Biologic Medicines for COPD: What They Are and Why to Use Them

This article was written by Jonnie Korinko, MSRC, RRT, RRT-ACCS.

People with COPD often cough, wheeze, and have trouble breathing. This happens because the airways or air sacs in their lungs swell and narrow.¹ About 20-30% of people with COPD have high levels of a type of blood cell called eosinophils.² This means they have inflammation in their lungs that may be making their COPD symptoms worse. Here's what happens:

Trigger

Something, like pollen, smoke, or pet dander, enters your body, and your immune system thinks that it could hurt you. These things aren’t harmful, but your immune system wants to protect you from them.²

Immune Response and Chain Reaction

Immune cells called Th2 cells activate. These cells send signals that tell your body to make more eosinophils. The eosinophils then move to the lungs and cause swelling and irritation.²

Symptoms

Inflammation in the lungs can cause more mucus and tightness in the chest for people with COPD.²

For people who have this type of inflammation, new medicines can help reduce swelling and make breathing easier.

What are biologics?

Biologics are medications made from biological substances. This means they are made from living things like cells and proteins from plants and animals. These medicines are more fragile than medicines made from chemicals, so there are usually important instructions on how to store them and take them safely.³

Many people use biologic medicines. Insulin was one of the first biologics developed and has been helping people for many years.

How do I know if a biologic could work for me?

If you have COPD symptoms even on your COPD treatment, talk to your health care provider to see what other treatments may help you breathe easier. For more about severe and worsening COPD, visit our webpage with resources.

Right now, there are two biologics available for people with COPD:

Dupixent (Dupilumab). Dupixent was the first biologic medicine approved for people with COPD who still have inflammation and symptoms even after treatment. It is used with other COPD medicines.
Nucala (Mepolizumab). Nucala was recently approved for people with COPD who have inflammation and COPD symptoms while on treatment. It is also used in combination with other COPD treatments.

These medicines are new, and there are new biologic medicines that may be available soon.

Global Initiative for Chronic Obstructive Lung Disease. Global strategy for prevention, diagnosis and management of COPD: 2025 Report. [accessed 2025 July]. Available from: https://goldcopd.org/2025-gold-report/
Singh D, Kolsum U, Brightling CE, et al. Eosinophilic inflammation in COPD: prevalence and clinical characteristics. Eur Respir J. 2014;44(6):1697-1700. doi:10.1183/09031936.00162414
In brief: Biologics and Biosimilars. InformedHealth.org [Internet]. February 8, 2023. Accessed July 18, 2025. https://www.ncbi.nlm.nih.gov/books/NBK499546/

7 Comments

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das23

Thanks for the info Jonnie
Reply
Celticgirl

This is such good news for those of us who have inflammation of the lungs.
Reply
Jlyjak

I have been on both Nucala and now Fasenra over the past one and a half years. They performed similarly and have been life-changing. I developed severe Asthma/COPD suddenly, and nothing worked until I was prescribed a biologic. I hope you have good insurance coverage because the costs are very high.

Jeff
Reply
HIcopd - Hawaii State Captain

I was started on Dupixent 11/2024. The year prior I had 3 exacerbations. Since starting Dupixent, NO exacerbations, though several things happened since I started Dupixent which would normally have likely triggered an exacerbation (like when both my oxygen concentrators malfunctioned at the same time). Dupixent just seems to give me a bigger buffer to absorb the bumps of everyday life without having a flareup.
Reply
BlairT

I also experienced life changing improvements when I started Nucala. Initially I thought I had chronic bronchitis, and the symptoms came on fast like Jeff about 6 years ago. The diagnosis I have now is 'severe eosinophilic asthma' even though I have no response to ventolin inhalers at all. I have been on Nucala for 3 years now with monthly shots, and I still do my Symbicort puffs twice a day. I seemed to worsen a bit earlier this year, and talked to my doc about other biologics at last appointment. Apparently there are a few others that can be tried if one loses its effectiveness. In my case, though, the symptoms improved again and I will therefore be staying on Nucala until something else changes. I live a pretty normal life on this drug and have not needed Prednisone since since I started it.
Reply
Barbara8645

I have heard there are lots of bad side effects to biologics in general: mostly from the commercials themselves. How prevalent are these side effects, or do they have to list them to CYA?.
Reply
- HIcopd - Hawaii State Captain
  
  There is of course CYA and there may be folks who get more side effects than others. For ME, the main side effect is fewer exacerbations and slight joint stiffness, called arthralgia, which is very manageable.
  Reply