Assessing response to biological therapies in severe asthma

Introduction: The management of severe asthma has shifted toward precision medicine, with clinical remission emerging as the ultimate therapeutic goal. This review evaluates the transition from predicting treatment response to achieving sustained remission through biologics. Areas covered: A comprehensive literature search was conducted in PubMed and Embase for articles published between January 2015 and February 2026. Keywords included ‘severe asthma,’ ‘biologic therapies,’ ‘clinical remission,’ and ‘T2 biomarkers.’ We analyze the predictive value of blood eosinophils (BEC), FeNO, and emerging indicators like CT-based mucus plugs. The review synthesizes data on ‘super-responders’ and the integration of real-world evidence into clinical practice. Expert opinion: Achieving clinical remission requires a multidimensional assessment beyond symptom control, including lung function stability and OCS elimination. Future management will likely focus on ‘disease modification’ and early biologic intervention. The identification of specific phenotypes, such as those with high mucus-plug burdens, will allow for more tailored therapy. However, standardized criteria for ‘remission off-treatment’ remain the primary challenge for the next decade of respiratory research.