Effective Management of Severe Asthma with Biologic Medications in Adult Patients: A Literature Review and International Expert Opinion

Roland Buhl, Elisabeth Bel, Arnaud Bourdin, Ignacio Dávila, Jo A. Douglass, J. Mark FitzGerald, David J. Jackson, Njira L. Lugogo, Andrea Matucci, Ian D. Pavord, Michael E. Wechsler, Monica Kraft

Research output: Contribution to journalReview articlepeer-review

31 Scopus citations


Severe asthma often remains uncontrolled despite effective treatments and evidence-based guidelines. A group of global experts in asthma and biologic medications from 9 countries considered the most relevant clinical variables to manage severe asthma in adult patients and guide treatment choice. The resulting recommendations address the investigation of biomarker levels (blood eosinophil count along with fractional concentration of exhaled nitric oxide [FeNO]), clinical features (oral corticosteroid [OCS] dependence, specific comorbid disease entities associated with severe type 2 asthma), and safety considerations. Current evidence suggests that biomarkers, including both blood or sputum eosinophil counts as well as FeNO, add prognostic and predictive value and should be measured in all patients with severe asthma. OCS use is an important factor in biologic selection, especially given the documented ability of some biologics to reduce OCS dependence. Comorbid diseases and relevant safety considerations to each biologic should also be considered. More data are needed to determine whether biomarker profiles identify patients suited to one biologic versus another as limited data support differential predictors of response. Further prospective head-to-head trials and post hoc analyses of clinical trial data are warranted. The authors believe that these recommendations have value as they offer expert opinion to assist health care providers in making difficult decisions regarding the quality of care in severe, type 2 asthma with biologic medications. They remain conditional and are based on limited data owing to a lack of head-to-head comparisons.

Original languageEnglish (US)
Pages (from-to)422-432
Number of pages11
JournalJournal of Allergy and Clinical Immunology: In Practice
Issue number2
StatePublished - Feb 2022


  • Algorithm
  • Eosinophils
  • Severe asthma

ASJC Scopus subject areas

  • Immunology and Allergy


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