disease's heterogeneity, underdiagnosis, and limited response to treatment in some phenotypes, even with the availability of traditional bronchodilators and corticosteroids. The purpose of this review is to highlight new pharmacological treatments that have the potential to revolutionise the treatment of COPD and to provide an overview of recent developments in our understanding of its pathophysiology. Summary: We now have a better understanding of the intricate pathophysiology of COPD thanks to recent discoveries in molecular and cellular mechanisms, microbiome interactions, and genetic and epigenetic regulation. Inadequate spirometry use and a lack of awareness of non-tobacco risk factors like air pollution and recurrent respiratory infections continue to impede early diagnosis. Pharmacological advancements include new drugs like ensifentrine, a dual PDE3/4 inhibitor with bronchodilatory and anti-inflammatory properties, and triple-therapy inhalers (LAMA/LABA/ICS), which provide better symptom control and fewer exacerbations. Mepolizumab and dupilumab, two biologic treatments that target type-2 inflammation, have shown promise in treating eosinophilic COPD phenotypes. Astegolimab, itepekimab, and tanimilast, future agents being studied, are encouraging developments in precision-based therapeutic strategies. Conclusion: The treatment of COPD is moving towards phenotype-driven, individualised care that focusses on the underlying inflammatory pathways rather than just the symptoms. To improve patient outcomes and quality of life, more research is needed on biomarkers, regenerative techniques, and disease-modifying therapies.