The effect of biologics on pulmonary function tests and small airways in patients with severe asthma: a real-life...

Significant advances have been made in the treatment and management of severe asthma with the development of biological treatments.

The aim of this study was to investigate changes in lung function tests potentially reflecting distal airflow limitation in patients with T2-high severe asthma treated with biological agents.

The study included a total of 80 patients diagnosed with T2-high severe asthma who were treated with biologics (omalizumab (n = 36 (45%)), mepolizumab (n = 35 (43.8%)), or benralizumab (n = 9 (11.2%)) for at least 1 year. The demographic data, comorbid diseases, asthma control test (ACT) scores, exacerbation rates, and pulmonary function test results of the patients were evaluated retrospectively.

The rate of male patients was higher in the benralizumab group (p = 0.017), allergic rhinitis and atopy were significantly higher in the omalizumab group (p < 0.001), and CRSwNP was higher in the mepolizumab and benralizumab groups compared to the omalizumab group (p < 0.001). At 12 months after treatment with omalizumab and mepolizumab, all pulmonary function tests (FEV1, FVC, FEV1/FVC, FEF25, FEF50, FEF75, FEF25-75, PEF) showed a statistically significant increase, ACT score increased, blood eosinophil count decreased, and the number of annual asthma exacerbations decreased (p < 0.05). At 12 months after treatment with benralizumab, the increase in FEF50 and FEV1/FVC and the decrease in the number of annual asthma exacerbations were statistically significant (p < 0.05).

In conclusion, the findings of this study support that biologics were associated with improvements in spirometric parameters potentially reflecting distal airflow limitation.