Background/Objectives: Patients with eosinophilic chronic obstructive pulmonary disease (COPD) often remain symptomatic despite optimized triple inhaled therapy. Dupilumab is a fully human monoclonal antibody that blocks the IL-4 receptor alpha subunit, thereby inhibiting IL-4 and IL-13 signaling. Evidence from randomized trials supports dupilumab for add-on treatment of type 2-high COPD, but data referring to short-term effectiveness in clinical practice are quite limited. Methods: We conducted an observational, compassionate-use study enrolling 13 consecutive outpatients with eosinophilic COPD (blood eosinophils ≥ 300 cells/µL) receiving add-on biologic therapy with dupilumab 300 mg every two weeks. Clinical (CAT, mMRC), functional (spirometry and body plethysmography), and inflammatory parameters (blood eosinophils/basophils, fibrinogen, FeNO) were evaluated at baseline and after four weeks of treatment. Safety was monitored after injection in a clinical setting, as well as via weekly phone follow-up. Results: Participants (84.6% male; mean age 67.08 ± 11.42 years) experienced rapid and clinically meaningful improvements at four weeks. CAT score decreased from baseline 21.40 ± 6.22 to 14.00 ± 5.58 (p < 0.001) and mMRC scale from 2.90 ± 0.73 to 1.80 ± 0.63 (p < 0.0001), respectively. Pre-bronchodilator FEV1 increased from baseline 1.35 ± 0.65 L to 1.59 ± 0.84 L (p < 0.05), and FVC from 2.36 ± 0.92 L to 2.83 ± 1.11 L (p < 0.01). A marked lung deflation was observed: indeed, residual volume declined from baseline 4.17 ± 1.98 L to 3.47 ± 2.07 L (p < 0.05), with a concomitant reduction in specific effective airway resistance (from baseline 3.15 ± 1.77 to 2.43 ± 1.44 kPa·s; p < 0.05) associated with significant increases in mid-expiratory flow (FEF25-75: from baseline 0.62 ± 0.38 to 0.86 ± 0.71 L/s; p < 0.05) and peak expiratory flow (3.80 ± 1.40 to 4.48 ± 1.79 L/s; p < 0.01). Type 2 inflammatory biomarkers changed as follows: blood eosinophil count fell from baseline 390.0 ± 43.75 to 190.0 ± 65.47 cells/µL (p < 0.001); blood basophil number decreased from baseline 37.50 ± 13.89 to 26.25 ± 13.02 cells/µL (p < 0.001); plasma fibrinogen lowered from baseline 388.4 ± 54.81 to 334.9 ± 72.36 mg/dL (p < 0.01); FeNO levels dropped from baseline 23.95 ± 18.10 to 14.00 ± 2.04 ppb (p < 0.0001). Dupilumab was well tolerated, and no treatment-related serious adverse events or discontinuations were detected. Conclusions: Within an exploratory context of daily medical activity referring to eosinophilic COPD already treated with maximal inhaled therapy, we found relevant therapeutic effects of a four-week add-on treatment with dupilumab. In particular, our patients manifested rapid improvements in symptoms, airflow limitation, and lung hyperinflation, paralleled by significant decrements of type 2 inflammatory signatures. Such encouraging results were associated with a favorable short-term safety profile. However, larger and longer studies are necessary to corroborate these preliminary findings.

Severe asthma is a heterogeneous disease typically characterized by inadequate symptom control, even with frequent oral corticosteroids, large doses of inhaled corticosteroids, and long-acting β 2-adrenergic agonists. The latest Global Initiative for Asthma (GINA) recommendations suggest adding biological therapies at Step 5 to optimize standard treatments. Although there is a wide range of therapeutic options for T2-high asthma, unfortunately, for T2-low asthma, we still have limited therapeutic choices. Our case report refers to a 64-year-old woman with severe T2-low asthma and chronic rhinosinusitis with nasal polyps (CRSwNP) who had already tested other standard therapies without clinical or functional benefits. She is being treated with tezepelumab (210 mg subcutaneous injection, administered every 4 weeks), an antithymic stromal lymphopoietin (TSLP) human monoclonal antibody. After the third dose, she showed significant clinical and functional benefits, which were also confirmed after 6 months of add-on biological therapy with anti-TSLP. In conclusion, this case study suggests that tezepelumab can provide rapid and effective therapeutic action in patients with severe T2-low asthma and nasal polyposis.

