1Allergy Unit, Department of Internal Medicine, University Hospital Ospedali Riuniti, Ancona, Italy
2Department of Clinical and Molecular Sciences, Marche Polytechnic University, Ancona, Italy
3Allergy and Asthma Outpatient Clinic, Ancona, Italy
4Istituti Clinici Scientifici Maugeri IRCCS, Division of Pulmonary Disease and Respiratory Rehabilitation, Bari Institute, Bari, Italy
5SOS Allergy and Clinical Immunology, USL Toscana Centro, Prato, Italy
6Pulmonology and Respiratory Pathophysiology Unit, A. Cardarelli Hospital, Naples, Italy
7Pulmonology Unit, Ospedale di Bussolengo, ULSS 9 Scaligera, Villafranca, Verona, Italy
8Former Head of Pneumology and Chief of Department of Medicine and Rehabilitation, Guido Salvini Hospital-ASST Rhodense, Garbagnate Milanese, Milan, Italy
9Allergy Unit, Casa della Salute di Scilla, Scilla, Reggio Calabria, Italy
10Pulmonary Unit, Integrated University Hospital of Verona, Verona, Italy
HistoryPublished: 13 July 2023
Accepted: 13 July 2023
Received: 12 July 2023
*IRSA Follow-up Study Group (major contributors with at least five follow-up visits recorded): Paolo Banfi (Milan, Italy), Michela Bettinzoli (Chiari, Brescia, Italy), Francesco Bini (Garbagnate Milanese Milan, Italy), Giulia Bonaiti (Monza, Monza-Brianza, Italy), Marcello Cilia (Scilla, Reggio Calabria, Italy), Caterina Colangelo (Pescara, Italy), Paola Contini (Bologna, Italy), Rosa Fasano (Chiaravalle, Catanzaro, Italy), Anna Rita Gabrielli (Perugia, Italy), Domenico Gargano (Avellino, Italy), Maria Stella Garritani (Ancona, Italy), Sergio Harari (Milan, Italy), Giovanni Inciso (Meta, Naples, Italy), Gianluca Manganello (Naples, Italy), Giuseppina Manzotti (Bergamo, Italy), Francesca Marchesani (Macerata, Italy), Chiara Massaccesi (Ascoli Piceno, Italy), Elisa Paolucci (Cesena, Italy), Federica Rivolta (Milan, Italy), Annamaria Romano (Avellino, Italy), Eugenio Sabato (Brindisi, Italy), Francesca Savoia (Treviso, Italy), Alessandro Scartabellati (Crema, Italy), Umberto Semenzato (Padua, Italy), Domenico Toraldo (San Cesario, Lecce, Italy), Salvatore Tripodi (Reggio Calabria, Italy), Giuseppe Valenti (Palermo, Italy), Maria Cristina Zappa (Rome, Italy), Umberto Zuccon (Pordenone, Italy)
Asthma affects millions of people worldwide, with a subgroup suffering from severe asthma (SA). Biologics have revolutionized SA treatment, but challenges remain in managing different patient traits. This study analyzed data from the Italian Registry on Severe Asthma (IRSA) to investigate changes in SA characteristics and effectiveness of treatments after one year of follow-up, and to identify factors associated with response to treatments in a real-world setting.
Data on SA patients with one year of follow-up were extracted from IRSA. Asthma control, exacerbations, lung function, and treatments, were assessed at follow-up and analyzed against baseline characteristics.
After one year of follow-up, notable improvements were observed in all the outcomes of SA of the included patients (n = 570). The effectiveness of biologic therapies was particularly evident, as they contributed significantly to these positive outcomes. Additionally, certain factors were found to be associated with improvement, namely T2 phenotype, baseline eosinophil count (BEC), and area of residence. On the other hand, comorbidities (obesity, gastro-esophageal reflux disease) and poor lung function were risk factors. Notably, poor-responders to biologics exhibited lower level of education, BEC, and exacerbations, and higher frequency of atopy and ACT score ≥ 20.
The findings demonstrate the effectiveness of biologics in asthma management, when implemented as part of a planned follow-up strategy aimed at optimizing and fine-tuning the therapy. Moreover, the study highlights the importance of considering key traits such as the T2 phenotype, BEC, education, and comorbidities when tailoring SA treatment. Overall, this study contributes to enhancing our understanding of SA management and guiding the development of personalized treatment approaches for patients with SA.
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