The U.S. Food and Drug Administration (FDA) has approved Nucala (mepolizumab) as an add-on maintenance treatment for adults with chronic obstructive pulmonary disease (COPD) that remains inadequately controlled despite existing therapies. The approval offers new hope to patients whose symptoms persist despite being on inhaled triple therapy.What is COPD?According to the World Health Organization (WHO), COPD is a common, preventable, and treatable disease that is characterized by persistent respiratory symptoms and airflow limitation due to airway and/or alveolar abnormalities. It typically results from significant exposure to noxious particles or gases.Symptoms of COPD include:Chronic coughShortness of breathWheezingChest tightnessExcess mucus productionCauses of COPD range from long-term smoking and air pollution exposure to occupational dusts and fumes. Genetics and respiratory infections in early life can also contribute.COPD is progressive and often worsens over time, severely impacting quality of life. One of the most critical challenges in managing the condition is reducing exacerbations—flare-ups that may require hospitalization or emergency treatment.Why Nucala MattersNucala is the only approved biologic that has been specifically studied in COPD patients with an eosinophilic phenotype defined by a blood eosinophil count (BEC) of ≥150 cells/μL. This is important because up to 70% of U.S. COPD patients who are not adequately managed on inhaled triple therapy fall into this category.Biologics like Nucala work by targeting specific pathways in the immune system. Mepolizumab, the active ingredient in Nucala, is an anti-IL-5 monoclonal antibody that reduces eosinophilic inflammation—a key contributor to COPD exacerbations in certain patients.Clinical Trial EvidenceThe FDA’s approval of Nucala is based on results from two large Phase 3 clinical trials, MATINEE and METREX, which evaluated its use alongside optimal inhaled therapy. Both were randomized, double-blind, and placebo-controlled.In the MATINEE trial, involving 804 patients with a BEC ≥300 cells/μL, Nucala showed:A significant reduction in moderate or severe exacerbations: 0.80 vs 1.01 events/year (rate ratio, 0.79).A 35% decrease in emergency visits or hospitalizations for COPD exacerbations (rate ratio, 0.65).The METREX trial produced similar outcomes. Patients on Nucala had:Fewer moderate or severe exacerbations: 1.40 vs 1.71 events/year (rate ratio, 0.82).Adverse events were comparable between the Nucala and placebo groups, suggesting a favorable safety profile.A New Era for COPD Management“COPD isn't just a disease, it's a relentless cycle,” said Dr. Jean Wright, CEO of the COPD Foundation. “Even with current therapies, managing exacerbations remains a daily battle. Biologics like mepolizumab offer new hope.”The FDA approval was granted to GSK, the pharmaceutical company that developed Nucala. With this decision, clinicians now have a novel option for patients with eosinophilic COPD who are still struggling despite standard treatment.