Damiana-Maria Vulturar 1, 2 *, Georgiana-Ioana Gaborean 1, 2, Ștefania Călugăreanu 1, 2, Gabriel-Flaviu Brișan 1, 2, Ștefania-Lucia Ghilea 1, 2, Doina Adina Todea 1, 2
1 Department of Pneumology, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
2 Department of Pneumology, Leon Daniello Pneumology Hospital, Cluj-Napoca, Romania
* Correspondence to: Damiana-Maria Vulturar, Department of Pneumology, Leon Daniello Pneumology Hospital, Cluj-Napoca, Romania. E-mail: vulturar.damianamaria@elearn.umfcluj.ro
Abstract
Chronic Obstructive Pulmonary Disease (COPD) management has transitioned from a generic treatment model to a precision-medicine approach targeting specific inflammatory endotypes. In 2026, the clinical landscape is defined by the integration of biologic therapies for the subset of patients exhibiting Type 2 inflammation. This review evaluates the pharmacology and clinical efficacy of targeted monoclonal antibodies, specifically those inhibiting IL-4/IL-13 and IL-5 pathways. Leading agents, including dupilumab and mepolizumab, have established relevant evidence for significantly reducing annualized exacerbation rates in patients with high blood eosinophil count. While these biologics differ in their molecular targets, both contribute to improved disease stability and a reduction in severe respiratory events that are refractory to standard triple therapy. Effective patient selection now relies on identifying “treatable traits”, primarily blood eosinophil and exacerbation history. By shifting the focus to molecular endotypes, these therapies offer a path toward personalized care that modifies disease trajectory. Despite favorable safety profiles, ongoing toxicology surveillance remains essential for managing long-term risks in the aging and comorbid COPD population.