PG 2025: Pulmonary Literature Review and Interactive Complex Case Presentations (PG)-Rogers

Rogers - CHESTAsthmaYIR2025fin

Pdf Summary

The 2025 Asthma Year in Review, presented by Dr. Linda Rogers, highlights significant advances and challenges in asthma management, focusing on anti-inflammatory reliever therapy, risks of high-dose inhaled corticosteroids (ICS), biologics, and the emerging role of GLP-1 therapies.<br /><br />Key guidelines from the Global Initiative for Asthma (GINA) emphasize that patients with mild intermittent asthma (Step 1) should not rely on short-acting beta agonists (SABA) alone. Instead, low-dose ICS combined with formoterol as needed reduces exacerbations more effectively than ICS-albuterol or SABA alone, with comparable symptom control.<br /><br />Recent clinical trials reinforce the superiority of as-needed ICS-formoterol over SABA monotherapy in lowering severe exacerbation rates without increasing adverse events. Observational data confirm that low-dose ICS carries minimal adverse events, while higher doses associate with dose-dependent risks including osteoporosis, cardiovascular events, and pneumonia—warranting caution and discouraging excessive ICS escalation.<br /><br />Biologics for severe asthma show promise for oral corticosteroid (OCS) sparing. New agents like depemokimab (an ultra-long-acting anti-IL5) have significantly reduced exacerbations in trials. Benralizumab, used in eosinophilic exacerbations of asthma and COPD, may outperform oral prednisolone in acute settings. Despite these advances, survival of clinical remission—defined by no exacerbations, no maintenance OCS, good symptom control, and lung function—is achieved in about one-third of patients on biologics. Lower remission likelihood is linked to longer disease duration, worse baseline lung function, and comorbidities.<br /><br />Importantly, emerging data reveal GLP-1 receptor agonists (GLP-1RA), commonly used for diabetes, reduce asthma exacerbations by approximately 40%, especially in obese patients with asthma, suggesting therapeutic potential beyond glucose control.<br /><br />Take-home messages include minimizing SABA-alone use, preferring ICS-formoterol as reliever, cautious use of high-dose ICS due to systemic risks, recognition of biologics’ evolving roles including OCS sparing and management of eosinophilic exacerbations, and promising adjunctive use of GLP-1RA for asthma control. Early intervention with biologics may improve outcomes.<br /><br />Overall, these findings underscore a shift towards personalized, biomarker-guided asthma management prioritizing safety, exacerbation reduction, and remission achievement.

Keywords

Asthma management 2025

Anti-inflammatory reliever therapy

Inhaled corticosteroids risks

Biologics in severe asthma

GLP-1 receptor agonists asthma

GINA asthma guidelines

ICS-formoterol therapy

SABA monotherapy risks

Oral corticosteroid sparing

Asthma exacerbation reduction