Selecting the right biologic for your patients with severe asthma

Objective: Severe asthma affects 5% to 10% of the adult asthma population and is associated with increased morbidity, mortality, and consumption of health care resources. Recently, several biologic medications have been approved for use in severe asthma. These medications target the type 2 inflammatory pathway, which is characterized by activation of cytokines, including interleukin (IL)-4, IL-5, and IL-13, which results in eosinophilia, high FeNO, and atopic features. The objective of this review was to provide clinicians with key points to assist in selecting the best biologic medication for each patient. Data Sources: A comprehensive literature search was performed, and data were reviewed from basic science articles of inflammatory mediators in type 2 airway inflammation, and clinical trials of biologic medications in patients with severe asthma. Study Selections: These studies analyzed outcomes of biologic medications in type 2-high severe asthma including clinical biomarkers, exacerbation rates, lung function, and quality of life measures. Results: Biologic mediations in type 2-high severe asthma improve outcomes, including clinical biomarkers, exacerbation rates, lung function, and quality-of-life measures. Conclusion: When choosing a biologic medication for patients with severe asthma, asthma endotype, clinical biomarkers, and patient-centered factors should be taken into account. (C) 2018 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.