Specialty Drug Trends in Chronic Respiratory Conditions
Respiratory care is undergoing a significant shift as specialty medications move beyond severe asthma and into conditions such as chronic obstructive pulmonary disease (COPD). While inhaled therapies remain the foundation of treatment, biologics are creating new options for select patients with uncontrolled disease. These developments have the potential to improve outcomes, but they also introduce important considerations related to cost, utilization, and patient selection. [1,2]
Biologics Are Expanding the Respiratory Treatment Landscape
Specialty drugs are typically used to manage complex or chronic conditions and often require additional monitoring, patient education, or specialized administration. In respiratory care, biologics such as dupilumab, mepolizumab, benralizumab, omalizumab, and tezepelumab have expanded treatment options for patients with severe asthma.
Unlike traditional therapies that broadly target symptoms, biologics focus on specific inflammatory pathways associated with disease. As a result, treatment selection often depends on factors such as eosinophil levels, disease severity, and exacerbation history, supporting a more individualized approach to care. [1,3]
One of the most significant recent developments has been the expansion of biologic therapy into COPD. In September 2024, the FDA approved dupilumab (Dupixent) as an add-on maintenance treatment for adults with inadequately controlled COPD and an eosinophilic phenotype. [4] In May 2025, mepolizumab (Nucala) received an expanded indication for adults with COPD and an eosinophilic phenotype. [5]
These approvals reflect a broader shift in respiratory medicine. The 2026 GOLD Report now includes biologic therapy as a treatment option for selected COPD patients who continue to experience exacerbations despite optimized inhaled therapy. [2]
Another recent addition to the market is depemokimab (Exdensur), which was approved in December 2025 for severe eosinophilic asthma. Unlike many biologics that require monthly or bimonthly administration, depemokimab is administered once every six months, potentially reducing treatment burden for appropriate patients. [6]
Together, these developments highlight the growing role of precision medicine, where treatment decisions are increasingly guided by specific disease characteristics rather than a one-size-fits-all approach.
Cost and Utilization Considerations
As biologics move into larger patient populations, including individuals with COPD, payers may see increased utilization of therapies that were previously reserved for a narrower group of patients.
IQVIA reported that specialty medicines accounted for approximately 53% of U.S. net medicine spending in 2024, totaling roughly $262 billion. [7] Spending is expected to continue growing as specialty medications receive additional indications and become available to broader patient populations.
For employers, payers, and claims professionals, the challenge is balancing access to innovative therapies with responsible utilization management. As more biologics enter respiratory care, questions surrounding clinical appropriateness, treatment duration, and financial impact are likely to become increasingly important.
Workers' Compensation Considerations
Specialty respiratory medications are particularly relevant to workers' compensation because some respiratory conditions may be caused or worsened by workplace exposures.
According to the Centers for Disease Control and Prevention (CDC), more than 300 workplace substances can cause or exacerbate asthma, including cleaning chemicals, dusts, pesticides, and metals. [8]
For workers with suspected work-related asthma, evaluating workplace exposures is a critical component of treatment planning. Providers often assess whether symptoms improve when the worker is away from work and whether modifications to the work environment may help reduce exposures. [9]
Determining whether workplace exposures are contributing to respiratory symptoms may have important implications for claim management, treatment planning, and long-term outcomes. As specialty respiratory therapies become more common, ensuring that treatment is appropriately aligned with the diagnosis and workplace risk factors will become increasingly important.
Workers' compensation programs can also support appropriate specialty drug use by:
Confirming the diagnosis
Ensuring standard therapy has been optimized
Reviewing relevant biomarkers
Documenting exacerbation history
Monitoring treatment response over time
Key Takeaway
Specialty respiratory medications are changing how severe asthma and COPD are managed, creating new targeted treatment options for select patients.
As biologics expand into additional respiratory conditions, stakeholders will need to balance:
Appropriate patient selection
Clinical outcomes
Workplace exposure considerations
Rising specialty drug costs
Understanding these trends will become increasingly important as specialty therapies continue to reshape respiratory care.
By Micah Anderson
PharmD Candidate (P4)
For questions, e-mail pharmd@prodigyrx.com
References
1. Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention 2026. Updated 2026. Accessed August 25, 2026. https://ginasthma.org 2. Global Initiative for Chronic Obstructive Lung Disease. Global Strategy for the Diagnosis, Management, and Prevention of COPD: 2026 Report. Updated 2026. Accessed August 25, 2026. https://goldcopd.org 3. American Academy of Allergy, Asthma & Immunology. Biologics for the Treatment of Asthma. Updated 2025. Accessed August 25, 2026. https://www.aaaai.org/tools-for-the-public/conditions-library/asthma/biologics-for-the-treatment-of-asthma 4. U.S. Food and Drug Administration. FDA approves Dupixent (dupilumab) as add-on maintenance treatment for adults with inadequately controlled COPD and an eosinophilic phenotype. Published September 2024. Accessed August 25, 2026. https://www.fda.gov 5. GSK. FDA approves Nucala (mepolizumab) for adults with COPD and an eosinophilic phenotype. Published May 2025. Accessed August 25, 2026. https://www.gsk.com 6. GSK. FDA approves depemokimab (Exdensur) for severe eosinophilic asthma. Published December 2025. Accessed August 25, 2026. https://www.gsk.com 7. IQVIA Institute. The Use of Medicines in the U.S. 2025: Usage and Spending Trends and Outlook to 2029. Published 2025. Accessed August 25, 2026. https://www.iqvia.com/insights/the-iqvia-institute/reports-and-publications/reports/the-use-of-medicines-in-the-us-2025 8. Centers for Disease Control and Prevention. Work-related Asthma. Updated 2025. Accessed August 25, 2026. https://www.cdc.gov/niosh/asthma 9. Centers for Disease Control and Prevention. Diagnosing Work-related Asthma. Updated 2025. Accessed August 25, 2026. https://www.cdc.gov/niosh/asthma/hcp/diagnosing/index.html 