{
  "abstract": "Chronic obstructive pulmonary disease (COPD) remains a leading cause of morbidity and mortality worldwide. Despite major pharmacological advances, a substantial gap persists between guideline recommendations and routine clinical practice, particularly after exacerbations. This narrative review summarizes current evidence supporting personalized pharmacological escalation in COPD, focusing on single-inhaler triple therapy (SITT) and the emergence of biologic therapy. SITT, combining an inhaled corticosteroid, a long-acting β ₂ -agonist and a long-acting muscarinic antagonist, is now the preferred inhaled strategy for patients requiring ICS-containing triple therapy. Real-world studies indicate that, compared with multiple-inhaler triple therapy, SITT is associated with better adherence and persistence, lower exacerbation rates and improved clinical outcomes, although observational findings require cautious causal interpretation. In parallel, COPD has entered the era of targeted biologic therapy. Dupilumab was the first biologic approved for COPD, following the BOREAS and NOTUS trials in patients with chronic bronchitis, blood eosinophils ≥300 cells/µL and persistent exacerbations despite triple therapy. Mepolizumab has more recently provided robust phase 3 evidence in eosinophilic COPD through the MATINEE trial. Early real-world dupilumab studies further suggest potential effectiveness in selected patients under-represented in pivotal trials, including those with advanced age, severe airflow limitation, oxygen dependence or high mucus burden. Beyond canonical type 2 pathways, IL-33 inhibition with tozorakimab may further broaden targeted treatment to COPD phenotypes without a clear eosinophilic signature. Integrating these advances within a treatable-traits framework may help optimize patient selection, close post-exacerbation therapeutic gaps, and align pharmacological escalation with comorbidity management, adherence, inhaler technique and rehabilitation needs.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Medical, Surgical and Health Sciences, University of Trieste",
    "Department of Pulmonology, Santa Maria Degli Angeli Hospital",
    "Department of Pulmonary Rehabilitation, Azienda Sanitaria Universitaria Friuli Centrale",
    "Department of Pneumology, Ruhrlandklinik, University Hospital Essen, University of Duisburg-Essen",
    "Rheumatology Unit, ASST Ovest Milanese, Legnano Hospital",
    "Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Science, School of Biological Sciences, Faculty of Biological Medicine and Health, the University of Manchester, Manchester Academic Health Science Centre",
    "Department of Rheumatology, Northern Care Alliance NHS Foundation Trust, Salford Care Organisation",
    "NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust",
    "Department of Experimental and Clinical Medicine, Division of Internal Medicine, Azienda Ospedaliera Universitaria Careggi, University of Florence",
    "Department of Rheumatology and Immunology, Shantou Central Hospital",
    "Department of Pulmonology, University Hospital of Cattinara",
    "Department of Cardiac, Respiratory Medicine, Thoracic, Vascular Sciences and Public Health, University of Padova"
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 12,
  "authors": [
    {
      "affs": [
        0,
        1
      ],
      "name": "Beatrice Da Re"
    },
    {
      "affs": [
        0,
        2
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      "name": "Nicolò Reccardini"
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    {
      "affs": [
        3
      ],
      "name": "Giorgio Monteleone"
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    {
      "affs": [
        4
      ],
      "name": "Eugenio Capparelli"
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    {
      "affs": [
        5,
        6,
        7
      ],
      "name": "Michael Hughes"
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    {
      "affs": [
        8
      ],
      "name": "Giulia Bandini"
    },
    {
      "affs": [
        9
      ],
      "name": "Yukai Wang"
    },
    {
      "affs": [
        10
      ],
      "name": "Paola Confalonieri"
    },
    {
      "affs": [
        10
      ],
      "name": "Francesco Salton"
    },
    {
      "affs": [
        0,
        10
      ],
      "name": "Marco Confalonieri"
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    {
      "affs": [
        11
      ],
      "name": "Umberto Semenzato"
    },
    {
      "affs": [
        0,
        10
      ],
      "name": "Barbara Ruaro"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/a48cdxze5nens.bib",
  "cited_by": 0,
  "doi": "10.3389/fphar.2026.1983112",
  "fulltext_url": "https://www.frontiersin.org/articles/10.3389/fphar.2026.1983112/full",
  "id": "a48cdxze5nens",
  "issns": [
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  "landing_url": "https://www.frontiersin.org/articles/10.3389/fphar.2026.1983112/full",
  "language": "en",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "lcc",
      "RM1-950"
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    [
      "openalex",
      "2740|Chronic Obstructive Pulmonary Disease (COPD) Research"
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  "openalex": "W7223329883",
  "pdf_url": "https://www.frontiersin.org/journals/pharmacology/articles/10.3389/fphar.2026.1983112/pdf",
  "pmcid": null,
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  "published": "2026-10-23",
  "publisher": "Frontiers Media SA",
  "ris": "https://research.draconitic.com/paper/a48cdxze5nens.ris",
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  "subjects": [
    {
      "field": "medicine",
      "origin": "lcc:RM1-950",
      "subfield": "pharmacology-toxicology"
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  ],
  "title": "COPD: real-world evidence on single-inhaler triple therapy and the emergence of biologic therapy",
  "title_text": "COPD: real-world evidence on single-inhaler triple therapy and the emergence of biologic therapy",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T13:44:00Z",
  "url": "https://research.draconitic.com/paper/a48cdxze5nens",
  "venue": "Frontiers in Pharmacology",
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}