Lung Function Improvement Following COPD Exacerbation Under Dupilumab Therapy: A Case Report

Introduction: Chronic obstructive pulmonary disease (COPD) exacerbations are a major contributor to long-term functional decline and healthcare burden. It is well established that patients often fail to recover baseline lung function following severe exacerbations. Re-cent trials have highlighted the role of type 2 inflammation in a subset of COPD patients and the therapeutic potential of dupilumab, a monoclonal antibody targeting IL-4/IL-13 pathways. However, its role in the post-exacerbation phase remains unexplored. Case Presentation: We report the case of a 79-year-old woman with severe COPD (GOLD stage III) and a history of two moderate exacerbations in the previous year. She was initiated on compassionate-use dupilumab after meeting eosinophilic criteria (0.33 × 10⁹/L). Baseline spirometry revealed a fixed ratio of 0.32, FEV₁ 0.49 L (30% predicted), and FVC 1.53 L (71%). Thirteen days after the first injection (March 2025), she was admitted with acute res-piratory failure and managed with non-invasive ventilation and high-dose corticosteroids in the ICU. She avoided intubation and was discharged clinically stable on home oxygen. At follow-up (April 10), spirometry showed significant improvement: FEV₁ 0.71 L (42%) and FVC 2.14 L (105%). At three months, FEV₁ remained improved (0.61 L / 36%) with a fixed ratio of 0.44. This case demonstrates an unexpected functional improvement following a se-vere exacerbation, contrary to the established lung function decline described in studies, such as WISDOM. The marked recovery in FEV₁ suggests a potential early therapeutic effect of dupilumab, possibly modulating type 2 inflammation even in the context of acute decompen-sation. The patient’s trajectory, including avoidance of mechanical ventilation and improved functional capacity, supports emerging evidence for biologic therapies in eosinophilic COPD. Conclusion: This report suggests a promising role of dupilumab in managing eosinophilic COPD beyond chronic phases, including acute exacerbations. Controlled studies are war-ranted to explore early biologic intervention and personalize COPD treatment pathways.