Type 2 biomarkers and airway hyper-responsiveness disconnect in patients with uncontrolled severe asthma taking benralizumab or dupilumab

Type 2 (T2) inflammation is driven by cytokines including interleukins 4, 5 and 131. It is a commonly seen central feature in severe asthma along with airway hyper-responsiveness (AHR) which drives poor symptom control and frequent exacerbations. In clinical practice, T2 inflammation is often identified by measuring fractional exhaled nitric oxide (FeNO), representative of IL-4 and IL-13 activity, and blood eosinophils representative of IL-5 activity. Eosinophil activation can also be measured via eosinophil-derived neurotoxin (EDN) which is released by eosinophils in response to T2 stimuli and has been found to be higher is patients with poorly controlled asthma2.