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Asthma Phenotypes and Biological Therapy Selection

A biologic agent selection algorithm for severe asthma subtypes

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Göğüs Hastalıkları department. Book Appointment →

What is Asthma Phenotypes and Biological Therapy Selection?

Approximately 5-10% of patients with severe asthma do not achieve adequate control with standard inhaler therapy. In these patients biomarkers (blood eosinophil count, serum IgE, FeNO) are used to determine the asthma phenotype and guide selection of an appropriate biologic agent.

Available biologic agents include anti-IgE (omalizumab), anti-IL-5/IL-5R (mepolizumab, benralizumab), anti-IL-4Rα (dupilumab), and anti-TSLP (tezepelumab). Each has a distinct biomarker profile and mechanism of action.

Symptoms

Asthma uncontrolled despite high-dose ICS plus LABA
At least two exacerbations per year or attacks requiring oral corticosteroids
Persistent airway obstruction (FEV1 <80%)
Oral corticosteroid dependence
Marked impairment of quality of life

Risk Factors

Eosinophilic phenotype (blood eosinophils ≥150/µL)
Allergic phenotype (high IgE plus allergen sensitization)
Early-onset allergic asthma (omalizumab candidate)
Coexisting nasal polyposis (dupilumab candidate)
Refractoriness across phenotypes (tezepelumab)

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Persistent lack of control despite high-dose ICS/LABA
  • Two or more severe exacerbations per year
  • Development of oral corticosteroid dependence
  • When biomarker profile assessment is required

Treatment Methods

01
Eosinophilic asthma (eos ≥300): mepolizumab, benralizumab, or dupilumab
02
Allergic asthma (high IgE): omalizumab
03
Eosinophilic plus allergic phenotype: dupilumab
04
Across phenotypes: tezepelumab (anti-TSLP)
05
Treatment-response evaluation at 4-6 months
06
Tapering of oral corticosteroids on biologic therapy

Which Department to Visit?

You can visit our Göğüs Hastalıkları department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

Learn About Göğüs Hastalıkları Department

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.