Journal Article Ahead of print
PubMed: 42547023 DOI: 10.1016/j.anai.2026.07.026
Improved peripheral airway reactance is associated with clinical remission following biologic therapy in severe asthma.
Ann Allergy Asthma Immunol
Authors: Jo Vi Lim, Brian Lipworth, Francesco Menzella, Omar Usmani, Marcello Cottini, Remo Poto, Zuzana Diamant, Philipp Suter, Robert Greig, Andrea Portacci, Ian M Adcock, Katie McGinty, Arlene Shaw, Dermot Ryan, Tom Fardon, Rory Chan
Affiliations
- University of Dundee, School of Medicine, Dundee, UK.
- Pulmonology Unit, S. Valentino Hospital, Montebelluna, TV, AULSS2 Marca Trevigiana, Italy.
- National Heart and Lung Institute, Imperial College, London, UK.
- Allergy and Pneumology Outpatient Clinic, Bergamo, Italy.
- Department of Translational Medical Sciences, Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II, Naples, Italy.
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Respiratory Medicine, First Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic; Department of Microbiology, Immunology and Transplantation, Catholic University of Leuven, KU Leuven, Belgium.
- Institute of Respiratory Disease, Department of Translational Biomedicine and neuroscience, University "Aldo Moro", Bari, Italy.
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom.
- University of Dundee, School of Medicine, Dundee, UK.
Abstract
BACKGROUND
Small airways dysfunction (SAD) is increasingly recognised as a treatable trait in severe asthma and may influence the likelihood of achieving clinical remission.
OBJECTIVE
To investigate whether oscillometry defined SAD parameters were associated with remission following biologic or standard-of-care treatment.
METHODS
Data from 237 adults with GINA-defined severe asthma were retrospectively collected at a tertiary specialist centre. 127 received add on biologic therapy (Benralizumab, Dupilumab or Tezepelumab) and 110 received standard of care alone. Spirometry, oscillometry, fractional exhaled nitric oxide (FeNO), blood eosinophil count (BEC), exacerbation frequency and Asthma Control Questionnaire (ACQ) scores were collected. Three component remission (3CR: no exacerbations, no maintenance OCS,ACQ <1.5) and four component remission (4CR: 3CR plus stable lung function defined as FEV₁) were assessed. Multivariable logistic regression was used to identify predictors of remission, adjusted for age, sex, BMI, ICS dose and smoking status.
RESULTS
Biologic therapy significantly improved lung function, oscillometry indices, type 2 biomarkers, exacerbation frequency and ACQ scores. In the biologics group, 50.4% achieved 3CR and 34.6% achieved 4CR, compared with 42.6% and 25.0% respectively in the standard-of-care group. Baseline FeNO ≥25ppb and ≥50ppb were associated with higher odds of achieving remission following biologic therapy. An improvement in FEV₁ ≥100mL was strongly associated with both 3CR and 4CR. Importantly, improvement in oscillometry-derived area under the reactance curve (AX) ≥0.65kPa/L, corresponding to the minimal clinically important difference, was significantly associated with 4CR (adjusted OR 2.61 [1.02-6.65], p<0.05). In the standard-of-care group (3CR: 42.6%; 4CR: 25%), higher baseline AX ≥1.0 kPa/L was associated with a lower likelihood of achieving 3CR (adjusted OR 0.36 [0.14-0.93], p<0.05).
CONCLUSION
Improvements in peripheral airway compliance measured using oscillometry are associated with clinical remission in severe asthma following biologic therapy. These findings support SAD as an important physiological correlate and potential treatable trait in achieving asthma remission.
MeSH
Lung, Hypersensitivity, Immunity, Therapeutics, Asthma, Biological Therapy