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New Clinical Advances in Chronic Asthma
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New Clinical Advances in Chronic Asthma

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Respiratory Medicine".

Deadline for manuscript submissions: 20 November 2025 | Viewed by 6633

Special Issue Editor

Dr. Vitaliano Nicola Quaranta

E-Mail Website
Guest Editor
Department of Basic Medical Sciences, Neuroscience and Sense Organs, Section of Respiratory Disease, University “Aldo Moro” of Bari, 70121 Bari, Italy
Interests: asthma; chronic obstructive pulmonary disease; pneumonia; bronchitis; respiratory insufficiency; snoring; tuberculosis; pulmonary mycobacteriosis; chronic respiratory insufficiency
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Chronic asthma is a multifaceted inflammatory disorder of the airways characterized by recurrent symptoms such as wheezing, breathlessness, and coughing. The landscape of asthma management has significantly evolved, with recent advances focusing on personalized treatment strategies, novel biologic therapies, and the concept of asthma remission.

Asthma management has traditionally aimed at symptom control and prevention of exacerbations through the use of inhaled corticosteroids (ICS) and long-acting beta-agonists (LABAs). However, a deeper understanding of asthma's heterogeneity has led to more refined, phenotype-driven approaches, with a growing emphasis on disease modification and remission.

The future of asthma management lies in the continued refinement of personalized treatment approaches, particularly through the use of new biologics targeting alarmins and other novel pathways. Research is ongoing to identify additional biomarkers and therapeutic targets, which will enable even more precise and effective treatments. Ultimately, the goal is to shift the focus from merely controlling asthma to potentially curing it through sustained remission.

This Special Issue on chronic asthma gives updates on current clinical research developments. Original research articles and reviews are welcome.

Dr. Vitaliano Nicola Quaranta
Guest Editor

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Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • chronic asthma
  • breathlessness
  • coughing
  • inhaled corticosteroids (ICS)
  • long-acting beta-agonists (LABAs)
  • personalized treatment
  • chronic rhinosinusitis
  • nasal polyps
  • bronchiectasis
  • endotypes
  • oral corticosteroids

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Published Papers (5 papers)

