Clinical Perspectives of Updated Management Strategies for COPD – The American Journal of Managed Care® (AJMC®)

Advancements in COPD Management Aligned with Sustainable Development Goal 3

The 2025 Global Initiative for Chronic Obstructive Lung Disease (GOLD) report introduces significant updates to the management of Chronic Obstructive Pulmonary Disease (COPD), a major non-communicable disease. These updates, focusing on new therapeutics and revised patient classification schemas, directly support the objectives of Sustainable Development Goal 3 (SDG 3), particularly Target 3.4, which aims to reduce premature mortality from non-communicable diseases through effective treatment and prevention.

Introduction of Novel Therapeutics for Refractory COPD

A primary focus of updated COPD management is the reduction of exacerbation frequency, as a single hospitalization is linked to a 50% reduction in 5-year life expectancy. In alignment with SDG 3, two new medications, dupilumab and ensifentrine, have been recommended for patients who remain symptomatic despite triple therapy.

Dupilumab for Eosinophilic Phenotypes

• Mechanism: Targets type-2 inflammation, a key driver in a subset of COPD patients.
• Target Population: Patients with elevated blood eosinophil counts (above 300 cells/µL) who continue to experience exacerbations on triple therapy.
• SDG Alignment: The introduction of this biologic therapy provides a targeted, effective treatment, contributing to better health outcomes and well-being (SDG 3).

Ensifentrine as a Dual-Action Inhaled Therapy

• Mechanism: A first-in-class inhaled, nebulized PDE3/4 inhibitor that provides both bronchodilation (PDE3 inhibition) and anti-inflammatory effects (PDE4 inhibition).
• Clinical Advantage: The nebulized formulation avoids the gastrointestinal adverse events associated with the oral PDE4 inhibitor, roflumilast, enhancing patient safety and adherence.
• SDG Alignment: This innovation supports SDG Target 3.8 by expanding access to safe and effective medicines.

Implementation Hurdles and Alignment with Universal Health Coverage (SDG 3.8)

The successful integration of these novel therapies into clinical practice faces challenges that directly relate to SDG Target 3.8, which advocates for universal access to quality and affordable essential medicines.

Key Adoption Hurdles

1. Managed Care Approval: The primary barrier is expected to be securing payer reimbursement. Prior authorizations will likely be required, which could limit patient access.
2. Administration Method: Ensifentrine is administered via a nebulizer, requiring patient education. Dupilumab is a self-injected biologic, though patient and provider acceptance of injections has increased significantly.

Evolution of Patient Stratification: The ABE Framework

The GOLD 2025 report replaces the former ABCD classification schema with a simplified ABE framework, enhancing the delivery of patient-centered care and contributing to improved health outcomes.

Streamlining Clinical Decision-Making

• The ABE schema prioritizes exacerbation history and symptom burden over respiratory function tests for disease characterization.
• This simplification facilitates easier implementation in primary care settings, where the majority of COPD patients are managed, thereby improving access to quality care (SDG 3.8).

Enhancing Patient-Centered Care

• The framework elevates the importance of patient symptoms, functional status, and overall quality of life.
• This patient-centered approach aligns with the holistic “well-being” component of SDG 3 by focusing on outcomes that are most meaningful to patients.

The Role of Diagnostic and Monitoring Tools

Spirometry in Diagnosis and Monitoring

Spirometry remains the essential tool for the initial diagnosis of COPD, confirming obstructive lung disease. It is also valuable for evaluating previously stable patients who develop new or worsening symptoms, helping to rule out other causes such as cardiac disease.

Integration of Patient-Reported Outcomes

Validated tools such as the COPD Assessment Test (CAT) are critical for measuring symptoms and quality of life. Tracking these outcomes longitudinally supports a holistic management approach consistent with the principles of SDG 3.

Integrated Care for Complex Comorbidities

Effective COPD management requires a comprehensive approach that addresses the high prevalence of comorbidities, such as cardiac disease and metabolic syndrome. This strategy is essential for reducing premature mortality and achieving the goals of SDG 3.4.

The Imperative for Team-Based Management

• Close coordination between pulmonologists, primary care providers, and other specialists is critical for optimizing outcomes in patients with multiple comorbidities.
• An integrated care model, with the primary care provider acting as a central coordinator, ensures all health issues are addressed cohesively.

Differentiating Inflammatory Phenotypes

• Treatment decisions for advanced disease are increasingly guided by biomarkers rather than rigid disease labels.
• For patients with eosinophilic COPD (eosinophil counts >300/µL) who experience exacerbations, the standard of care is to escalate to triple therapy (LAMA/LABA/ICS).
• Biologics like dupilumab are reserved for patients who continue to have exacerbations despite optimized triple therapy, ensuring appropriate and effective use of advanced medicines.

Analysis of Sustainable Development Goals in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

• SDG 3: Good Health and Well-being

  The entire article is dedicated to improving the health and well-being of individuals suffering from Chronic Obstructive Pulmonary Disease (COPD), a major non-communicable disease. It discusses advanced treatment options, updated management strategies (GOLD 2025), and patient-centered care approaches. The focus is on reducing symptoms, preventing disease exacerbations, improving quality of life, and ultimately reducing mortality associated with the disease.

2. What specific targets under those SDGs can be identified based on the article’s content?

1. Target 3.4: By 2030, reduce by one-third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.

   The article directly addresses this target by focusing on improved treatment for COPD. The text highlights the severe impact of the disease on life expectancy, stating, “just a single hospitalization in a patient with COPD reduced their 5-year life expectancy to only 50%.” The introduction of new medications like dupilumab and ensifentrine and the emphasis on “reducing exacerbation frequency” are strategies aimed at treating the disease more effectively to prevent such outcomes and reduce premature mortality.

2. Target 3.8: Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.

   The article touches upon the critical issue of access to new, effective medicines. Dr. Panettieri notes, “The biggest hurdle for both therapies will be managed care approval. I expect both will require prior authorizations from payers, and payer reimbursement mechanisms will be critical determinants of access.” This statement underscores the challenge of ensuring that innovative treatments are affordable and accessible to the patients who need them, which is a core component of universal health coverage. The discussion on the ABE schema simplifying care in “primary care settings, where most patients with COPD receive most of their care” also relates to improving the quality and accessibility of essential health services.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

• Indicator for Target 3.4: Mortality rate attributed to chronic respiratory disease.

  The article implies this indicator by directly linking COPD exacerbations to mortality. The statistic that a single hospitalization reduces “5-year life expectancy to only 50%” serves as a powerful proxy for the mortality rate. Therefore, tracking the frequency of exacerbations and hospitalizations, as emphasized by the ABE schema, can be used to measure progress in reducing COPD-related mortality.

• Indicator for Target 3.8: Proportion of the population with access to affordable essential medicines.

  This indicator is implied when the article discusses the barriers to adopting new medications. The mention of “managed care approval” and “payer reimbursement mechanisms” as “critical determinants of access” suggests that the rate of insurance approval and patient uptake for new therapies like dupilumab and ensifentrine would be a practical measure of progress towards ensuring access to these essential medicines.

• Indicator for Target 3.8: Health service coverage.

  The article’s emphasis on a “team-based management” approach involving primary care providers, pulmonologists, and other specialists for patients with complex comorbidities points to the importance of comprehensive health service coverage. The shift to the ABE schema, which is easier to implement in “primary care settings,” is a strategy to improve the reach and quality of COPD management, thereby enhancing service coverage for this patient population.

4. Summary Table of SDGs, Targets, and Indicators

Source: ajmc.com