People living with chronic obstructive pulmonary disease (COPD) who continue to experience flare-ups despite optimised treatment may now have access to an additional treatment option, with mepolizumab (Nucala) now available on the Pharmaceutical Benefits Scheme (PBS) for eligible patients.
Nucala is the first biologic therapy to be PBS subsidised for people with uncontrolled COPD and high eosinophil levels, offering a new option for those who continue to experience exacerbations despite using recommended inhaler treatment.
What is Nucala?
Nucala is a type of medicine known as a biologic. Unlike inhalers, it is administered by injection and works by targeting eosinophils, a type of white blood cell involved in inflammation.
For some people with COPD, elevated eosinophil levels may contribute to ongoing flare-ups, also known as exacerbations. By reducing eosinophilic inflammation, Nucala may help reduce the risk of future exacerbations.
Eosinophil levels are commonly measured through a routine full blood count (FBC). Because eosinophil levels can vary over time, only one documented result of 300 cells per microlitre or higher within the previous 12 months is required to meet this eligibility criterion.
Who may be eligible?
To access PBS-subsidised Nucala for COPD, patients must meet all of the following criteria:
- Have a blood eosinophil count of at least 300 cells per microlitre recorded at some point during the previous 12 months.
- In the past 12 months, have experienced either:
- At least one severe exacerbation requiring hospitalisation; or
- At least two moderate exacerbations requiring treatment with oral corticosteroids such as prednisone and/or antibiotics.
- Have been using a triple therapy inhaler (LAMA, LABA and ICS) with confirmed correct inhaler technique and adherence for at least three months.
Important information for patients
There are several important requirements people should be aware of before discussing Nucala with their healthcare team.
Nucala is designed as an add-on treatment and does not replace existing inhaler therapy. Patients who commence Nucala must continue their prescribed triple inhaler treatment.
Nucala can only be prescribed by a respiratory specialist or a physician experienced in COPD management.
People currently receiving another PBS-subsidised biologic medicine for asthma, nasal polyps or other conditions cannot use Nucala at the same time. A minimum four-week gap is required between biologic treatments.
What should people with COPD do next?
If you are living with COPD and continue to experience flare-ups despite treatment, it is important to discuss your current management plan with your healthcare team.
- Speak with your GP, respiratory specialist, nurse or pharmacist about your symptoms, exacerbation history and current treatment plan. They can advise whether additional treatment options or support services may be appropriate for you.
- Have your inhaler technique reviewed. Correct inhaler technique and regular use of prescribed medications are essential for achieving the best possible outcomes from COPD treatment. Ask your doctor, nurse, pharmacist or other healthcare professional to review your inhaler technique and adherence. If you are exploring additional treatment options such as biologics, ensure this review is documented in your medical record.
Looking ahead
As treatment options for COPD continue to evolve, guidance for healthcare professionals is also being updated. The COPD-X Biologics Module is currently under development and is expected to be available in December 2026, providing additional information on the role of biologic therapies in COPD management.
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