Immune checkpoint inhibitors were not associated with poor asthma control in patients with pre-existing asthma

Immune checkpoint inhibitors (ICIs) are associated with various pulmonary toxicities. Their impact on pre-existing asthma remains poorly characterized.

We conducted a retrospective cohort study of adult cancer patients with pre-existing asthma who received at least one ICI dose. Asthma control before and after ICI therapy was assessed based on changes in asthma medications, exacerbations requiring systemic corticosteroids, and asthma-related hospitalizations. Poor asthma control was defined as worsening in any of these parameters following ICI initiation.

Among 340 patients, 56 (16.5%) experienced poor asthma control after ICI initiation, including medication escalation in 40 (11.7%), increased corticosteroid-treated exacerbations in 22 (6.5%), and increased asthma-related hospitalizations in 9 (2.7%). ICI doses and CIP were associated with poor asthma control in univariate analyses, and ICI doses remained independently associated in multivariable analysis. Traditional clinical factors associated with poor asthma control or ICI-related pulmonary toxicity were not associated with poor asthma control. Sensitivity analyses excluding patients with CIP yielded similar findings.

Most patients with pre-existing asthma did not experience poor asthma control during ICI treatment and within 6 months of discontinuation. No clear baseline clinical predictors were identified, and the observed association with ICI doses may reflect longer treatment exposure and follow-up time rather than a dose-dependent effect. These findings support the continued use of ICIs in patients with asthma, with appropriate monitoring. Larger, prospective studies are needed to determine whether specific patient populations are at higher risk for poor asthma control after ICI treatment.