COPD Precision Medicine Still Lags: Francesca Polverino, MD, PhD

Precision medicine approaches for chronic obstructive pulmonary disease (COPD) are lagging, creating gaps in care and leaving biologics and patient biomarkers as the primary determinants for course of treatment.

COPD treatment pathways were a recurrent topic at the European Respiratory Society (ERS) 2026 International Congress in Barcelona, Spain. Currently, clinicians use patient biomarkers like eosinophil count, comorbidities, and other risk factors to determine a patient's susceptibility to COPD exacerbation and then their course of treatment, Francesca Polverino, MD, PhD, a physician scientist and tenured Lester and Sue Smith Professor of Medicine at Baylor College of Medicine, and a speaker at ERS congress, said in an interview with The American Journal of Managed Care^®.

“For example, if it's an elderly patient with a lot of comorbidities, maybe, in that case, you should consider escalation of the treatment,” she explained. “However, if it's a younger patient with not many risk factors, you can, and the exacerbation is an isolated event in time, maybe you don't need to escalate immediately.”

Although clinicians disagree, with many arguing that even a single exacerbation is enough to warrant treatment escalation, current GOLD guidelines don't offer much clarity on what to do after just 1 exacerbation, Polverino said. That leaves a need for greater consensus on what constitutes a severe versus a mild COPD exacerbation and when treatment escalation is necessary, without assuming a one-size-fits-all approach.

“I think the decision-making process has to be very much associated with the clinical judgment of the individual physician,” she said.

While stressing the need for greater consensus on severity, Polverino also cautioned that a single standardized rule shouldn't replace individualized clinical judgment.

“Especially when it comes to exacerbation, we need to evaluate every single patient separately with risk factors,” Polverino said.

The lack of consensus extends beyond the clinic, she added: as a journal section editor, she reviews papers on the topic that will never get published and still sees no agreement. Ultimately, she said, it comes down to “common sense when it comes to the physician and handling each patient separately with a precision medicine approach.”

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