Impact of biologics on oscillometry defined small airway dysfunction in uncontrolled asthma

TY - JOUR

T1 - Impact of biologics on oscillometry defined small airway dysfunction in uncontrolled asthma

AU - Greig, Robert

AU - Suter, Philipp

AU - Chan, Rory

AU - Lipworth, Brian

N1 - Copyright: © 2026 The Author(s). Clinical & Experimental Allergy published by John Wiley & Sons Ltd.

PY - 2026/7

Y1 - 2026/7

N2 - Small airways dysfunction (SAD) is a recognised treatable trait within severe asthma, associated with worse symptom control and increased exacerbations. It can be measured using forced oscillometry technique (FOT). FOT is an effective and effort-independent method of measuring peripheral lung resistance and compliance. Type 2 inflammation can affect the small airways via eosinophilic inflammation, mucus plugging and smooth muscle inflammation. These are all potential targets of monoclonal antibody therapy. Clinical trials have shown that mepolizumab, dupilumab and tezepelumab all effect both significant and clinically meaningful improvements in oscillometry-defined SAD; however, benralizumab does not. Furthermore, in indirect matched head-to-head comparisons, dupilumab exerts greater improvements compared to either benralizumab or tezepelumab. Future research should consider oscillometry-defined SAD being incorporated as a key clinical outcome in phase 2 studies as new monoclonal antibodies are developed, such as bispecifics, especially both dual upstream (IL33/TSLP) or downstream blockade (IL4/5/13).

AB - Small airways dysfunction (SAD) is a recognised treatable trait within severe asthma, associated with worse symptom control and increased exacerbations. It can be measured using forced oscillometry technique (FOT). FOT is an effective and effort-independent method of measuring peripheral lung resistance and compliance. Type 2 inflammation can affect the small airways via eosinophilic inflammation, mucus plugging and smooth muscle inflammation. These are all potential targets of monoclonal antibody therapy. Clinical trials have shown that mepolizumab, dupilumab and tezepelumab all effect both significant and clinically meaningful improvements in oscillometry-defined SAD; however, benralizumab does not. Furthermore, in indirect matched head-to-head comparisons, dupilumab exerts greater improvements compared to either benralizumab or tezepelumab. Future research should consider oscillometry-defined SAD being incorporated as a key clinical outcome in phase 2 studies as new monoclonal antibodies are developed, such as bispecifics, especially both dual upstream (IL33/TSLP) or downstream blockade (IL4/5/13).

KW - asthma

KW - benralizumab

KW - biologics

KW - dupilulmab

KW - mepolizumab

KW - monoclonal antibodies

KW - oscillometry

KW - small airways dysfunction

KW - tezepelumab

U2 - 10.1111/cea.70349

DO - 10.1111/cea.70349

M3 - Review article

C2 - 42178280

SN - 0954-7894

VL - 56

SP - 710

EP - 717

JO - Clinical and Experimental Allergy

JF - Clinical and Experimental Allergy

IS - 7

ER -