Impact of sputum neutrophilia on the efficacy of biologics in severe asthma.

Introduction: Patients with severe asthma have new therapeutic opportunities with biologic agents, reducing exacerbation rates, symptom scores, and oral corticosteroid use; however, their effects on lung function appear to be variable. The aim of this study is to evaluate the clinical and inflammatory outcomes of biologic therapy in patients with severe asthma, stratified according to baseline bronchial inflammation. Methods: This was a retrospective observational study in patients with severe asthma at 6 and 12 months after initiation of biologic therapy. Patients were categorized according to their baseline airway inflammatory profile. The inflammatory biomarkers evaluated included induced sputum, fractional exhaled nitric oxide (FeNO), and peripheral blood leukocyte counts. Lung function, comorbidities, exacerbation rate, and asthma control (assessed by ACQ-6 and ACT) were also recorded. Results: A total of 113 patients with severe asthma were analyzed. Patients with a paucigranulocytic pattern were excluded from further analyses due to their small number ( Conclusions: After 12 months of biologic therapy, patients showed phenotype-dependent responses, with neutrophilic patients demonstrating smaller clinical and inflammatory improvements compared with those with eosinophilic or mixed granulocytic phenotypes.