Severe asthma causes a high disease burden despite modern treatment

In the new study, the researchers analysed data from 13,455 adults with severe asthma in 22 European countries. The patients were included in the European SHARP registry. The researchers examined factors including lung function, asthma control, exacerbations, use of oral corticosteroids and biological markers of inflammation.

Although 79 percent of the patients were treated with biologic therapies, many still showed signs of active disease. Among patients for whom all four disease domains studied could be assessed, 89 percent had at least one active domain and more than two-thirds had at least two. Impaired airflow was also common: 62 percent had lung function, measured as FEV1, below 80 percent of the predicted value. Comorbidities were also common among many patients.

“Results show that biologic therapies have become an important part of the treatment of severe asthma, but also that many patients still have a significant disease burden. It is therefore not enough to look only at inflammatory markers. We also need to monitor symptoms from an early stage, exacerbations, lung function and comorbidities, often related to corticosteroid use, which we must aim to eliminate,” says Apostolos Bossios, Associate Professor at the Institute of Environmental Medicine, Karolinska Institutet, and Senior Consultant in Pulmonary Medicine at Karolinska University Hospital.

The researchers also identified a group of patients who were not yet receiving biologic therapies and whose disease burden had increased rapidly. In 35 percent of these patients, several signs of active disease had accumulated within less than ten years – an alarming finding.

“This suggests that there may be an important window of opportunity in which we need to identify high-risk patients earlier and initiate the appropriate treatment before more permanent changes in the airways have had time to develop,” says Apostolos Bossios.

The study is observational and therefore cannot establish that a particular treatment causes the patterns observed by the researchers. The researchers emphasise that the findings need to be followed up in longitudinal studies in which patients are monitored over time.

Publication

Severe asthma and remission prospects in Europe (SHARP): insights from a multicentre observational study based on the European Severe Asthma Registry.
Fouka E, Bansal AT, Håkansson KEJ, Jaun F, Louis R, Hanon S, Brusselle G, Ziant S, Paulus V, Popović-Grle S, Pavlisa G, Lampalo M, Vergles M, Kasap EB, Sedlak V, Søndergaard M, Hansen S, Sergejeva S, Perotin JM, Taillé C, Devouassoux G, Giboin C, Klising E, Estellat C, Metdaoui D, Hamelmann E, Samitas K, Porpodis K, Zervas E, Gaga M, Csoma Z, Horvath I, Lúdvíksdóttir D, Sigurdardóttir KD, Canonica GW, Heffler E, Cardini C, Alloni A, Kroiča I, Matisa D, Bieksiene K, Palacionyte J, Christian N, Tching R, Boudewijn I, Sont JK, Hashimoto S, Kuna P, Morawska M, Loureiro CC, Fonseca JA, Canhoto D, Santos H, Mendes A, Belchior I, Lopes C, Mihaltan F, Hromis S, Stjepanovic M, Cupurdija V, Tomic-Spiric V, Skrgat S, Kopac P, Ramos-Barbon D, Pérez de Llano L, Garcia VL, Morenos Martos D, Dahlén B, Yasinska V, Tenselius O, Janson C, Egesten A, Richter J, Emilsson ÖI, Leuppi J, Gemicioglu B, Celik G, Damadoglu E, Goksel O, Heaney L, Busby J, Redmond C, Masoli M, Chaudhuri R, Dennison P, Doe S, Kurukulaaratchy R, Bel E, Djukanovic R, Bourdin A, Ten Brinke A, Schleich F, Porsbjerg C, Bossios A. 
Lancet Respir Med. 2026 Aug;14(8):659-672. doi: 10.1016/S2213-2600(26)00141-4. PMID: 42341792