PATIENTS WITH COPD CARRY A HEAVY BURDEN1,2

In a highly heterogeneous disease, many patients continue to experience exacerbations despite inhaled triple therapy1,2

IL-33 is released at the epithelium3,5,8-17

Interleukin-33 (IL-33) Driven Cycle of Inflammation And Mucus Dysfunction In COPD Interleukin-33 (IL-33) Driven Cycle of Inflammation And Mucus Dysfunction In COPD

IL-33 can activate an array of cells that drives inflammation in the majority of patients with COPD3,5,8-17

IL-33 can drive mucus dysfunction, which is characterized by mucus hypersecretion, impaired clearance, and mucus plugs3,5,8-17,25-27

Lung illustration showing increased risk of COPD symptoms Lung illustration showing increased risk of COPD symptoms

IL-33 CAN INCREASE THE RISK OF COPD SYMPTOMS3,6,18-21

IL-33 CAN INCREASE THE RISK OF COPD SYMPTOMS3,6,18-21

Common symptoms of COPD, including dyspnea and chronic cough with mucus, can have a serious impact on patients’ daily living. Airflow limitation contributing to these symptoms may stem from inflammation and mucus dysfunction.

Lung illustration showing increased risk of exacerbations Lung illustration showing increased risk of exacerbations

IL-33 CAN INCREASE THE RISK OF EXACERBATIONS2,5,18,22-24

IL-33 CAN INCREASE THE RISK OF EXACERBATIONS2,5,18,22-24

Increased COPD symptoms may lead to moderate or severe exacerbations, requiring medical intervention and even hospitalization. IL-33 signaling was linked to a twofold increased risk of exacerbations over
1 year.

COULD IL-33 REVEAL NEW WAYS OF THINKING ABOUT COPD?

Learn more about the dual pathways of IL-33 and their roles in COPD.

