Biologics worked as well in smokers with severe asthma

Design

Retrospective real-world registry analysis (ERS SHARP)

Population

3876 adults with severe asthma on biologics, 16 European countries

Primary outcome

Change in control, exacerbations, quality of life and OCS use at 1 year

Effect

Improvement of similar magnitude across smoking groups

This retrospective analysis of the ERS SHARP registry included 3876 adults with severe asthma from 16 European countries, assessed at baseline and after one year of biologic treatment. Of these, 2383 had never smoked, 1352 were former smokers and 141 current smokers. It was published in the American Journal of Respiratory and Critical Care Medicine on 22 September.

In all groups, symptom control and quality of life improved, frequent exacerbations fell and oral corticosteroid use declined, and the size of change did not differ significantly by smoking status. A survey of participating countries found 29% reported opposition to prescribing biologics to current smokers.

Withholding a biologic because a patient smokes is not supported by these data. Smoking cessation remains central, but it should run alongside biologic therapy rather than be a precondition for it.

• Assess eligibility for biologics on phenotype and exacerbation history, not smoking status.
• Offer smoking cessation support at the same visit.
• Record pack-years and consider coexisting COPD in heavy smokers.
• Reassess response at 4–6 months as for any patient.

Why it matters

It challenges a common informal barrier to biologic access.

Don't overread it

Observational registry data with few current smokers cannot prove equal efficacy.

The statistics, in plain English

This is registry data without randomisation, and only 141 current smokers were included, so estimates for that group are imprecise. Smokers who were prescribed biologics may have been selected as likely responders.

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