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ICS-LABA adherence is important for patients with severe asthma treated with biologics

Published online July 1, 2025

The uncontrolled nature of severe asthma, as exhibited through high exacerbations rates and high symptom burden, means patients require additional treatments to their standard inhaled corticosteroid/long-acting β2-agonists (ICS-LABA) and other controller therapies. Add-on treatments, such as biologics, are highly effective for the majority of patients with severe asthma and because of this, clinicians are concerned that patients will stop or reduce their other asthma medications, such as ICS-LABA against their recommendations. The extent to which a patient follows their prescribed medications is called adherence.  

Published in The Journal of Allergy and Clinical Immunology: In Practice, an analysis of linked data by Shackleford et al. assessed ICS-LABA adherence in patients with severe asthma who received biologic treatments at Northern Ireland’s Regional Severe Asthma service. Adherence to ICS-LABA was measured using dispensing records before and after biologics were introduced. In addition, to investigate the impact of ICS-LABA adherence, patients’ outcomes such as exacerbations rates whilst on biologics were compared between patients with good adherence and poor adherence. 

The introduction of biologics did not impact ICS-LABA adherence at the population level with a small reduction (91.8% to 89.6%) in mean adherence being reported within the first year of use. However, individual changes did occur, with 21.5% of patients with good adherence prior to the introduction of biologics becoming poorly adherent at one year. Patients with poor adherence to ICS-experienced a higher rate of exacerbations and were noted to have a higher Fractional exhaled Nitric Oxide (FeNO), a biomarker for type-2 inflammation. This underlines the importance of adherence to ICS/LABA whilst on biologics and the need to counsel patients and continually assess adherence, particularly in patient’s failing biologic therapy.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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