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Severe Asthma Management in the Era of Biologics: Insights of the Italian Registry on Severe Asthma (IRSA).

Summary
Background.The Italian Registry on Severe Asthma (IRSA) is the most recent and largest registry in Italy. Objective. To improve the knowledge on the clinical and biological features of severe asthma (SA), and to monitor its treatments. Methods. To analyze clinical, functional, inflammatory, and treatment characteristics of severe asthmatics from the IRSA registry. Results. 851 subjects were enrolled. 31.8% and 64.5% of patients were submitted to oral corticosteroids (OCS), and monoclonal antibodies (MABs), respectively. At least two comorbidities affected 77.4% patients. Asthma was uncontrolled in 62.2% patients. Uncontrolled patients had a higher frequency of exacerbations, and hospitalization, showing a higher eosinophilic phenotype, a greater use of OCS, and being treated with MAB less frequently. However, uncontrolled patients treated with MAB had a lower use of OCS and a lower rate of hospitalization. Comparing SA patients with atopy and without atopy, the latter showed a greater use of OCS, and more frequent nasal polyposis and osteoporosis. Among SA patients with atopy treated with MAB, 36% were on a treatment targeting the IL-5 pathway. Conclusions and clinical relevance. This study shows the features of the greatest Italian registry of SA patients, revealing at the time of enrollment a poor disease control, and the use of OCS and MABs in about one third and two thirds of patients, respectively. SA is a complex disease that requires a more precise phenotyping and a greater disease control.