Persistent Uncontrolled Severe Asthma Despite Widespread Biologic Use: Care Gaps from the French FASE2-CPHG...

Biologic therapies have transformed the management of severe asthma, yet many patients in routine care remain symptomatic. Most real-world data originate from tertiary centers and may not reflect broader health care delivery.

To describe disease control, exacerbations, adherence, comorbidities, phenotypes, and care gaps in adults with severe asthma managed in French nonacademic hospitals in the biologic's era.

France Asthme Sévère-Collège des Pneumologues des Centres Hospitaliers Généraux (FASE2-CPHG) was a national, multicenter, cross-sectional study conducted between 2022 and 2023 in French nonacademic hospitals. Adults with Global Initiative for Asthma 2022 Step 5 asthma were consecutively included during routine care. Physicians completed electronic case report forms and patients completed questionnaires assessing asthma control (Asthma Control Test [ACT]), adherence (Girerd score), anxiety and depression (Hospital Anxiety and Depression Scale), and physical activity (Ricci-Gagnon questionnaire). Clinical characteristics, biomarkers, imaging, exacerbations, and treatments, including biologics, were recorded.

Among 970 patients (mean age, 54.5 ± 15.8 years; 66.3% female), 71.2% were receiving biologic therapy. Despite these treatments, 59.8% had partially controlled or uncontrolled asthma according to the ACT questionnaire. Globally, 62.6% experienced at least 1 exacerbation in the previous year. The median annual exacerbation rate was 1 (interquartile range, 0-3). Only 31.6% of patients reported full adherence, whereas 88.7% were considered adherent by physicians. Anxiety and depressive symptoms were present in 45.6% and 24.6% of patients, respectively. Biologic therapy was prescribed in 71.2% of patients, with omalizumab used in most case (41.2%). The mean duration of the ongoing treatment with biologics was 2.9 years (±5.1 years).

In routine nonacademic hospital practice, biologics are widely implemented, but a majority of patients remain uncontrolled. Major care gaps include unrecognized poor adherence; high psychological, metabolic, and ears, nose, and throat comorbidity burden; and incomplete optimization of inhaled therapy. Addressing these gaps may yield gains comparable to the introduction of new biologic agents.