TOPLINE

Dupilumab was associated with a marked 1-year reduction in exacerbations among patients with severe asthma, with similar benefits regardless of whether chronic obstructive pulmonary disease (COPD) coexisted. However, patients with both conditions were less likely to achieve a complete response.

METHODOLOGY

• Researchers conducted a nationwide observational cohort study using data from the Danish Severe Asthma Register to compare the real-world effectiveness of dupilumab in patients with severe asthma and coexisting COPD and in those with severe asthma alone.
• They included a total of 401 patients aged 40 years or older with severe asthma (58% men) who started dupilumab, considering both biologic-naive patients and those switching from another biologic; 93 patients met the criteria for coexisting COPD, and 308 patients without COPD served as the comparators.
• COPD was defined as a postbronchodilator forced expiratory volume in 1 second/forced vital capacity ratio < 0.70, tobacco exposure ≥ 10 pack-years, and persistent symptoms despite optimized asthma care.
• Outcomes assessed after 12 months included change in exacerbations, daily maintenance oral corticosteroid dose, and symptom control (based on the 6-item Asthma Control Questionnaire), as well as complete response, defined as no exacerbations and no maintenance oral corticosteroid use.
• The researchers limited the effectiveness analyses to patients who were on treatment for 200 days or more.

TAKEAWAY

• After 12 months, the mean annual exacerbation rate declined by 61% in patients with severe asthma and COPD and by 81% in those with severe asthma alone, with no significant between-group difference.
• The mean maintenance oral corticosteroid dose decreased in both groups, with no significant between‑group difference.
• Patients with severe asthma and COPD achieved complete response less often than those with severe asthma alone (51% vs 72%; P < .001). After adjustment for age, sex, and markers of type 2 inflammation, patients with severe asthma alone had higher odds of achieving complete response (odds ratio, 2.02; P = .017).
• The improvement in symptom control in both groups was similar. The change in biomarkers in both groups was also similar: The blood eosinophil counts increased and fractional exhaled nitric oxide levels decreased in both groups, with no significant between‑group differences.

IN PRACTICE

"These results support dupilumab as an effective therapy in patients with asthma and coexisting COPD," the authors wrote.

SOURCE

The study was led by Sammy Ameri, MD, Copenhagen University Hospital - Bispebjerg, Copenhagen, Denmark. It was published online on October 29, 2026, in ERJ Open Research.

LIMITATIONS

COPD could have been misclassified because detailed chest scans and lung diffusion tests were not available, so diagnoses relied on age, smoking history, and spirometry. Fewer patients than guidelines recommend received triple inhaled therapy before starting a biologic, and the reasons were unknown. The groups also showed differences in baseline characteristics — those with both conditions were older, more often male, and had lower blood eosinophil counts.

DISCLOSURES

The authors did not report study-specific funding. Several authors reported receiving consulting fees, lecture honoraria, research support, and serving on advisory boards, from multiple pharmaceutical companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.