Predictors of biological therapy in severe asthma patients. An ambispective study from the BIOBADALER consortium.

<bold>Background:</bold> Some patients with severe asthma (SA) remain uncontrolled despite maximal inhaled therapy. Respiratory comorbidities in addition to several systemic diseases might influence the need of biologicals in subjects with T2 SA. In this work, we investigate the impact of respiratory and extra-respiratory diseases in the prescription of biologicals for SA. <bold>Method:</bold> Patients with SA from the Spanish centers of the BIOBADALER consortium were invited to participate. Their clinical and analytical data were obtained from electronic health records and entered in a RedCap© database. Data was collected in an ambispective manner. <bold>Results:</bold> 358 patients with SA provided written informed consent. 231/358 individuals (64.5%) were on biologicals. The predictors of the need for biologicals were smoking habit (p=0.001), NSAID-exacerbated respiratory disease (NERD)(p=0.01), chronic rhinosinusitis (CRS)(p=0.001), chronic rhinosinusitis with nasal polyps (CRSwNP)(p<0.001), gastroesphageal reflux disease (GERD)(p=0.028), Obstructive sleep apnea/hypopnea syndrome (OSAHS)(p=0.024), depression/anxiety (p=0.002) and cardiovascular disease (p=0.005). Conversely, atopy, food allergy, atopic dermatitis, obesity and asthma-COPD overlap syndrome (ACOS) did not influence the prescription of biologicals. <bold>Conclusion:</bold> Respiratory comorbidities related to T2 inflammation (CRSwNP and NERD) increase the need of biologicals in SA patients. Nevertheless, other respiratory (smoking, OSAHS) and extra-respiratory (GERD, depression/anxiety, and cardiovascular disease) conditions not related to T2 inflammation are also more frequent in SA subjects on biologicals as compared to patients off biologicals.