Read the latest updates on severe asthma triggers and treatment presented at the 2021 American College of Allergy, Asthma and Immunology (ACAAI) Annual Scientific Meeting and the recent approval of Tezspire™ (tezepelumab-ekko) for the add-on maintenance treatment of severe asthma.

Common Severe Asthma Triggers

Weather, viral infections, and allergies are the most common patient-reported asthma triggers in adults with severe asthma, according to data presented by Bradley E. Chipps, MD, and colleagues at the 2021 ACAAI Annual Scientific Meeting.1

The findings are based on data from the observational, real-world CHRONICLE study, in which researchers compared findings from subspecialist-treated patients with severe asthma who received biologics or maintenance systemic corticosteroids and patients with uncontrolled asthma who received high-dosage inhaled corticosteroids with additional controllers. Of 2793 enrolled patients, 1434 completed the triggers questionnaire.

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Patients reported 8 trigger categories on average, with the most prevalent being:

  • Weather changes (78%)
  • Viral infections (70%)
  • Seasonal allergies (67%)
  • Year-round allergies (67%)

For patients who reported worse health-related quality of life, the most common triggers were cleaning/housework (35%) and strong emotions (34%). Patients who reported cleaning/housework or strong emotions as triggers were more likely to be female, have comorbidities (such as sleep apnea, gastroesophageal reflux disease, hypertension, depression, and anxiety), have uncontrolled asthma, report reduced work productivity, and be disabled.

Real-World Data Biologic Therapies for Asthma

The CHRONICLE trial findings also provided real-world outcomes on patients treated with the monoclonal antibody benralizumab and showed that some patients may need accelerated access to biologic therapy, as reported at the 2021 ACAAI Annual Scientific Meeting.2

Panettieri et al found that benralizumab use in patients with severe asthma was associated with large reductions in asthma exacerbations, emergency department (ED) visits, and hospitalizations over 1 year.

While treatment escalation is recommended in patients with severe uncontrolled asthma, findings by Genofre et al indicated that 4 in 10 uncontrolled patients with exacerbations initiated biologics and that biologic initiation was significantly sooner in patients with more than 1 exacerbation.3

Dupilumab Improves Chances of Clinical Remission in Uncontrolled Asthma

Treatment with the monoclonal antibody dupilumab led to asthma remission by 24 and 52 weeks in a substantial proportion of patients with uncontrolled moderate-to-severe disease compared with placebo (83.3% vs 61.0% at 24 weeks and 72.7% vs 46.2% at 52 weeks), according to data from a post hoc analysis of the phase 3 Liberty Asthma QUEST trial presented at the ACAAI Annual Scientific Meeting. Dupilumab treatment also reduced exacerbations and improved lung function and asthma control in patients who did not experience remission, Pavord et al reported.4

Tezspire Approved as Add-On Maintenance Treatment for Severe Asthma

The Food and Drug Administration (FDA) has approved Tezspire™ (tezepelumab-ekko) for the add-on maintenance treatment of patients 12 years and older with severe asthma. Treatment is administered subcutaneously by a health care provider once every 4 weeks.5

Tezspire is a first-in-class human monoclonal antibody that works by blocking thymic stromal lymphopoietin, an epithelial cytokine involved in the initiation and persistence of airway inflammation.

In the phase 3 NAVIGATOR trial, 1061 patients 12 years and older were randomly assigned to receive tezepelumab 210 mg subcutaneously every 4 weeks or placebo, in addition to standard of care. The primary endpoint was the annualized asthma exacerbation rate during the 52-week treatment period.

Treatment with tezepelumab was associated with a statistically significant and clinically meaningful 56% reduction in annualized asthma exacerbation rate in the overall patient population compared with placebo (0.93 vs 2.10; rate ratio, 0.44 [95% CI, 0.37-0.53]; P <.001). Tezepelumab also was associated with a significantly lower rate of annualized asthma exacerbations requiring an emergency room visit or hospitalization (0.06 vs 0.28 for placebo; rate ratio, 0.21 [95% CI, 0.12-0.37]).

Similar findings were observed in the 52-week PATHWAY trial, which enrolled 550 adult patients with severe asthma. Tezepelumab significantly reduced the annualized rate of asthma exacerbations compared with placebo (0.20 vs 0.72; rate ratio, 0.29 [95% CI, 0.16-0.51]).

The most common adverse reactions reported with tezepelumab included pharyngitis, arthralgia, and back pain.6


1. Chipps B, Soong W, Panettieri R, et al. Disease triggers and associated quality of life among specialist-treated US patients with severe asthma. Presented at: American College of Allergy, Asthma & Immunology (ACAAI) Annual Scientific Meeting; November 4-8, 2021; New Orleans, LA. Abstract P065.

2. Panettieri R, Lugogo N, Moore W, et al. Benralizumab real-world effectiveness on exacerbations among us specialist-treated patients with severe asthma: data from CHRONICLE. Presented at: American College of Allergy, Asthma & Immunology (ACAAI) Annual Scientific Meeting; November 4-8, 2021; New Orleans, LA. Abstract P062.

3. Genofre E, Nowojewski A, Scetinina T, Ambrose C. Timing of biologic initiation following exacerbations among US specialist-treated patients with severe asthma 8023. Presented at: American College of Allergy, Asthma & Immunology (ACAAI) Annual Scientific Meeting; November 4-8, 2021; New Orleans, LA.  Abstract P081.

4. Pavord I, Busse W, Israel E, et al. Dupilumab leads to clinical asthma remission indicative of comprehensive improvement in patients with asthma. Presented at: American College of Allergy, Asthma & Immunology (ACAAI) Annual Scientific Meeting; November 4-8, 2021; New Orleans, LA.  Abstract P067.

5. FDA approves Tezspire™ (tezepelumab-ekko) in the US for severe asthma. News release. Amgen. December 17, 2021. Accessed December 20, 2021.

6. Tezspire. Package insert. Amgen; 2021. Accessed December 20, 2021.