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News
Not everyone with severe asthma needs long-term biologic therapy. A new study found that 70% of biologic-eligible adults saw their exacerbation rates drop with standard care alone, while a smaller group with persistent eosinophilia continued to struggle. Researchers say better biomarkers are needed to identify high-risk patients earlier.
Good news for the majority of severe asthma patients: standard care may be enough. A large UK study published in CHEST tracked over 10,000 biologic-eligible adults with severe asthma over a median of 4 years and found that 70% fell into a "remitting-stable" trajectory — their exacerbation rates dropped from a median of 4 to just 1 per year and stayed low, all without biologics.
The remaining 30%, however, told a different story. About 20% had persistently frequent exacerbations (median: 5/year), and 10% had an extremely high burden with more than 10 exacerbations per year — the most refractory group. Persistent blood eosinophilia was a key distinguishing feature of the chronic-frequent group, with elevated counts observed years before and after meeting biologic eligibility criteria.
By the Numbers:
Why it matters: These findings challenge the assumption that all frequent exacerbators need long-term biologics. Identifying who truly needs sustained treatment — versus who will improve on their own — could optimize care and reduce unnecessary costs. Researchers are now calling for better biomarkers to catch high-risk patients earlier, before their disease becomes harder to control.
