Beyond Inhalers: Where Pharma Bets Next

Why is the respiratory market splitting into two models?

The traditional respiratory model remains commercially important: large patient populations, inhaled maintenance therapies, primary-care prescribing and established brands. The emerging model is different. It is defined by patients whose treatment depends on phenotype, biomarker, genotype or risk profile, and by the specialist, access and delivery systems needed to turn that identification into sustained use.

Primary care does not become less important. In asthma and COPD, it may become even more important as the point of identification, referral and long-term management. But launches in the emerging model must connect primary care to specialized treatment pathways more effectively than traditional inhaler launches have required.

The respiratory growth model is shifting from broad prescription volume to targeted populations, specialist pathways and care-model execution.

What are the five signals reshaping respiratory strategy?

Five signals define where the strategic value is moving. Select a signal to see what it means for a respiratory portfolio.

Together the signals point to one requirement: the emerging respiratory portfolio is unlikely to be won by one type of asset. Commercial durability will depend on capabilities that sit beyond the product itself.

Is the product becoming a care model in severe asthma?

In severe asthma, biologics already compete across patient phenotype, exacerbation reduction, oral-corticosteroid sparing and safety. Newer programs suggest that administration burden may become a more visible dimension of differentiation. GSK's depemokimab program is positioned around an ultra-long-acting, twice-yearly dosing model for people with severe asthma with an eosinophilic phenotype.

1. 01

   An ultra-long-acting dosing model

   Depemokimab is positioned around twice-yearly dosing for people with severe asthma with an eosinophilic phenotype.^[1]

2. 02

   A first approval under a brand name

   In March 2026, GSK announced Chinese approval for Exdensur, its brand name for depemokimab, in this population.^[1]

3. 03

   A different question for payers

   Lower-frequency administration could affect patient burden, clinic appointment patterns and adherence tracking, and may change whether a dosing model contributes to persistence, fewer exacerbations or more efficient care.

The implication is not simply that GSK has another biologic. In this category, convenience is becoming part of the product proposition rather than a secondary feature, and the payer question shifts toward whether a different dosing model contributes to persistence, fewer exacerbations or more efficient care.

Can a biologic reach scale in an inhaler-led disease like COPD?

COPD is the clearest example of the established respiratory model: a large patient population, major primary-care involvement, inhaler-based treatment and persistent challenges around diagnosis, spirometry, inhaler technique and adherence. The development of biologic strategies in selected inflammatory populations introduces a different commercial model.

Sanofi and Regeneron continue to develop and commercialise Dupixent across respiratory diseases, including COPD populations defined by elevated blood eosinophils. In 2026, Sanofi stated that Dupixent had regulatory approvals in more than 60 countries for one or more indications, including certain patients with asthma and COPD^[2].

The commercial question is therefore not simply whether a biologic works in a selected trial population. It is whether healthcare systems can identify the appropriate patient at scale. COPD may become the clearest test of whether respiratory innovation can move beyond inhalers while still reaching a meaningful patient population.

When does specialist infrastructure become part of the asset?

Pulmonary arterial hypertension is smaller than asthma or COPD, but it illustrates a distinct form of respiratory opportunity: complex disease, specialist-center concentration, multi-drug treatment and greater reliance on risk stratification and long-term outcomes.

The lesson is not that every respiratory company needs a PAH asset. It is that growth is increasingly being sought in markets where care infrastructure is part of the product proposition. In these settings, value depends on whether patients can be diagnosed early enough, specialist centers can adopt and monitor treatment, therapy fits with established combination regimens, and evidence supports a value proposition beyond a short-term clinical endpoint.

What does cystic fibrosis show about franchise strength and platform risk?

Vertex has built cystic fibrosis into one of the clearest examples of a disease-modifying respiratory franchise. In June 2026, it presented additional data for ALYFTREK, framing the work within its long-standing effort to restore CFTR function for people living with CF^[3].

The strategic issue is residual unmet need: people whose mutations do not produce enough CFTR protein to respond adequately to current modulators, and people for whom existing outcomes leave meaningful room for improvement. This is why inhaled RNA, gene therapy and gene-editing approaches continue to attract interest.

But it also shows the challenge of translating a compelling platform concept into a viable respiratory treatment. In May 2026, Vertex discontinued the Phase I/II study of VX-522, an investigational inhaled CFTR mRNA candidate developed with Moderna. Moderna said the termination precluded a full efficacy and safety assessment and ended further development of the candidate^[4].

CFTR modulation demonstrates the value of disease-modifying franchises. VX-522 highlights that pulmonary delivery, repeat dosing and tolerability remain central risks for next-generation approaches.

Why is care-pathway execution now a portfolio capability?

The signals point to one common requirement: the emerging respiratory portfolio is unlikely to be won by one type of asset. Companies are pursuing larger but more segmented biologic opportunities, high-value specialist disease franchises and genetic or RNA delivery technologies.

Their commercial durability will depend on capabilities that sit beyond the product itself: patient identification, referral, access, site-of-care design and persistent use.

What should respiratory portfolio leaders decide now?

Mature inhaler businesses can remain cash-generative, but they may not provide sufficient innovation-led growth on their own. The immediate task for respiratory portfolio leaders is to determine which opportunities can become durable franchises, and which will remain clinically compelling but operationally difficult niches.

Respiratory is not leaving inhalers behind. But the center of strategic value is moving toward patient segments that require biomarker identification, specialist care infrastructure, targeted evidence and sustained treatment support.

What is still unresolved in respiratory strategy?

The signals show where investment is moving, but they do not settle how each bet resolves. Four questions decide whether an asset becomes a durable franchise or an operationally difficult niche.

Those questions sit with the people shaping respiratory care: pulmonologists and allergists, specialist-center leaders, respiratory nurses and care coordinators, specialty pharmacy and access decision-makers, payers, and former industry executives.

The most attractive respiratory opportunities increasingly depend not only on the molecule, but on whether the surrounding care pathway can find, treat and retain the right patients.