Introduction:Severe asthma is characterized by persistent uncontrolled symptoms despite optimal standard therapy and/or by the need for high-intensity treatment to maintain control. Thymic stromal lymphopoietin (TSLP) is a key innate cytokine that promotes bronchial inflammation in both T2-high and T2-low asthma, thus representing a suitable therapeutic target. Tezepelumab, a human monoclonal antibody designed to block TSLP, has been shown to be able to dampen airway inflammation and improve patients' symptoms and overall outcomes. Methods:This study evaluated the effectiveness of tezepelumab in patients with severe asthma in a real-world clinical setting, examining its capacity to induce clinical remission and improve radiological markers of disease. Twenty patients with severe uncontrolled asthma received subcutaneous tezepelumab at a dose of 210 mg every 4 weeks. Clinical, functional, biologic, and radiological data were collected at baseline and after 12 months of treatment. Results:The results showed a significant increase in Asthma Control Test (ACT) score, from baseline 11.70 ± 1.78 to 20.15 ± 1.38 (p < 0.0001). Oral corticosteroid (OCS) intake decreased from 12.50 mg/day (5.00-25.00) to 0.00 mg/day (0.00-3.75) (p < 0.0001), and the rate of yearly exacerbations lowered from 2.0 (2.0-3.0) to 0.0 (0.0-1.0) (p < 0.0001). There was also a notable increase in pre-bronchodilator forced expiratory volume in 1 s (FEV1), from baseline 57.15% ± 17.18% to 66.35% ± 18.09% (p < 0.001). Clinical remission was achieved by 30% of patients, while 55% reached partial remission. Radiologically, the Mucus Plug Score (MPS) decreased from 5.36 ± 2.85 to 3.94 ± 2.69 (p < 0.0001), and radiological metrics showed inverse correlations with functional parameters. In simple logistic regression analysis, lower MPS values at baseline and at follow-up were significantly associated with higher odds of achieving complete clinical remission at 12 months of add-on tezepelumab therapy. Conclusion:In summary, tezepelumab induced significant benefits in patients with severe asthma in this real-world cohort, improving symptoms, lung function, and radiological outcomes.

Severe eosinophilic asthma represents a relatively small proportion of the overall asthma population but accounts for a disproportionate burden of exacerbations, oral corticosteroid (OCS) exposure and healthcare use. The advent of biologic therapies targeting type 2 (T2) inflammation has made clinical remission a realistic goal and raised new questions about how and when to de-escalate inhaled corticosteroids (ICS) and biologics in patients achieving stable disease. This narrative review summarizes current evidence and expert recommendations on: definitions and levels of clinical remission in severe eosinophilic asthma; the role of different biologics in inducing remission; safety and feasibility of ICS and biologic de-escalation after remission; and clinical and biological predictors of sustained remission and successful step-down. Biologics such as anti-IgE, anti-IL-5/5Rα, anti-IL-4Rα and anti-thymic stromal lymphopoietin (TSLP) markedly reduce exacerbations, OCS use and, in a substantial minority of patients, induce clinical or "deep" remission on-treatment. Prospective randomized controlled trials and real-world data (e.g. SHAMAL and registry studies) indicate that structured, physician-guided ICS reduction is feasible for many patients without loss of control, whereas abrupt or unsupervised reduction is associated with worse outcomes. Evidence on biologic withdrawal is more heterogeneous: discontinuation of mepolizumab, tezepelumab or omalizumab frequently leads to loss of control, although a subset maintains remission off-treatment. Favorable predictors of remission and tolerability of de-escalation include fewer prior exacerbations, lower chronic OCS exposure, shorter disease duration, better preserved FEV1 and effective suppression of T2 biomarkers. Within the context of severe eosinophilic asthma remission, de-escalation of therapy may follow a cautious, hierarchical, clinician-led strategy prioritizing OCS, then ICS, and only subsequently biologics, with predefined failure criteria and shared decision-making. This proposed pathway is presented as a pragmatic synthesis of the available evidence and should be interpreted as expert opinion rather than formal guideline recommendations. Robust, standardized definitions and validated predictors are still needed to safely expand off-treatment remission to a larger proportion of patients.

