Breaking Update: Here’s a clear explanation of the latest developments related to Breaking News:Respiratory Biologics Underused in High-BMI Asthma– What Just Happened and why it matters right now.
RESPIRATORY biologics were prescribed to few eligible adults with asthma and obesity, yet reduced exacerbations significantly.
Respiratory Biologics Prescribing Remains Low
Patients with asthma and elevated BMI have higher baseline exacerbation risk and greater vulnerability to corticosteroid adverse effects. In a retrospective observational analysis of electronic health records from a large U.S. health system spanning 2018–2023, investigators assessed adult patients with active, moderate-to-severe asthma and BMI ≥25 kg/m² who met FDA-specified eligibility criteria for respiratory biologics. The primary outcomes were whether a respiratory biologic was prescribed and the time from eligibility to prescription, with secondary outcomes examining exacerbation changes and factors associated with prescribing.
Among 5,805 biologic-eligible patients with asthma and overweight or obesity, only 11.9% were prescribed respiratory biologics. Most eligible patients had obesity, comprising 59.8% of the cohort, and prescribing was even lower in this group, with 10.4% receiving a biologic. In adjusted analyses, obesity was associated with reduced odds of prescription and a longer time to initiation, indicating that higher BMI may be linked to delays or barriers to respiratory biologics even when patients meet T2 biomarker criteria.
Respiratory Biologics Prescription Predictors
Subspecialist care emerged as the strongest predictor of respiratory biologics prescription. This finding suggests that referral patterns, access to biomarker-driven evaluation, and specialty management may be central to whether eligible patients receive advanced asthma therapies. The results also point toward a potential role for health system processes, including how asthma severity and eligibility are recognized, documented, and acted upon within routine care.
Outcomes in Obesity and a Biomarker Question
For patients with obesity who were prescribed T2-directed respiratory biologics, annualized exacerbation rates significantly declined across users, supporting real-world effectiveness even at higher BMI. The study also explored obesity-adjusted eosinophil criteria using a threshold of ≥96 cells/µL. Applying this obesity-adjusted approach expanded biologic eligibility by 11.3%, but exploratory analyses did not show a clear exacerbation benefit from the additional eligibility it created. Together, the findings suggest two parallel needs: improving equitable access to respiratory biologics for patients already meeting standard biomarker criteria, and clarifying how best to interpret biomarkers such as eosinophils in obesity-associated asthma to guide prescribing without diluting expected clinical benefit.
Reference: Foer D et al. Respiratory biologics utilization, prescription predictors, and outcomes in patients with asthma and comorbid overweight or obesity. J Allergy Clin Immunol Pract. 2026;doi:10.1016/j.jaip.2026.02.021.
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