Asthma affects approximately 350 million people of all ages worldwide, with approximately 5% to 10% of those experiencing severe disease.1–2 Type 2 mediated disease accounts for the vast majority—up to 80%—of cases.2–3 Biologic therapies have had a profound impact on disease management in patients with moderate to severe asthma. These agents have been shown to decrease exacerbations and the reliance on oral steroids, improve lung function and quality of life in a subset of patients, and even reduce the need for inhaled corticosteroid maintenance therapy.4–8
Overall, this has led to a paradigm shift in asthma management goals from control to remission across patients with varying levels of disease severity. Achieving remission has become an aspirational goal for asthma management. However, only about one-third of patients receiving biologics can achieve remission.9–10 Thus, there is still a need to improve the approach for patients with severe asthma.
Despite the lack of comparative effectiveness trials across currently available biologic therapies, a new CHEST guideline on the use of biologics for severe disease was created to assist with therapeutic decision-making based on individual patient characteristics.11 As research continues to demonstrate enduring efficacy for these agents, clinicians should be encouraged to make greater use of biologic therapies for their patient populations, especially for those with more severe disease or with comorbid conditions such as chronic rhinosinusitis with nasal polyps.
More recently, radiographic findings have been found to be important for identifying phenotypes in asthma. For example, mucus plugging seen on chest CT scans has been linked to severe asthma and acute exacerbations, sometimes resulting in death.12 Patients who have evidence of mucus plugging have been shown to have greater type 2 inflammation and more frequent severe exacerbations.13–14
Novel research, such as the VESTIGE trial, has shown that biologic therapies may have a greater response for these patients.15 Such research demonstrates how the addition of radiographic assessments can further advance patient care.16 Looking ahead, ultra-long-acting biologics are poised to change the treatment paradigm in severe asthma and may provide sustained control of type 2 inflammation with less frequent dosing.17–18 (see “Adding to the toolkit: Depemokimab”)
Adding to the toolkit: Depemokimab
Depemokimab, an interleukin-5 (IL-5) targeted agent, was recently approved (December 2025) for use by the US Food and Drug Administration and is the first ultra-long-acting biologic approved for severe asthma.
In the phase 3A, randomized, placebo-controlled replicate SWIFT-1 and SWIFT-2 trials, the pooled annualized rate of exacerbations was 0.51 (95% CI, 0.43-0.60) compared with 1.11 (95% CI, 0.92-1.33) for placebo. In addition, the every-six-month dosing is expected to result in improved patient quality of life.17–18
This article was originally published in the Spring 2026 issue of CHEST Physician.
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