Biologics for COPD: what they are and who might benefit

If you’re still getting frequent COPD flare-ups despite inhalers and rehab, biologics might be worth asking about. Biologics are prescription drugs made from proteins that target specific immune signals that drive inflammation. Unlike inhalers, they’re given by injection and aim at molecular targets such as IL‑5 or its receptor — pathways linked to eosinophil-driven inflammation.

These drugs aren’t for everyone. They’re mainly considered when a person has repeated exacerbations (hospital visits or steroid-treated flare-ups) even after using long-acting bronchodilators, inhaled steroids, and lifestyle measures like quitting smoking. Doctors look for a specific pattern called eosinophilic COPD — where blood eosinophil counts are higher and inflammation looks similar to certain types of asthma.

Which biologics are being used or studied?

Two of the better-known options are mepolizumab (targets IL‑5) and benralizumab (targets the IL‑5 receptor). Clinical trials showed that mepolizumab can reduce exacerbations in people with higher blood eosinophils. Results with benralizumab were mixed — some studies didn’t show a clear benefit for all patients. Newer targets and trials are ongoing, so the picture is still evolving. Important point: the benefit in COPD tends to be smaller and more selective than what we see in severe eosinophilic asthma.

How to know if you’re a candidate

Start by checking two things: your exacerbation history and your blood eosinophil count. Many clinicians consider biologics when exacerbations keep happening despite optimal inhaled therapy AND your blood eosinophils are in a higher range (often around 150–300 cells/µL or more, depending on the guideline). Your pulmonologist will review your full history, smoking status, infections, and other conditions before recommending a trial.

What to expect if you start one: administration is usually a subcutaneous injection every 4–8 weeks, sometimes given in clinic or at home. Common side effects include injection-site reactions, headache, or mild respiratory symptoms. Serious allergic reactions are rare but possible. Because these drugs affect immune signaling, your doctor will review recent infections and vaccine status before starting therapy.

Cost and access matter. Biologics are expensive and usually require prior authorization or proof that standard treatments weren’t enough. That means specialists — pulmonologists or COPD clinics — typically handle approval and monitoring. If insurance won’t cover it, patient-assistance programs from manufacturers may help.

Want to explore this option? Ask your doctor for a copy of your exacerbation record and a recent blood eosinophil count. If you fit the profile, a pulmonologist can explain likely benefits, side effects, and how long a trial should run to tell if it’s helping. Biologics aren’t a quick fix, but for the right person they can lower flare-ups and improve quality of life.