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Research

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23 pages, 4250 KB  
Article
Too Much SAMA, Too Many Exacerbations: A Call for Caution in Asthma
by Fernando M. Navarro Ros and José David Maya Viejo
J. Clin. Med. 2025, 14(14), 5046; https://doi.org/10.3390/jcm14145046 - 16 Jul 2025
Viewed by 1118
Abstract
Background/Objectives: The overuse of short-acting β2-agonists (SABAs) has been associated with increased asthma morbidity and mortality, prompting changes in treatment guidelines. However, the role of frequent short-acting muscarinic antagonists (SAMAs) use remains poorly defined and unaddressed in current recommendations. This study [...] Read more.
Background/Objectives: The overuse of short-acting β2-agonists (SABAs) has been associated with increased asthma morbidity and mortality, prompting changes in treatment guidelines. However, the role of frequent short-acting muscarinic antagonists (SAMAs) use remains poorly defined and unaddressed in current recommendations. This study offers the first real-world analysis of SAMA overuse in asthma, quantifying its association with exacerbation risk and healthcare utilization and comparing its predictive value to that of SABAs. Methods: A retrospective multicenter cohort study analyzed electronic health records (EHRs) from 132 adults with asthma in the Spanish National Health System (SNS). Associations between annual SAMA use and clinical outcomes were assessed using negative binomial regression and 5000-sample bootstrap simulations. Interaction and threshold models were applied to explore how SAMA use affected outcomes and identify clinically actionable cutoffs. Results: SAMA use was independently associated with a 19.2% increase in exacerbation frequency per canister and a nearly sixfold increase in the odds of experiencing ≥1 exacerbation (OR = 5.97; 95% CI: 2.43–14.66). An inflection point at 2.5 canisters/year marked the threshold beyond which annual exacerbations exceeded one. Increased SAMA use was also associated with a higher number of respiratory consultations and with more frequent prescriptions of systemic corticosteroids and antibiotics. The risk increased more sharply with SAMAs than with SABAs, and the lack of correlation between them suggests distinct clinical patterns underlying their use. Conclusions: SAMA use emerges as a digitally traceable and clinically meaningful indicator of asthma instability. While the associations observed are robust and consistent across multiple outcomes, they should be considered provisional due to the study’s retrospective design and limited sample size. Replication in larger and more diverse cohorts is needed to confirm external validity. These findings support the integration of SAMA tracking into asthma management tools—alongside SABAs—to enable the earlier identification of uncontrolled disease and guide therapeutic adjustment. Full article
(This article belongs to the Special Issue New Clinical Advances in Chronic Asthma)
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19 pages, 2216 KB  
Article
Long-Term Clinical Remission on Benralizumab Treatment in Severe Eosinophilic Asthma: A Four-Year Real-Life Study
by Carla Maria Irene Quarato, Pasquale Tondo, Donato Lacedonia, Piera Soccio, Dalila Pescatore, Maria Lisa Baccellieri, Giorgia Lepore, Maria Pia Foschino Barbaro and Giulia Scioscia
J. Clin. Med. 2025, 14(6), 2075; https://doi.org/10.3390/jcm14062075 - 18 Mar 2025
Viewed by 1516
Abstract
Background: The current availability of monoclonal antibodies against key mediators of type-2 (T2) inflammation has led to a redefinition of the ultimate objectives of severe asthma treatment to a more composite concept of disease remission. Objectives: The aim of this real-life study was [...] Read more.
Background: The current availability of monoclonal antibodies against key mediators of type-2 (T2) inflammation has led to a redefinition of the ultimate objectives of severe asthma treatment to a more composite concept of disease remission. Objectives: The aim of this real-life study was to estimate the percentage of patients who achieved clinical remission over 4 years of treatment with benralizumab, and to identify baseline predictors for the achievement of such a composite outcome in the long term. Methods: Data from a 4-year follow-up of 23 patients who were prescribed benralizumab as an add-on therapy because of uncontrolled severe eosinophilic asthma were retrospectively analyzed and compared. Clinical remission was considered to be “complete” if oral corticosteroid (OCS) use was not required, there were no exacerbations, an asthma control test (ACT) score ≥ 20 was achieved and a pre-bronchodilation percent predicted a forced expiratory volume in 1 s (FEV1%) ≥ 80%. Clinical remission was considered to be “partial” if OCS use was not required, plus at least two of the other three aforementioned criteria. Results: The overall percentage of patients who achieved clinical remission was 86.9% after 12 months, and 91.3% after 24 and 48 months of treatment. The rate of complete remission over partial remission increased over time. After 12 months of treatment, 65% of patients fulfilled the criteria for complete remission and 35.0% for partial remission. After 48 months of treatment, 71.4% of patients were in a status of complete remission and 28.6% in a status of partial remission. A long-term composite outcome of complete clinical remission was more likely to be achieved by severe eosinophilic asthma patients with comorbid nasal polyposis, bronchiectasis and osteoporosis, and with OCS dependency, a predicted pre-bronchodilation FEV1% ≥ 80% and a predicted FEF25–75% < 65% at baseline. Conclusions: Our real-life experience suggests that treatment with benralizumab may allow the achievement and long-term maintenance of clinical remission in a high percentage of severe eosinophilic asthma patients, up to 4 years of follow-up. Full article
(This article belongs to the Special Issue New Clinical Advances in Chronic Asthma)
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15 pages, 1139 KB  
Article
Clinical Remission Predictors in Non-Colonized Bronchiectasis and Severe Asthma with Type 2-Targeted Biologic Therapy: A Retrospective Real-Life Pilot Study
by Vitaliano Nicola Quaranta, Andrea Portacci, Francesca Montagnolo, Silvano Dragonieri, Ilaria Iorillo, Ernesto Lulaj, Leonardo Maselli, Enrico Buonamico and Giovanna Elisiana Carpagnano
J. Clin. Med. 2024, 13(21), 6309; https://doi.org/10.3390/jcm13216309 - 22 Oct 2024
Cited by 1 | Viewed by 1381
Abstract
Background/Objective: Patients with severe asthma (SA) and non-cystic fibrosis bronchiectasis (BE) without microbiological colonization represent a unique and understudied population. Type 2-targeted biologic therapies have emerged as a promising treatment for these patients. However, predictive factors for achieving clinical remission remain unclear. This [...] Read more.
Background/Objective: Patients with severe asthma (SA) and non-cystic fibrosis bronchiectasis (BE) without microbiological colonization represent a unique and understudied population. Type 2-targeted biologic therapies have emerged as a promising treatment for these patients. However, predictive factors for achieving clinical remission remain unclear. This study aims to identify the predictive factors for achieving clinical remission in patients with severe asthma and non-colonized bronchiectasis undergoing type 2-targeted biologic therapies. Methods: A retrospective longitudinal analysis was conducted on 14 patients with severe asthma and non-cystic fibrosis bronchiectasis without microbiological colonization. Clinical remission was assessed at baseline (T0) and after 12 months (T1) of biologic therapy. Clinical remission was defined according to the Severe Asthma Network Italy (SANI) criteria, including the absence of oral corticosteroid use, no asthma-related symptoms, stable lung function, and no exacerbations. Logistic regression was performed to identify predictors of remission. ROC curves were constructed to evaluate the predictive accuracy of lung function parameters, specifically FEV1 and FVC. Results: After 12 months of biologic therapy, 28.6% of patients (n = 4) achieved clinical remission. The mean FEV1 percentage at baseline was significantly higher in the remission group (92.25 ± 15.64%) compared to the non-remission group (65.10 ± 23.36%, p = 0.034). Logistic regression analysis identified baseline FEV1 as a significant predictor of remission (OR = 1.008, p = 0.050). ROC curve analysis revealed that an FEV1 cutoff of 72.5% had a sensitivity of 100% and a specificity of 70% (AUC = 0.900, p = 0.024) for predicting clinical remission. Conclusions: FEV1 is a crucial predictor of clinical remission in patients with severe asthma and non-colonized bronchiectasis treated with type 2-targeted biologic therapies. An FEV1 threshold of 72.5% can guide clinicians in identifying patients most likely to achieve remission. These findings underline the importance of preserving lung function to optimize therapeutic outcomes in this complex population. Full article
(This article belongs to the Special Issue New Clinical Advances in Chronic Asthma)
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Review

