Biologic Therapy in Severe Asthma: A Phenotype-Driven and Targeted Approach

Area of Science:

• Pulmonology
• Immunology
• Pharmacology

Background:

• Severe asthma management remains challenging for patients uncontrolled by standard therapies.
• Biologic agents offer targeted treatment based on inflammatory endotypes (T2-high, T2-low).
• Selecting the optimal biologic is complex due to overlapping phenotypes and limited biomarkers.

Purpose of the Study:

• To review the clinical utility of biomarkers in guiding severe asthma biologic therapy.
• To examine clinical factors and comorbidities influencing treatment selection.
• To present a practical decision-making framework for choosing biologics.

Main Methods:

• Extensive literature search on PubMed.
• Analysis of key biomarkers: blood eosinophils, FeNO, periostin, IgE.
• Integration of clinical assessment, guidelines, and real-life experience.

Main Results:

• Biomarkers (eosinophils, FeNO, IgE, periostin) are crucial for stratifying patients.
• Clinical characteristics and comorbidities impact biologic choice.
• A decision-making platform and table match phenotypes with specific biologics (omalizumab, mepolizumab, etc.).

Conclusions:

• Integrating biomarker analysis and clinical assessment provides a logical framework for biologic selection.
• This approach supports personalized medicine for uncontrolled severe asthma.
• Further research is needed for novel biomarkers and long-term outcome evaluation.