Managing asthma in the era of biological therapies

Asthma treatments have been remarkably successful at controlling symptoms. Up to 75% of people with asthma can achieve adequate asthma control on inhaled corticosteroids (ICS) with or without long-acting β2-agonists (LABA).1 But real-life studies have been sobering, indicating that full asthma control is only attained in about 30–40% of people with asthma.2. Many patients retain impairment of lung function and poor quality of life.3 Suboptimal asthma control might occur for various reasons, but there is consensus that poor adherence with asthma medications is a cardinal cause.3 Studies have suggested that asthmatics are especially prone to lapse treatment during asymptomatic periods when having to take regular treatment interferes with their lifestyle. Patients also have concerns about long-term side-effects of ICS, and many choose to live with persistent asthma symptoms. Finally, since asthma is a disease characterised by chronic airway inflammation with variable airflow limitation and unpredictable symptoms, treatment often requires frequent adjustment to achieve total control of chronic asthma. This aim might only be possible to attain in a small proportion of patients.