Exploring COPD: A Look at Causes and New Treatment Options

Having to work to breathe, a daily cough that brings up mucus, wheezing, feeling short of breath. These symptoms all make daily life challenging for a person living with COPD. Although the term is familiar to almost everyone, what exactly is COPD? Good question- lets look at this closer. COPD stands for Chronic Obstructive Pulmonary Disease. COPD is a combination of 2 disorders- emphysema and chronic bronchitis. In emphysema the air sacs in the lungs, called alveoli, become damaged and are unable to stretch and fill with air like they normally do in a healthy lung. Their inability to function also makes it hard to move the air out of your lungs, which results in wheezing, shortness of breath and poor oxygen intake. The other part of COPD is chronic bronchitis. When chronic bronchitis comes into play, it causes inflammation in the bronchial tubes that carry the air back and forth to the lungs. The result of this is a cough and mucus production that become constant, daily symptoms.

What Causes COPD

The most common cause of COPD is smoking. As smoke from cigarettes and other forms of tobacco continually enter the lungs, it starts to cause damage to the alveoli and inflammation of the bronchial tubes. With repeated exposure to cigarettes and smoke, the damage becomes permanent and results in COPD. Although smoking is the most common cause, COPD can be caused by any repeated exposure to inhaled chemicals, pollutants or irritants. This means that even if a person never smoked a day in their life, they could still develop COPD if they had occupational exposure or lived in an environment with poor air quality.

Newer research has found that some individuals with COPD also have type 2 inflammation driven by eosinophils. As an important part of our immune system, we all have eosinophils. However, when there are too many, the eosinophils start to create airway inflammation.

Although less common, there is also a genetic form of COPD that occurs when a genetic mutation occurs in a gene called SERPINA1. In order for this to cause problems, you must have inherited one abnormal SERPINA1 gene from each parent. The SERPINA1 gene provides instructions for making a protein called alpha-1 antitrypsin, whose role involves making sure the immune cells do not attack the body’s own tissues. However, when there is a problem with SERPINA1 and there is not enough alpha-1 antitrypsin, the immune cells start attacking the lungs and the liver, sometimes leading to severe damage and dysfunction (What is Alpha-1?, 2025). The genetic test for this is relatively simple and requires only a few drops of blood from a fingerstick or a sample of saliva and cells from a cheek swab. At Monarch Medical, we offer this genetic test to help you identify if you may be someone living with this form of genetic COPD.

Treatment Options

For years now, the standard of care has been to treat the symptoms of COPD with inhalers. The newest guidelines, which discuss the best treatments based on research, still recommend inhalers that contain medications such as LAMA (long acting muscarinic antagonist), LABA (Long acting beta agonist) and in some individuals an ICS (inhaled corticosteroid).

Recently, there has been more study on the role of eosinophilic inflammation in COPD. So, what is eosinophilic inflammation? The eosinophil is a specific type of white blood cell that plays an important role in our immune system. In a healthy individual, the eosinophil helps protect the body from parasites and other germs. However, in some individuals, this system can become unbalanced. When this occurs, the eosinophils start to create inflammation in the airways, which results in symptoms. The role of the eosinophil and its relationship with asthma has been well known now for some time. However, the fact that this same eosinophilic inflammation can occur in COPD is an exciting new development for better understanding and treating individuals with COPD.

There are currently 2 FDA approved biologics for COPD: Dupixent and Nucala.

Dupixent targets two key drivers of type 2 inflammation, Il4 and IL13. When these pathways are “blocked” by the Dupixent, we are able to reduce the inflammation and therefore the corresponding symptoms. Dupixent is approved for individuals with COPD that have more than 300 eosinophils per uL. When used in people who meet this criteria, the studies showed that Dupixent reduced COPD exacerbation by 34% (at week 52 in the trial) and an improvement in overall lung function. In the trials, the FEV1 ( how much air can be blown out of the lungs in 1 second), went from an 84 ml before dupixent, up to 158 ml after 12 weeks of taking Dupixent. (Sanofi and Regeneron Pharmaceuticals, Inc., 2025).

Nucala works by targeting the eosinophils. Nucala is indicated for those patients whose eosinophil count is greater than 150 cells/ uL and inhalers are not adequately controlling symptoms. When Nucala reduces the eosinophils, we see the inflammation and the related symptoms improve. Nucala has shown to reduce exacerbation and need for hospital visits by 35% (at week 52 of the study) (GSK, 2025).

COPD is a disease that causes a significant impact on quality of life and health. Understanding your personal triggers and having a treatment plan that is tailored to your needs is an important part of being able to best control your symptoms. At Monarch Medical, we understand that everyone’s COPD is different and therefore, we work to create personalized treatment plans that help you take control of your symptoms. If you are struggling with COPD, make an appointment today so we can help you step out of the shadow of COPD.

References

GSK. (20225). Nucala. https://nucalahcp.com/copd/

 Sanofi and Regeneron Pharmaceuticals (2025). Dupixent. https://www.dupixenthcp.com/

What is Alpha -1? (2025). Alpha-1 Foundation. https://alpha1.org/