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The following is a summary of “Choosing the right biologic treatment for individual patients with severe asthma – lessons learnt from Picasso.,” published in the August 2024 issue of Pulmonology by Teri et al.

Severe asthma poses a significant challenge for clinicians due to its complexity in accurately assessing underlying endo/phenotypes and selecting the most effective, personalized treatment. While asthma is inherently heterogeneous, many patients can achieve near-complete disease control or even remission with conventional, step-based pharmacotherapy, often without the need for detailed phenotyping. However, the limitations of this approach became apparent with the advent of biological therapies for severe asthma, highlighting the need for a more nuanced understanding of the disease’s etiopathogenic diversity. The introduction of biologics has underscored the necessity of distinguishing between different types of asthmatic inflammation and accurately matching the right biologic to the right patient. 

To address this, clinicians must answer three critical questions: Is the condition indeed severe asthma? Is it eosinophilic? If eosinophilic, is it predominantly allergen-driven? Effective management requires evaluating current clinical characteristics and laboratory biomarkers and assessing their evolution over time to identify the most relevant and achievable “euphenotypes”—a refined combination of endotypes and phenotypes. This paper outlines a pragmatic, three-step approach to diagnosing and managing severe asthma aimed at enhancing precision in treatment and improving patient outcomes through a more targeted and dynamic understanding of the disease.

Source: sciencedirect.com/science/article/abs/pii/S0954611124002415