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21 pages, 719 KB  
Review
Biologic Therapy in Severe Asthma: A Phenotype-Driven and Targeted Approach
by Maria D’Amato, Daniela Pastore, Chiara Lupia, Claudio Candia, Andrea Bruni, Eugenio Garofalo, Federico Longhini, Angelantonio Maglio, Albino Petrone, Alessandro Vatrella, Girolamo Pelaia and Corrado Pelaia
J. Clin. Med. 2025, 14(13), 4749; https://doi.org/10.3390/jcm14134749 - 4 Jul 2025
Viewed by 1444
Abstract
Asthma is a highly heterogeneous respiratory disease that, in its severe forms, is characterized by persistent symptoms, frequent exacerbations, and a significant impact on patients’ quality of life. Despite high-dose inhaled corticosteroids and long-acting bronchodilators, a subset of patients remains uncontrolled, necessitating advanced [...] Read more.
Asthma is a highly heterogeneous respiratory disease that, in its severe forms, is characterized by persistent symptoms, frequent exacerbations, and a significant impact on patients’ quality of life. Despite high-dose inhaled corticosteroids and long-acting bronchodilators, a subset of patients remains uncontrolled, necessitating advanced therapeutic strategies. The advent of biologic therapies has revolutionized the management of severe asthma, offering targeted interventions based on the underlying inflammatory endotypes, primarily T2-high and T2-low. However, selecting the most appropriate biologic remains challenging due to overlapping phenotypic features and the limited availability of validated biomarkers. This narrative review explores the clinical utility of key biomarkers, including blood eosinophils, fractional exhaled nitric oxide (FeNO), periostin, and total and specific IgE, in guiding biologic therapy. All the information provided is based on an extensive literature search conducted on PubMed. We also examine the clinical characteristics and comorbidities that influence therapeutic choices. Furthermore, we present a practical decision-making platform, including a clinical table matching phenotypes with biologic agents, such as omalizumab, mepolizumab, benralizumab, dupilumab, and tezepelumab. By integrating biomarker analysis with clinical assessment, based on current guidelines and our extensive real-life experience, we aim to offer a logical framework to help clinicians select the most suitable biologic treatment for patients with uncontrolled severe asthma. Future research should focus on identifying novel biomarkers, refining patient stratification, and evaluating long-term outcomes to further advance precision medicine in the management of severe asthma. Full article
(This article belongs to the Special Issue New Clinical Advances in Chronic Asthma)
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Other

