Presentation (CTI)

OBJECTIVES: Chronic Obstructive Pulmonary Disease (COPD) is a progressive respiratory condition and leading cause of morbidity and mortality globally. Patients with Type-2 inflammation (T2i) characterised by elevated blood eosinophils (≥300 cells/µL) continue to experience frequent exacerbations despite optimised inhaled-therapy. 2026 Global Initiative for Chronic Lung Disease (GOLD) recommend biologic therapies as add-on treatment for this population.However, no biologics are currently reimbursed for COPD in Ireland, leaving a clinically defined and guideline-endorsed cohort without access to recommended care. This analysis explores the disparity between international guideline recommendations and real-world COPD management in Ireland, examining the impact on patient and health-system outcomes.
METHODS: A narrative synthesis was conducted using:1. Comparative review of GOLD 2026 guidelines and Irish clinical practice.2. Targeted review of COPD biologic access and reimbursement pathways in Ireland.3. Structured qualitative insights from respiratory specialists in Ireland.
RESULTS: Respiratory experts identified COPD patients with frequent exacerbations, T2i, and persistent symptoms despite optimised inhaled-therapy as having significant unmet clinical need. Without access to guideline-recommended biologic therapies, these patients experience persistent hospitalisations and suboptimal disease control, resulting in long-term clinical and economic burden on the healthcare system.Phase 3 clinical trials demonstrate that GOLD-recommended biologic therapies significantly reduce moderate-to-severe exacerbations in COPD patients with T2i receiving optimised inhaled-therapy, with associated improvements in healthcare resource utilisation.Beyond direct patient benefits, experts identified biologic introduction as an opportunity to drive system-wide improvements in COPD care, with potential to elevate standards of care across all COPD patients by driving improved disease awareness, phenotyping, and care pathway optimisation.
CONCLUSIONS: Clear unmet need exists for patients with COPD and T2i in Ireland. Establishing access to GOLD-recommended biologic therapies has potential to improve outcomes for high-risk patients, reduce health-system burden, and catalyse improvements in COPD care standards, extending across the broader COPD population.