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oa Lung Function Improvement Following COPD Exacerbation Under Dupilumab Therapy: A Case Report
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- 17 Jul 2025
- 16 Oct 2025
- 26 Jan 2026
Abstract
Chronic obstructive pulmonary disease (COPD) exacerbations are a major contributor to long-term functional decline and healthcare burden. It is well established that patients often fail to recover baseline lung function following severe exacerbations. Recent trials have highlighted the role of type 2 inflammation in a subset of COPD patients and the therapeutic potential of dupilumab, a monoclonal antibody targeting IL-4/IL-13 pathways. However, its role in the post-exacerbation phase remains unexplored.
We report the case of a 79-year-old woman with severe COPD (GOLD stage III) and a history of two moderate exacerbations in the previous year. She was initiated on compassionate-use dupilumab after meeting eosinophilic criteria (0.33 × 109/L). Baseline spirometry revealed a fixed ratio of 0.32, FEV1 0.49 L (30% predicted), and FVC 1.53 L (71%). Thirteen days after the first injection (March 2025), she was admitted with acute respiratory failure and managed with non-invasive ventilation and high-dose corticosteroids in the ICU. She avoided intubation and was discharged clinically stable on home oxygen. At follow-up (April 10), spirometry showed significant improvement: FEV1 0.71 L (42%) and FVC 2.14 L (105%). At three months, FEV1 remained improved (0.61 L / 36%) with a fixed ratio of 0.44. This case demonstrates an unexpected functional improvement following a severe exacerbation, contrary to the established lung function decline described in studies, such as WISDOM. The marked recovery in FEV1 suggests a potential early therapeutic effect of dupilumab, possibly modulating type 2 inflammation even in the context of acute decompensation. The patient’s trajectory, including avoidance of mechanical ventilation and improved functional capacity, supports emerging evidence for biologic therapies in eosinophilic COPD.
This report suggests a promising role of dupilumab in managing eosinophilic COPD beyond chronic phases, including acute exacerbations. Controlled studies are warranted to explore early biologic intervention and personalize COPD treatment pathways.