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  1. Global Initiative for Chronic Obstructive Lung Disease. Global Strategy for Prevention, Diagnosis and Management of COPD: 2026 Report. Accessed July 6, 2026. https://goldcopd.org/2026-gold-report-and-pocket-guide/
  2. Nordon C, Carstens D, Fagerås M, et al. Characteristics and outcomes of people with COPD who experience exacerbations while on inhaled triple therapy: results of the SIRIUS I cohort study in the US (2015-2019). Int J Chron Obstruct Pulmon Dis. 2025;20:1851-1864. doi:10.2147/COPD.S513573
  3. Strickson S, Houslay KF, Negri VA, et al. Oxidised IL-33 drives COPD epithelial pathogenesis via ST2-independent RAGE/EGFR signalling complex. Eur Respir J. 2023;62(3):2202210. doi:10.1183/13993003.02210-2022
  4. Rabe KF, Rennard S, Martinez FJ, et al. Targeting type 2 inflammation and epithelial alarmins in chronic obstructive pulmonary disease: a biologics outlook. Am J Respir Crit Care Med. 2023;208(4):395-405. doi:10.1164/rccm.202303-0455CI
  5. Calderon AA, Dimond C, Choy DF, et al. Targeting interleukin-33 and thymic stromal lymphopoietin pathways for novel pulmonary therapeutics in asthma and COPD. Eur Respir Rev. 2023;32(167):220144. doi:10.1183/16000617.0144-2022
  6. Kearley J, Silver JS, Sanden C, et al. Cigarette smoke silences innate lymphoid cell function and facilitates an exacerbated type I interleukin-33-dependent response to infection. Immunity. 2015;42(3):566-579. doi:10.1016/j.immuni.2015.02.011
  7. Liew FY, Girard JP, Turnquist HR. Interleukin-33 in health and disease. Nat Rev Immunol. 2016;16(11):676-689. doi:10.1038/nri.2016.95
  8. Hiemstra PS, Heijink IH. Oxidation alters IL-33 function: new insights in the biology of different forms of IL-33 and their relevance for COPD. Eur Respir J. 2023;62(3):2301301. doi:10.1183/13993003.01301-2023
  9. Gabryelska A, Kuna P, Antczak A, Białasiewicz P, Panek M. IL-33 mediated inflammation in chronic respiratory diseases—understanding the role of the member of IL-1 superfamily. Front Immunol. 2019;10:692. doi:10.3389/fimmu.2019.00692
  10. Angelis N, Porpodis K, Zarogoulidis P, et al. Airway inflammation in chronic obstructive pulmonary disease. J Thorac Dis. 2014;6(Suppl 1):S167-S172. doi:10.3978/j.issn.2072-1439.2014.03.07
  11. Baraldo S, Turato G, Saetta M. Pathophysiology of the small airways in chronic obstructive pulmonary disease. Respiration. 2012;84(2):89-97. doi:10.1159/000341382
  12. Varricchi G, Poto R. Towards precision medicine in COPD: targeting type 2 cytokines and alarmins. Eur J Intern Med. 2024;125:28-31. doi:10.1016/j.ejim.2024.05.011
  13. Plichta J, Kuna P, Panek M. Biologic drugs in the treatment of chronic inflammatory pulmonary diseases: recent developments and future perspectives. Front Immunol. 2023;14:1207641. doi:10.3389/fimmu.2023.1207641
  14. Abdo M, Pedersen F, Kirsten A-M, et al. Association of airway inflammation and smoking status with IL-33 level in sputum of patients with asthma or COPD. Eur Respir J. 2024;64(3):2400347. doi:10.1183/13993003.00347-2024
  15. Jin KN, Lee HJ, Park H, et al. Mucus plugs as precursors to exacerbation and lung function decline in COPD patients. Arch Bronconeumol. 2025;61(3):138-146. doi:10.1016/j.arbres.2024.07.017
  16. Mettler SK, Nardelli P, Campo MI, et al. Longitudinal changes in airway mucus plugs and FEV1 in COPD. N Engl J Med. 2025;392(19):1973-1975. doi:10.1056/NEJMc2502456
  17. Mettler SK, Nath HP, Grumley S, et al. Silent airway mucus plugs in COPD and clinical implications. Chest. 2024;166(5):1010-1019. doi:10.1016/j.chest.2023.11.033
  18. Kim SW, Rhee CK, Kim KU, et al. Factors associated with plasma IL-33 levels in patients with chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis. 2017;12:395-402. doi:10.2147/COPD.S120445
  19. Choate R, Pasquale CB, Parada NA, Prieto-Centurion V, Mularski RA, Yawn BP. The burden of cough and phlegm in people with COPD: a COPD patient-powered research network study. Chronic Obstr Pulm Dis. 2020;7(1):49-59. doi:10.15326/jcopdf.7.1.2019.0146
  20. Stott-Miller M, Müllerová H, Miller B, et al. Defining chronic mucus hypersecretion using the CAT in the SPIROMICS cohort. Int J Chron Obstruct Pulmon Dis. 2020;15:2467-2476. doi:10.2147/COPD.S267002
  21. Sutherland ER, Martin RJ. Airway inflammation in chronic obstructive pulmonary disease: comparisons with asthma. J Allergy Clin Immunol. 2003;112(5):819-827. doi:10.1067/mai.2003.1760
  22. Mannino DM, Roberts MH, Mapel DW, et al. National and local direct medical cost burden of COPD in the United States from 2016 to 2019 and projections through 2029. Chest. 2024;165(5):1093-1106. doi:10.1016/j.chest.2023.11.040
  23. Nordon C, Carstens D, Fagerås M, et al. Exacerbation and mortality in COPD patients on triple inhaler and at high exacerbation risk. Poster presented at: European Respiratory Society (ERS) Congress 2024; September 7-11, 2024; Vienna, Austria. Poster PA1287.
  24. Joo H, Park SJ, Min KH, Rhee CK. Association between plasma interleukin-33 level and acute exacerbation of chronic obstructive pulmonary disease. BMC Pulm Med. 2021;21(1):86. doi:10.1186/s12890-021-01423-8
  25. Borger JG, Lau M, Hibbs ML. The influence of innate lymphoid cells and unconventional T cells in chronic inflammatory lung disease. Front Immunol. 2019;10:1597. doi: 10.3389/fimmu.2019.01597
  26. Shah BK, Singh B, Wang Y, Xie S, Wang C. Mucus hypersecretion in chronic obstructive pulmonary disease and its treatment. Mediators Inflamm. 2023;2023:8840594. doi: 10.1155/2023/8840594
  27. Washko G, Bhatt SP, Gispert JD, et al. Tozorakimab reduces quantitative mucus plugging metrics in patients with moderate-to-severe COPD. Poster presented at: American Thoracic Society (ATS) International Conference 2026; May 15–20, 2026; Orlando, FL, USA. Poster D96-08.