Background/Objectives: Chronic Obstructive Pulmonary Disease (COPD) is frequently associated with dyspnea, impaired health-related quality of life (HRQoL), and cognitive dysfunction. Although pulmonary rehabilitation (PR) is considered a core therapeutic strategy, its specific effects on cognitive function, dyspnea, and dysphonia remain unclear. This systematic review aimed to evaluate the impact of PR and respiratory or cognitive-focused rehabilitative interventions on dyspnea, quality of life, cognitive performance, and voice outcomes in adults with COPD. Methods: This review was conducted in accordance with PRISMA 2020 guidelines and registered in PROSPERO (CRD420251131325). A systematic search of PubMed, Scopus and Web of Science identified studies published between 2010 and 21 August 2025. Eligible designs included randomized and non-randomized controlled studies, cohort, and mixed-method studies involving adults with COPD undergoing rehabilitative interventions targeting dyspnea, cognition, dysphonia, or swallowing. Outcomes included cognitive measures, dyspnea scales, voice parameters, and HRQoL indices. Results: Twelve studies (n ≈ 810 participants) met inclusion criteria. Most PR and exercise-based programs showed improvements in global cognition and executive functions, particularly when combined with cognitive training or high-intensity exercise modalities. Dyspnea improved consistently following short- to medium-term PR or respiratory muscle training, whereas low-frequency long-term programs yielded limited benefit. HRQoL improved across structured PR programs, especially in multidimensional interventions. Only one study assessed dysphonia, reporting transient improvements in maximum phonation time following inspiratory muscle training. No included study evaluated dysphagia-related outcomes. Conclusions: PR and respiratory muscle training can enhance cognition, dyspnea, and HRQoL in COPD, although evidence for dysphonia remains scarce and dysphagia is entirely unaddressed. Future high-quality trials should adopt standardized outcome measures, include long-term follow-up, and integrate voice and swallowing assessments within PR pathways.

INTRODUCTION:The management of severe asthma has shifted toward precision medicine, with clinical remission emerging as the ultimate therapeutic goal. This review evaluates the transition from predicting treatment response to achieving sustained remission through biologics. AREAS COVERED:A comprehensive literature search was conducted in PubMed and Embase for articles published between January 2015 and February 2026. Keywords included 'severe asthma,' 'biologic therapies,' 'clinical remission,' and 'T2 biomarkers.' We analyze the predictive value of blood eosinophils (BEC), FeNO, and emerging indicators like CT-based mucus plugs. The review synthesizes data on 'super-responders' and the integration of real-world evidence into clinical practice. EXPERT OPINION:Achieving clinical remission requires a multidimensional assessment beyond symptom control, including lung function stability and OCS elimination. Future management will likely focus on 'disease modification' and early biologic intervention. The identification of specific phenotypes, such as those with high mucus-plug burdens, will allow for more tailored therapy. However, standardized criteria for 'remission off-treatment' remain the primary challenge for the next decade of respiratory research.

Background/objectivesChronic respiratory diseases represent a major cause of morbidity/mortality and healthcare expenditure due to disease exacerbations, emergency department (ED) presentations, hospitalizations, and length of stay (LOS). This systematic review primarily aimed to evaluate the impact on the healthcare system of telenursing vs. traditional nursing care in the management of adults (≥18 years) with chronic respiratory diseases; secondarily, on treatment adherence, acceptability, and satisfaction.MethodsElectronic (PubMed, Scopus, Web of Science) and manual searches were performed until April 6, 2025, following PRISMA statement (PROSPERO CRD420251175395). Data were qualitatively synthesized; studies included were judged using dedicated tools.Results39 studies including 4,340 patients (2,731 telenursing vs. 1,609 comparison), 3,231 with COPD and 888 with asthma, were included. Telenursing reduced exacerbation rates per patient: means 1.2 in telenursing vs. 0.9 in the comparison group at six months and 2.1 vs. 5.8 at twelve months. ED presentations remained similar (1.2 at twelve months in both groups). Hospital admissions were lower with telenursing (0.65 vs. 0.8 at six months; 0.7 vs. 1.25 at twelve months). LOS showed minimal differences (5.2 vs. 5.7 days at six months; 9.1 vs. 9.2 days at twelve months).ConclusionsTelenursing potentially slightly unburdens healthcare systems, reducing exacerbation and hospitalization rates, but did not shorten LOS once patients required inpatient care. This lack of consistency across all outcomes may suggest that telenursing may have a prevention/early detection role for clinical exacerbations, but may have limited influence on the clinical course once hospitalization becomes necessary. Further studies with standardized assessment methods are needed to evaluate treatment adherence, acceptability, and satisfaction.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420251175395, PROSPERO CRD420251175395.

