. 2025 Mar 27;65(3):2400691.

doi: 10.1183/13993003.00691-2024. Print 2025 Mar.

Patient-centred composite scores as tools for assessment of response to biological therapy for paediatric and adult severe asthma

Ekaterina Khaleva^{1

2}, Chris Brightling³, Thomas Eiwegger^{4

5

6

7}, Alan Altraja⁸, Philippe Bégin^{9

10}, Katharina Blumchen¹¹, Apostolos Bossios^{12

13}, Arnaud Bourdin¹⁴, Anneke Ten Brinke¹⁵, Guy Brusselle¹⁶, Roxana Silvia Bumbacea^{17

18}, Andrew Bush¹⁹, Thomas B Casale²⁰, Graham W Clarke^{21

22}, Rekha Chaudhuri²³, Kian Fan Chung²⁴, Courtney Coleman²⁵, Jonathan Corren²⁶, Sven-Erik Dahlén^{27

28}, Antoine Deschildre^{29

30}, Ratko Djukanovic^{2

31}, Katrien Eger³², Andrew Exley³³, Louise Fleming²⁴, Stephen J Fowler^{34

35}, Erol A Gaillard³⁶, Monika Gappa³⁷, Atul Gupta³⁸, Hans Michael Haitchi^{2

31

39

40}, Simone Hashimoto^{32

41}, Liam G Heaney⁴², Gunilla Hedlin⁴³, Markaya Henderson⁴⁴, Wen Hua⁴⁵, David J Jackson^{46

47}, Bülent Karadag⁴⁸, Constance Helen Katelaris⁴⁹, Mariko S Koh^{50

51}, Matthias Volkmar Kopp^{52

53}, Gerard H Koppelman^{54

55}, Inger Kull⁵⁶, Ramesh J Kurukulaaratchy^{2

31

57}, Ji-Hyang Lee⁵⁸, Vera Mahler⁵⁹, Mika Mäkelä⁶⁰, Matthew Masoli⁶¹, Alexander G Mathioudakis^{62

63}, Angel Mazon⁶⁴, Erik Melén⁵⁶, Katrin Milger^{65

66}, Alexander Moeller⁶⁷, Clare S Murray^{34

35}, Prasad Nagakumar^{68

69}, Parameswaran Nair⁷⁰, Jenny Negus⁷¹, Antonio Nieto⁷², Nikolaos G Papadopoulos^{73

74}, James Paton⁷⁵, Mariëlle W Pijnenburg⁷⁶, Katharine C Pike⁷⁷, Celeste Porsbjerg⁷⁸, Anna Rattu¹, Hitasha Rupani³⁹, Franca Rusconi⁷⁹, Niels W Rutjes⁴¹, Sejal Saglani²⁴, Paul Seddon⁸⁰, Salman Siddiqui⁸¹, Florian Singer^{67

