COPD 2.0: Bronchodilators, biologics and beyond - A systematic review

Chronic obstructive pulmonary disease (COPD) is a progressive respiratory disorder characterized by persistent airflow limitation and chronic inflammation. Conventional bronchodilators have been the mainstay of therapy; however, their efficacy in certain COPD phenotypes remains limited, and uncontrolled disease continues to be prevalent despite optimal conventional treatment. In recent years, biologic therapies have emerged as promising options, particularly for eosinophilic COPD phenotypes. This systematic review evaluates the efficacy, safety, and clinical implications of biologic agents and novel therapeutic approaches in COPD. A comprehensive search of PubMed, Scopus, and Cochrane Library databases was conducted for studies published up to March 2025, including randomized controlled trials, cohort studies, and real-world evidence on biologic treatments. Several agents, including monoclonal antibodies targeting eosinophilic inflammation such as anti-interleukin (IL)-5 and anti-IL-4/13 therapies, have demonstrated significant benefits in specific COPD subgroups with frequent exacerbations and elevated eosinophil counts. These biologics have been associated with reductions in exacerbation rates and improvements in quality-of-life metrics, with an acceptable safety profile. Biologic therapies therefore represent a new frontier in the personalized management of COPD, especially in eosinophilic phenotypes. Further high-quality studies are warranted to better define their long-term safety, cost-effectiveness, and broader applicability in COPD populations.