Angelantonio Maglio,1 Carolina Vitale,1 Luisa Oriana D’Auria,1 Valeria Longobardi,1 Antonio Franzese,1 Corrado Pelaia,2 Girolamo Pelaia,2 Cecilia Calabrese,3 Alessandro Vatrella11Department of Medicine, Surgery, and Dentistry "Scuola Medica Salernitana”, University of Salerno, Salerno, Italy; 2Department of Medical and Surgical Sciences, University "Magna Graecia” of Catanzaro, Catanzaro, Italy; 3Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, ItalyCorrespondence: Alessandro Vatrella, Department of Medicine, Surgery, and Dentistry "Scuola Medica Salernitana”, University of Salerno, Salerno, Italy, Email avatrella@unisa.itAbstract: Severe eosinophilic asthma (SEA) is a type-2 inflammatory phenotype driven by persistent eosinophilia, characterized by frequent exacerbations, progressive lung function decline, and substantial oral corticosteroid (OCS) dependence, for which conventional therapies remain insufficient in a significant minority of patients. Benralizumab—a humanized, afucosylated anti-interleukin-5 receptor alpha (IL-5Rα) monoclonal antibody—achieves near-complete depletion of eosinophils and basophils through dual receptor blockade and afucosylation-enhanced antibody-dependent cell-mediated cytotoxicity (ADCC), producing one of the most extensive anti-eosinophilic effects among currently approved biologics. Pivotal Phase 3 trials (SIROCCO, CALIMA, ZONDA) demonstrated annual exacerbation rate reductions of up to 51%, robust OCS-sparing with complete elimination in 52.7% of OCS-dependent patients, and significant improvements in forced expiratory volume in 1 second (FEV1). Long-term extension data over five years (MELTEMI) confirmed sustained efficacy and safety, without evidence of adverse consequences attributable to chronic eosinophil depletion. Landmark studies including PONENTE, SHAMAL, and ABRA have further extended benralizumab’s clinical impact: enabling structured OCS elimination, demonstrating that well-controlled patients can reduce inhaled corticosteroids to as-needed therapy, and establishing biologic-based treatment of acute eosinophilic exacerbations as a viable new approach. Real-world evidence consistently corroborates trial findings, with clinical remission—defined as the composite achievement of exacerbation freedom, OCS independence, symptom control, and preserved lung function—reported in 17– 44% of patients at 12 months and up to 91% in selected longer-term cohorts. Beyond asthma, benralizumab demonstrates meaningful activity in comorbid chronic rhinosinusitis with nasal polyps, eosinophilic granulomatosis with polyangiitis, and eosinophilic esophagitis. This review comprehensively examines benralizumab’s molecular pharmacology, pivotal and real-world clinical evidence, comorbidity management, and its central role in driving the paradigm shift from symptom control toward clinical remission in severe eosinophilic airway disease.Keywords: severe eosinophilic asthma, IL-5 receptor alpha, clinical remission, oral corticosteroid sparing, type-2 inflammation, biologic therapy

