[Severe asthma revisited by biologic therapies emergences]

Severe asthma defined as uncontrolled or refractory asthma despite adequate use of high dose of inhaled steroid and additional long acting bronchodilators is associated with a high risk of comorbidities, exacerbations and persistent asthma-related symptoms. It remains a significant health care problem and represents the majority of health costs due to asthma. A better understanding of the basic mechanisms of the disease has allowed identification of new phenotypes and endotypes and of some predictive biomarkers. In the meantime an increasing number of promising biologicals are commercialized or on development providing new hopes to achieve asthma control and decrease exacerbation rate without the use of systemic corticosteroid. The increasing number of highly expensive available molecules poses physicians a new challenge: the identification of "the good treatment for the good patient". This article discuss the different biological available or in development in the field of severe asthma based on their mechanism of action and target. One of the aims is to help clarify the clinical decision-making process taking in account both the phenotype/endotype of the patient and the characteristics of these new drugs.