Guideline in Focus
Biologic Management in Severe Asthma for Adults

Biologic agents have become a standard of care in patients unresponsive to usual treatments, yet the choice of biologic agent is complex. This guideline examines the literature related to choice of biologic agent in patients with severe asthma and consists of seven evidence-based recommendations to optimize their use.

PUBLISHED September 24, 2025

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Key Recommendations

In adult patients with severe allergic asthma and ≥ one exacerbation per year, we suggest either omalizumab or dupilumab.

In adult patients with severe asthma who are steroid dependent, we suggest either anti-IL-5/5Ra or dupilumab.

In adult patients with severe asthma who have not demonstrated a clinical response to anti-IL-5/5Ra therapy after four to six months, we suggest either dupilumab or tezepelumab.


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5%-10%
Individuals with asthma
classified as severe
≥ 300 cells/µL
Absolute eosinophil count in T2-high asthma
4-6 months
Treatment period to determine good clinical response to biologics

Implement this guideline into practice

Our guidelines are aimed at helping you respond to today’s clinical challenges and improve patient health outcomes. Our panel of experts has developed multimedia content to facilitate adoption of this guideline into your day-to-day practice.


PRESS RELEASE

CHEST Releases Guideline on Biologic Management in Severe Asthma
In a release issued to the media, lead author Amber J. Oberle, MD, speaks to the importance of this guideline in practice.

2 MINUTE READ

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