INTRODUCTION:Sex influences asthma phenotypes and treatment outcomes. However, real-world data on sex-related differences in severe asthma patients treated with biologics are limited. The objective of this study was to assess sex differences in baseline characteristics and treatment outcomes in a cohort of severe eosinophilic asthma (SEA) patients treated with biologics. METHODS:We retrospectively analyzed 370 SEA patients (235 females, 135 males) treated with mepolizumab, benralizumab, or dupilumab. Clinical remission was defined as no OCS use plus at least two of: no exacerbations, ACT ≥20, or FEV1 >80%. Logistic regression was used to identify sex-specific predictors of remission at 24 months. RESULTS:Severe type 2 asthma showed a prevalence in females (female-to-male ratio of 1.7:1). Baseline characteristics revealed higher prevalence of obesity (p = 0.015) and osteoporosis (p = 0.006) in females, and greater tobacco exposure (p = 0.05), FeNO (p = 0.03), and nasal polyposis (p = 0.0002) in males. Males had greater reduction in FeNO (p ≤ 0.05) and more male patients stopped exacerbations at 24 months (p < 0.0001), while females showed greater FEF25-75% (p ≤ 0.05) improvement and larger IgE drops (p < 0.0001). Remission rates were similar across sexes at both 12 months (64.3% versus 74.1%; p = 0.06) and 24 months (71.5% versus 77.0%; p = 0.27). In females, remission was associated with eosinophils >300/μL (OR: 2.68; 95% CI: 1.41-5.07; p = 0.003), FeNO >50 ppb (OR: 21.05; 95% CI: 10.24-43.34; p < 0.0001), and nasal polyposis (OR: 2.74; 95% CI: 1.46-5.13; p = 0.001); obesity (OR: 0.20; 95% CI: 0.11-0.37; p < 0.0001), smoking (OR: 0.38; 95% CI: 0.21-0.70; p = 0.002), anxiety (OR: 0.47; 95% CI: 0.23-0.94; p = 0.04), and reflux (OR: 0.47; 95% CI: 0.27-0.84; p = 0.01) were negative predictors. In males, OCS dependency (OR: 0.35; 95% CI: 0.13-0.94; p = 0.03) and FEV1 <80% (OR: 0.18; 95% CI: 0.05-0.63; p = 0.004) were negative predictors. CONCLUSION:Biologics were equally effective in inducing clinical remission across sexes, but different predictors influenced outcomes. Sex-aware strategies may support personalized asthma care.

Single-inhaler triple therapy with fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) is recommended for patients with chronic obstructive pulmonary disease (COPD) who remain symptomatic or experience exacerbations despite dual bronchodilation. However, real-world evidence on its ability to achieve multidimensional “disease stability”, integrating symptoms, lung function, and exacerbation outcomes, remains limited. The aim of our study was therefore to evaluate, in a real-world cohort of exacerbating patients with COPD, the effects of once-daily FF/UMEC/VI on lung function, respiratory symptoms, health status, and exacerbation rates over 12 months. This retrospective single-center study included 86 adults with COPD treated with FF/UMEC/VI 92/55/22 µg at the Respiratory Unit of “Magna Graecia” University Hospital (Catanzaro, Italy). Lung function tests (forced expiratory volume in the first second, FEV1; forced vital capacity, FVC; forced mid-expiratory flow between 25

BACKGROUND:Severe asthma is characterized by impaired lung function and elevated cardiovascular risk. Type 2 inflammation, primarily mediated by IL-4 and IL-13, contributes to both airway and cardiac remodeling. Dupilumab, an IL-4Rα antagonist, has shown efficacy in improving respiratory outcomes; however, its impact on cardiac function remains insufficiently studied. OBJECTIVE:To assess the 12-month effects of dupilumab on echocardiographic parameters and evaluate its potential association with clinical remission in patients with severe type 2 asthma. METHODS:This single-centre observational study enrolled 24 patients with severe type 2 asthma receiving dupilumab. Echocardiographic assessments and lung function tests were conducted at baseline and after 12 months. Clinical remission was defined by meeting all of the following: zero exacerbations, zero OCS use, ACT score ≥20, and pre-bronchodilator FEV1 ≥ 80 % predicted. RESULTS:Twelve-month dupilumab therapy led to significant improvements in both cardiac and respiratory parameters. LV-GLS improved from -17.00 % to -19.00 % and RV-GLS from -17.33 % to -19.11 % (both p < 0.0001). TAPSE and TAPSE/S-PAP ratio also increased significantly (p < 0.0001). Lung function showed notable gains in FEV1 and FEF25-75, alongside reductions in residual volume and airway resistance. Clinical remission was achieved by 45.83 % of patients. Baseline LV-GLS emerged as a strong predictor of remission (AUC = 0.832), unlike RV-GLS (AUC = 0.545). CONCLUSIONS:Dupilumab markedly improved cardiac and pulmonary function and may promote clinical remission. Baseline LV-GLS may serve as a predictive marker, supporting cardiovascular assessment in asthma management.

