Emerging care management strategies for severe asthma: integrating biologic therapy

Severe asthma accounts for 5% to 10% of asthma cases. Despite this, patients with uncontrolled severe asthma consume significant healthcare resources. Approximately 40% of patients with severe asthma have uncontrolled disease. Treatment guidelines lack strong recommendations because of the heterogeneity of the disease. Together, prescribers and pharmacists can personalize treatment plans with biologics, using patient phenotypes to maximize disease control. Biomarkers such as fraction of exhaled nitric oxide levels, immunoglobulin E, and serum periostin levels help identify inflammation type and stratify patients by endotype. Currently, there are 5 biologics that treat eosinophilic inflammation and 1 newer biologic that treats both eosinophilic inflammation and noninflammatory non-eosinophilic asthma. Healthcare professionals need to consider phenotype and endotype to individualize patient treatment. As medications and hospitalizations are the largest drivers of asthma-related costs to health systems, choosing optimal therapies to reduce uncontrolled symptoms and exacerbations curbs cost. Successful disease management strategies are employed by managed care organizations that have a collaborative team to ensure patient access to biologics.