Marco Caminati, Jeremy Charriot, Aruna T Bansal, Shane Hanon, Renaud Louis, Florence Schleich, Muriel Delvaux, Guy Brusselle, Stéphanie Ziant, Virginie Paulus, Sanja Grle Popovic, Gordana Pavlisa, Marina Lampalo, Celeste Porsbjerg, Kjell Håkansson, Susanne Hansen, Arnaud Bourdin, Eve Klising, Candice Estellat, Caroline Giboin, Dounya Metdaoui, Zsuzsanna Csoma, Dora Lúðvíksdóttir, Giorgio Walter Canonica, Enrico Heffler, Cristina Cardini, Anna Alloni, Iveta Kroica, Kristina Bieksiene, Romain Tching, Anneke Ten Brinke, Jacob Sont, Piotr Kuna, Maria Morawska, Florin Mihaltan, Sanja Hromis, Aleksa Golubovic, Mihailo Stjepanovic, Vojislav Ćupurdija, Peter Kopac, Valentyna Yasinska, Fabienne Jaun, Joerg Leuppi, Ebru Damadoglu, Ozlem Goksel, Sabina Skrgat, Ratko Djukanovic, Bilun Gemicioglu
Our study reveals a lower prevalence of biologic therapy among adults with severe asthma who smoke and provides evidence suggesting this practice is unwarranted. Former/current smokers who underwent biologic therapy for one year responded as effectively as never-smokers. Recognising the complexity of nicotine dependence, smoking cessation should remain a central goal in asthma management. This study underscores the need for randomized controlled trials in smokers to enable more robust and inclusive scientific conclusions and guidelines.
RATIONALE: The efficacy of biologics remains debatable in current or ex- smokers with severe asthma.
OBJECTIVES: This study aimed to evaluate responses to biologics by smoking exposure and to assess variations in management practice across Europe.
METHODS: This was a retrospective real-world study of adults with severe asthma from 16 European countries assessed at baseline and after 1-year of biologic treatment. Data were collected within the ERS SHARP (Severe Heterogeneous Asthma Research-Patient Centred) registry, applying the OMOP Common Data Model.
MEASUREMENTS AND MAIN RESULTS: Of the 3,876 adult patients, 2,383 were never-smokers, 540 ex-smokers (<10 pack-years), 812 (≥10 pack-years), and 141 current-smokers. In all 4 groups, symptom control (ACT≥20/ACQ≤1.5) improved, frequent exacerbations (≥2/year) decreased, asthma quality of life (AQLQ) improved, and oral corticosteroid use decreased. While the starting point sometimes differed, the order of magnitude of change was not statistically different between groups. A country-averaged analysis of the SHARP survey revealed that 29% of participating nations reported opposition to prescribing biologics to current smokers, while 59% expressed dissatisfaction with current treatment guidelines.
CONCLUSION: Our study reveals a lower prevalence of biologic therapy among adults with severe asthma who smoke and provides evidence suggesting this practice is unwarranted. Former/current smokers who underwent biologic therapy for one year responded as effectively as never-smokers. Recognising the complexity of nicotine dependence, smoking cessation should remain a central goal in asthma management. This study underscores the need for randomized controlled trials in smokers to enable more robust and inclusive scientific conclusions and guidelines.