ROLE OF SUBACUTE BRONCHIAL INFECTION IN PATIENTS WITH SEVERE ASTHMA CANDIDATES FOR BIOLOGIC THERAPY

<bold>Introduction:</bold> Patients with severe uncontrolled asthma (SUA) considered candidates for biologic therapy (BT) may suffer from hidden aggravating factors that play a role in not achieving control, among them subacute infections. <bold>Objective:</bold> To determine the role of infection in SUA patients who are candidates for biological therapy and the final indication of BT after treating infection. <bold>Material and methods:</bold> observational study of consecutive stable SUA patients candidates for biologic therapy who underwent bronchoscopy and microbiological culture of bronchial aspirate (BAS) as part of their asthma work-up. Patients with growth of potentially pathogenic bacteria (PPB) or fungus received targeted antibiotic or antifungal therapy. Epidemiological and clinical characteristics and the need for biologic initiation 6 months after bronchoscopy were evaluated. <bold>Results:</bold> Seventy-eight patients were included (mean age 58±14 years, 96% eosinophilic T2 phenotype, ACT 15±4, annual exacerbations rate 4±3, post-bronchodilator FEV1 68±19%). 27 patients (35%) had growth of PPB or fungi in BAS, of which 13 (48%) had CT-diagnosed bronchiectasis. The most frequent PPB isolated were Pseudomonas aeruginosa (8), Staphylococcus aureus (6), Aspergillus spp (6) and Haemophilus influenzae (3). 24 out of 27 received targeted therapy and after 6-month follow-up 7 patients started biologics (26%) and 20 did not (74%). <bold>Conclusions:</bold> Respiratory tract infections in patients with SUA may act as a hidden aggravating factor leading to poor control. The appropriate treatment could delay or avoid the initiation of BT. Supported by FIS 19/07521