Audreesh Banerjee, MD
Credit: UPenn
Over the past decade, the landscape of airway disease management has undergone a fundamental shift. Once managed within rigid silos, asthma and chronic obstructive pulmonary disease (COPD) are now increasingly understood as overlapping syndromes that share inflammatory mechanisms, symptom patterns, and treatment responses—particularly among patients with eosinophilic inflammation. This evolving understanding has coincided with a wave of biologic approvals and expanded indications for agents targeting type 2 inflammation, leading to new possibilities for patients previously underserved by traditional inhaler-based regimens.
As the science has progressed, so too have the clinical realities. Providers must now navigate a more nuanced disease spectrum, make treatment decisions amid ongoing guideline divergence, and advocate for access in a payer landscape that has been slow to catch up. Recent innovations in biologic therapy, including agents approved for both asthma and COPD, signal a turning point in how respiratory disease may be approached in the coming years—not as separate entities, but as points along a continuum requiring personalized care.
At a recent clinical forum convened by HCPLive in Philadelphia, Pennsylvania, a group of pulmonologists, led by Audreesh Banerjee, MD, Associate Professor of Clinical Medicine (Pulmonary, Allergy and Critical Care), and Clinical Director, Asthma, Department of Medicine Division of pulmonary, and Clinical co Director, COPD, Department of Medicine Division of pulmonary, and Asthma Program Leader, Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, at University of Pennsylvania, gathered to examine how these developments continue to evolve the treatment field of COPD and asthma.
They discussed the diagnostic and therapeutic challenges of managing patients with features of both asthma and COPD. They emphasized the limitations of current guidelines, siloed treatment approaches, and the impact of payer-driven restrictions on optimal care. The discussion highlighted the emerging role of biologics, especially for eosinophilic inflammation, and how new approvals and improved access could transform treatment for patients with overlapping phenotypes.
“I think there’s a lot more patients with it than we really know about it, because I feel like we see them as a COPD patient, right? Like when they came in, they have the smoking history, they have emphysema, they have fixed obstruction, but maybe they were an asthma patient before we saw them, and they just were not managed. Asthma doesn’t go away because you smoke cigarettes. I have a ton of my patients with COPD who tell me about their childhood asthma that went away and then came back as they started smoking cigarettes, and then they have high EO, so I think that definitely exists. I think what we’re gonna see is a world with more allergy and more asthma development in everybody, which we saw this last year with the worst pollen season. We had people who didn’t have allergies now have allergies. So I think this is the trend over the next couple of decades,” one panelist said.
The group underscored the need for more cohesive guidance that reflects real-world patient complexity, broader biomarker use, and clearer pathways to minimize steroid use. Access to appropriate treatments, especially in underserved populations, remains a pressing concern, alongside the importance of clinician advocacy, shared decision-making, and adapting treatment to evolving evidence and patient goals.
“I think one of the things that we see in asthma, even for patients that have very persistent disease, is some more recoverable lung function over time or maybe some change in their airway remodeling. So, is that true of COPD? We have very limited pulmonary rehab, valves, lung transplant, but do we have anything to sort of change fixed airway remodeling? That would be a great indicator of maybe markers, maybe sputum test, however we decide to cipher that lung function testing,” a panelist said.