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26 pages, 612 KB  
Systematic Review
Asthma Control Among Adults in Saudi Arabia: A Systematic Review and Meta-Analysis
by Mohammed M. Alqahtani, Mansour M. Alotaibi, Saeed Mardy Alghamdi, Ali Alammari, Jameel Hakeem, Fawzeah Alenazi, Nour Aldhaefi, Deema Faleh Almutairi, Ahad Adel Alghamdi and Hamdan Al-Jahdali
J. Clin. Med. 2025, 14(16), 5753; https://doi.org/10.3390/jcm14165753 - 14 Aug 2025
Viewed by 557
Abstract
Background/Objectives: Asthma is a condition caused by chronic lower airway inflammation. Its primary treatment focuses on managing the condition and reducing the frequency of exacerbation episodes. Monitoring the level of asthma control among adults is essential for both clinical care and public health [...] Read more.
Background/Objectives: Asthma is a condition caused by chronic lower airway inflammation. Its primary treatment focuses on managing the condition and reducing the frequency of exacerbation episodes. Monitoring the level of asthma control among adults is essential for both clinical care and public health planning. This systematic review aimed to assess the level of asthma control among adults in Saudi Arabia and to determine the prevalence of controlled asthma in this population. Methods: The literature search was conducted using PubMed. We included all English-language, empirical, quantitative studies that investigated the prevalence of asthma control among Saudi adults. National Institutes of Health (NIH) Study Quality Assessment Tools guided determination of the quality of the included studies. This review is registered with PROSPERO (CRD42024484711). Results: Of the 107 initially identified studies, 17 met the inclusion criteria. Quality assessment tool rated 11 studies as good, 5 as fair, and 1 as poor. Most of the included studies used cross-sectional design from different geographical locations and varied in sample size. Overall, the prevalence of uncontrolled asthma among Saudi adults ranged from 23.4% to 68.1%. In some studies, well-controlled asthma was reported in as few as 3% of patients. Factors associated with uncontrolled asthma included lower educational attainment, unemployment, low income, female gender, tobacco use, poor medication adherence, and lack of regular medical follow-up. Environmental triggers and comorbid conditions, such as allergic rhinitis, were also frequently cited as contributing factors. Conclusions: Asthma control among adults in Saudi Arabia remains a significant public health concern. Improving outcomes requires a multifaceted approach that includes patient education, regular follow-up care (including pulmonary function tests, asthma severity assessments, and personalized treatment plans), and broader public health initiatives aimed at reducing exposure to allergens and pollutants. Strengthening primary care services and implementing nationwide asthma management programs may play a critical role in enhancing disease control and improving quality of life. Continued research in this field is strongly recommended. Full article
(This article belongs to the Special Issue New Clinical Advances in Chronic Asthma)
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