Addressing unmet needs in uncontrolled asthma through a specialized severe asthma center

Severe asthma represents a clinically challenging proportion of the asthma population, characterized by persistent symptoms, frequent exacerbations, and a higher healthcare burden. To address the complexity of uncontrolled disease, specialized severe asthma clinics have emerged as key models for delivering precision medicine through multidimensional assessment and tailored interventions. This paper describes the organization, clinical approach, and multidisciplinary framework of a tertiary Severe Asthma Centre established in Northern Italy in 2017. The center integrates prioritized outpatient access with a structured day-hospital program (Complex Outpatient Macro Activity, MAC), enabling accelerated diagnostic work-up, comprehensive phenotyping/endotyping, and repeated educational interventions. Central elements include confirmation of diagnosis, assessment of type 2 inflammatory biomarkers (FeNO, IgE, blood and sputum eosinophils), evaluation of airway inflammation, and systematic identification of pulmonary and extrapulmonary treatable traits. A broad multidisciplinary network supports the management of comorbidities such as allergic rhinitis, chronic rhinosinusitis, hypereosinophilic disorders, allergic bronchopulmonary aspergillosis, metabolic and endocrine complications, gastroesophageal reflux disease, and vocal cord dysfunction. Pulmonary rehabilitation is integrated as an adjunctive intervention, particularly for patients with severe disease. Our severe asthma clinic implements precision medicine and the treatable traits approach in clinical practice to optimize outcomes, rationalize biologic therapy use, and reduce glucocorticoid exposure. Future perspectives include expansion toward a "united airways disease" clinic, integrating upper and lower airway management to further improve care for complex inflammatory airway diseases.