The treatment of severe uncontrolled asthma using biologics

The numbers of deaths due to asthma have decreased because of the development of inhaled corticosteroid (ICS) treatment. However, about 5% of patients with asthma are still difficult to control with ICS treatment. In severe uncontrolled asthma, the balance between type 2 inflammation and non-type 2 inflammation is assumed to be different. Asthma can be said to be a heterogeneous disease; however, several biologics have recently been developed for use in severe uncontrolled asthma. Omalizumab, mepolizumab, reslizumab, benralizumab, and dupilumab, targeting type 2 inflammation, have been approved for use worldwide. Severe uncontrolled asthma is heterogeneous, and it is becoming necessary to classify phenotype and endotype for individual patients to determine treatment options. This review will explain treatment options for severe uncontrolled asthma, with a focus on biologics.