BACKGROUND:Airway eosinophilic inflammation is a key pathobiologic trait of severe asthma, a complex chronic disease which affects about 5-10% of asthmatic patients worldwide. Therefore, an in-depth knowledge of the immunopathologic mechanisms underlying severe eosinophilic asthma (SEA) is essential to understand the beneficial effects of currently available, eosinophil-targeted anti-asthma treatments, as well as to develop new therapeutic strategies. AREAS COVERED:This narrative review article aims to provide a concise coverage of the pathophysiology of severe eosinophilic asthma, followed by an updated overview of current and newly emerging therapeutic approaches capable of counteracting airway eosinophilic inflammation. All information reported comes from an extensive literature search conducted on PubMed. EXPERT OPINION:The recent advances regarding our understanding of the proinflammatory pathways characterizing the various SEA endotypes are allowing to shape effective therapeutic options, driven by the accurate selection of relevant molecular targets. Such successful developments are at the basis of the sustained clinical remission of eosinophilic asthma, which today represents a realistic goal for many severe asthmatic patients.

Abstract Background Despite the availability of numerous guidelines for asthma management, their recommendations are not consistently implemented in clinical practice. This discrepancy between guidelines and real‐world practice among Italian healthcare professionals was explored during the “Revolution in Asthma” training program, which identified “gray areas” and barriers preventing clinicians from adopting guideline‐based approaches. Objective This study aims to analyze the key challenges in asthma management and provide evidence‐based solutions to improve adherence to guidelines in clinical practice. Methods A group of experts from the Scientific Committee of the Revolution in Asthma project reviewed the program's findings, focusing on three main areas of asthma management: diagnosis, control, and treatment. The experts summarized clinicians' main needs and questions for each area and provided evidence‐based responses and practical recommendations. Results The study highlights critical challenges in asthma treatment, addressing two key questions: (a) What are the possible uses and indications for short‐acting β‐agonists in asthma patients? (b) How should asthma treatment be initiated and adjusted based on asthma control? The expert panel developed practical, operational tools to support general practitioners and specialists (pulmonologists and allergists) in optimizing asthma management. Conclusion This paper serves as a knowledge co‐creation initiative, bridging the gap between clinical guidelines and daily practice. By offering concrete recommendations, it aims to enhance the application of guideline‐based asthma management among healthcare professionals.

BACKGROUND:Tezepelumab is a fully human monoclonal antibody which specifically binds to thymic stromal lymphopoietin (TSLP), thus effectively inhibiting its pleiotropic pathogenic actions. Tezepelumab has been licensed for add-on biologic therapy of severe asthma, regardless of biomarker levels or phenotype expression. OBJECTIVE:The aim of this real-life, retrospective, single-centre investigation has been to evaluate the therapeutic efficacy of tezepelumab in different phenotypes of severe asthma. METHODS:At baseline and after 4 weeks of add-on therapy with tezepelumab, several clinical, functional and biologic parameters were assessed in 30 patients with either T2-high or T2-low severe asthma, who had been or not previously treated with other biologics. RESULTS:After 4 weeks of treatment, tezepelumab induced significant improvements in symptom control (ACT score), asthma-related quality of life (AQLQ score), oral corticosteroid intake, and lung function (FEV1, FEF25-75, Rtot). Tezepelumab also significantly decreased the levels of fractional exhaled nitric oxide (FeNO) and blood basophil count. Moreover, tezepelumab significantly lowered the serum concentrations of interleukin-2 (IL-2) and vascular endothelial growth factor (VEGF). The above clinical, functional, and biologic effects of tezepelumab were observed in both T2-high and T2-low severe asthmatic patients, as well as in subjects with or without previous therapeutic experiences based on the use of other biologics. CONCLUSIONS:The results of this real-world study suggest that tezepelumab can be used, in both T2-high and T2-low severe asthmatic patients, as a valuable add-on biologic drug characterized by a very fast onset of action.

Moderate–severe asthma affects a significant proportion of patients and poses challenges in symptom control and exacerbation prevention. The preferred track 1 endorsed by the Global Initiative for Asthma (GINA) recommendations offers a single-inhaler approach combining inhaled corticosteroids and formoterol for both maintenance and symptom relief (maintenance and reliever therapy; MART). However, MART’s real-world adoption remains suboptimal and concerns regarding its correct implementation persist. “What About MART Posology” (WAMP) survey assessed the knowledge and clinical application of MART among Italian healthcare professionals (HCPs) and patients. WAMP was a cross-sectional, web-based survey conducted among 1000 Italian HCPs and 400 patients with moderate–severe asthma. HCPs answered questions regarding treatment preferences, adherence to GINA recommendations and MART implementation. Patients reported on their therapeutic regimens, inhaler use, and adherence behaviors. Most HCPs demonstrated awareness of GINA recommendations. Pulmonologists (73.6

Background: Uncontrolled asthma remains a significant clinical challenge, often linked to impaired lung function and increased diaphragmatic workload. Recent studies have shown promising results using a triple inhaled therapy comprising beclomethasone dipropionate/formoterol fumarate/glycopyrronium (BDP/FF/G). This study assessed the real-world efficacy of BDP/FF/G on lung function and diaphragmatic workload in patients with uncontrolled asthma. Methods: A prospective observational study enrolled 21 adult patients diagnosed with uncontrolled asthma despite high-dose ICS/LABA therapy. Patients underwent lung function tests and right diaphragmatic ultrasound assessments at baseline and after three months of treatment with BDP/FF/G (172/5/9 mcg, administered as two inhalations every 12 h). Results: After three months, significant improvements were observed in FEV1 (from 57.75 ± 12.30% to 75.10 ± 18.94%, p < 0.001) and FEF25–75 (from 47.80 ± 19.23% to 75.10 ± 36.06%, p < 0.001). Additionally, during the same period, we recorded significant reductions in residual volume (from 130.10 ± 28.20% to 92.55 ± 21.18%, p < 0.001) and total airway resistance (Rtot) (from 164.60 ± 83.21% to 140.70 ± 83.25%, p < 0.05). The mean asthma control test (ACT) score increased by 5.6 points (p < 0.001), surpassing the established minimal clinically important difference (MCID) of 3 points and raising the cohort mean above the well-controlled threshold. The right diaphragmatic workload was significantly decreased, as shown by a reduction in thickening fraction (TF) (from 63.86 ± 17.67% to 40.29 ± 16.65%, p < 0.01). Correlation analysis indicated significant associations between diaphragmatic function and some lung function parameters (FEV1, FEF25–75, and Rtot). Conclusions: In this real-world pilot, triple BDP/FF/G was linked to improvements in airflow, hyperinflation, symptoms, and a reduction in diaphragmatic thickening fraction, indicating potential physiological benefit. Due to the small sample size, single-centre design, and 3-month follow-up, these results should be viewed as hypothesis-generating and need to be confirmed in larger, controlled, multicentre studies with longer follow-up.

Asthma is a highly heterogeneous respiratory disease that, in its severe forms, is characterized by persistent symptoms, frequent exacerbations, and a significant impact on patients’ quality of life. Despite high-dose inhaled corticosteroids and long-acting bronchodilators, a subset of patients remains uncontrolled, necessitating advanced therapeutic strategies. The advent of biologic therapies has revolutionized the management of severe asthma, offering targeted interventions based on the underlying inflammatory endotypes, primarily T2-high and T2-low. However, selecting the most appropriate biologic remains challenging due to overlapping phenotypic features and the limited availability of validated biomarkers. This narrative review explores the clinical utility of key biomarkers, including blood eosinophils, fractional exhaled nitric oxide (FeNO), periostin, and total and specific IgE, in guiding biologic therapy. All the information provided is based on an extensive literature search conducted on PubMed. We also examine the clinical characteristics and comorbidities that influence therapeutic choices. Furthermore, we present a practical decision-making platform, including a clinical table matching phenotypes with biologic agents, such as omalizumab, mepolizumab, benralizumab, dupilumab, and tezepelumab. By integrating biomarker analysis with clinical assessment, based on current guidelines and our extensive real-life experience, we aim to offer a logical framework to help clinicians select the most suitable biologic treatment for patients with uncontrolled severe asthma. Future research should focus on identifying novel biomarkers, refining patient stratification, and evaluating long-term outcomes to further advance precision medicine in the management of severe asthma.