82}, Tomoko Tajiri⁸³, Steve Turner^{84

85}, John W Upham^{86

87}, Susanne J H Vijverberg^{32

41}, Peter A B Wark⁸⁸, Michael E Wechsler⁸⁹, Valentyna Yasinska^{27

90}, Graham Roberts^{91

2}; 3TR Asthma Definition of Response Working Group

Affiliations

¹ Clinical and Experimental Sciences and Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK.
² NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
³ Institute for Lung Health, Leicester NIHR BRC, University of Leicester, Leicester, UK.
⁴ Karl Landsteiner University of Health Sciences, Krems, Austria.
⁵ Translational Medicine Program, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada.
⁶ Department of Immunology, University of Toronto, Toronto, ON, Canada.
⁷ Department of Pediatric and Adolescent Medicine, University Hospital St. Pölten, St. Pölten, Austria.
⁸ Department of Pulmonology, University of Tartu and Lung Clinic, Tartu University Hospital, Tartu, Estonia.
⁹ Department of Medicine, CHUM, Montréal, QC, Canada.
¹⁰ Department of Pediatrics, CHU Ste-Justine, Montréal, QC, Canada.
¹¹ Department of Children and Adolescent Medicine, Division of Pneumology, Allergology and Cystic fibrosis, University Hospital Frankfurt, Goethe-University, Frankfurt, Germany.
¹² Karolinska Severe Asthma Center, Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Huddinge, Sweden.
¹³ Division for Lung and Airway Research, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
¹⁴ PhyMedExp, University of Montpellier, Montpellier, France.
¹⁵ Department of Respiratory Medicine, Medical Centre Leeuwarden, Leeuwarden, The Netherlands.
¹⁶ Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium.
¹⁷ Department of Allergology "Carol Davila", University of Medicine and Pharmacy, Bucharest, Romania.
¹⁸ Department of Allergology "Carol Davila", Nephrology Clinical Hospital, Bucharest, Romania.
¹⁹ Centre for Paediatrics and Child Health and National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, London, UK.
²⁰ Division of Allergy/Immunology, Morsani College of Medicine, University of South Florida, Tampa, FL, USA.
²¹ Translational Science and Experimental Medicine, Research and Early Development, Respiratory and Immunology, BioPharmaceuticals, R&D, AstraZeneca, Molndal, Sweden.
²² School of Immunology and Microbial Sciences, King's College London, London, UK.
²³ School of Infection and Immunity, University of Glasgow, Glasgow, UK.
²⁴ National Heart and Lung Institute, Imperial College London, London, UK.
²⁵ European Lung Foundation, Sheffield, UK.
²⁶ David Geffen School of Medicine, UCLA, Los Angeles, CA, USA.
²⁷ Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Huddinge, Sweden.
²⁸ Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
²⁹ Univ Lille, CHU Lille, Unité de Pneumologie et Allergologie Pédiatrique, Hôpital Jeanne de Flandre, Lille, France.
³⁰ U1019 - UMR 8204 - CIIL - Center for Infection and Immunity of Lille, Lille, France.
³¹ Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.
³² Department of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
³³ Adept Biologica Consulting Limited, London, UK.
³⁴ Faculty of Biology, Medicine and Health, School of Biological Sciences, Division of Infection, Immunity and Respiratory Medicine, The University of Manchester, Manchester, UK.
³⁵ NIHR Manchester Biomedical Research Unit and Manchester University NHS Foundation Trust, Manchester, UK.
³⁶ University of Leicester, Department of Respiratory Sciences, Leicester NIHR Biomedical Research Centre (Respiratory theme), Leicester, UK.
³⁷ Department of Pediatrics, Evangelisches Krankenhaus Düsseldorf, Düsseldorf, Germany.
³⁸ Department of Paediatric Respiratory Medicine, King's College Hospital, London, UK.
³⁹ Respiratory Medicine Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
⁴⁰ Institute for Life Sciences, University of Southampton, Southampton, UK.
⁴¹ Department of Pediatric Respiratory Medicine and Allergy, Emma Children's Hospital, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands.
⁴² Wellcome-Wolfson Centre for Experimental Medicine School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK.
⁴³ Department of Women's and Children's Health and Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden.
⁴⁴ European Federation of Allergy and Airways Diseases Patients' Associations, Brussels, Belgium.
⁴⁵ Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.
⁴⁶ King's Centre for Lung Health, King's College London, London, UK.
⁴⁷ Guy's Asthma Centre, Guy's and St Thomas' NHS Trust, London, UK.
⁴⁸ Marmara University Faculty of Medicine, Division of Pediatric Pulmonology, Istanbul, Turkey.
⁴⁹ Immunology and Allergy Unit Campbelltown Hospital and Western Sydney University Campbelltown, Sydney, Australia.
⁵⁰ Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore.
⁵¹ Duke-National University Singapore, Singapore.
⁵² University Children's Hospital of Bern, Inselspital, University of Bern, Bern, Switzerland.
⁵³ Airway Research Center North (ARCN), German Center for Lung Research (DZL), Luebeck, Germany.
⁵⁴ University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Department of Pediatric Pulmonology and Pediatric Allergology, Groningen, The Netherlands.
⁵⁵ University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, The Netherlands.
⁵⁶ Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
⁵⁷ David Hide Asthma and Allergy Centre, St Mary's Hospital, Newport, UK.
⁵⁸ Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
⁵⁹ Paul-Ehrlich-Institut, Federal Institute for Vaccines and Biomedicines, Division of Allergology, Langen, Germany.
⁶⁰ HUS Skin and Allergy Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
⁶¹ University of Exeter, Royal Devon and Exeter Hospital, Exeter, UK.
⁶² Division of Immunology, Immunity to Infection and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester, UK.
⁶³ North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.
⁶⁴ Unit of Pediatric Allergy and Pneumology, Health Research Institute La Fe, University and Polytechnic Hospital La Fe, Valencia, Spain.
⁶⁵ Department of Medicine V, University Hospital, LMU Munich, Munich, Germany.
⁶⁶ Comprehensive Pneumology Center Munich (CPC-M), member of the German Center for Lung Research (DZL), Munich, Germany.
⁶⁷ Department of Respiratory Medicine, University Children's Hospital Zurich and Childhood Research Center, Zurich, Switzerland.
⁶⁸ Department of Respiratory Medicine, Birmingham Children's Hospital, Birmingham, UK.
⁶⁹ Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.
⁷⁰ Department of Medicine, Division of Respirology, St Joseph's Healthcare and McMaster University, Hamilton, ON, Canada.
⁷¹ 3TR respiratory working group, Brussels, Belgium.
⁷² Pediatric Pulmonology and Allergy Unit, Health Research Institute, Hospital la Fe, Valencia, Spain.
⁷³ Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece.
⁷⁴ Lydia Becker Institute of Immunology and Inflammation, University of Manchester, Manchester, UK.
⁷⁵ School of Medicine, College of Medical, Veterinary, and Life Sciences, University of Glasgow, Glasgow, UK.
⁷⁶ Erasmus MC - Sophia Children's Hospital, University Medical Centre Rotterdam, Department of Paediatrics/Paediatric Respiratory Medicine and Allergology, Rotterdam, The Netherlands.
⁷⁷ Department of Paediatric Respiratory Medicine, Bristol Royal Hospital for Children, Bristol, UK.
⁷⁸ Department of Respiratory Medicine, Respiratory Research Unit, Bispebjerg Hospital, Copenhagen, Denmark.
⁷⁹ Department of Mother and Child Health, Azienda USL Toscana Nord Ovest, Pisa, Italy.
⁸⁰ Respiratory Care, Royal Alexandra Children's Hospital, Brighton, UK.
⁸¹ Imperial NIHR Biomedical Research Centre, National Lung and Heart Institute, Imperial College London, London, UK.
⁸² Division of Paediatric Pulmonology and Allergology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria.
⁸³ Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University School of Medical Sciences, Nagoya, Japan.
⁸⁴ Women and Children Division, NHS Grampian, Aberdeen, UK.
⁸⁵ Child Health, University of Aberdeen, Aberdeen, UK.
⁸⁶ Frazer Institute, The University of Queensland, Brisbane, Australia.
⁸⁷ Princess Alexandra Hospital, Brisbane, Australia.
⁸⁸ School of Translational Medicine, Monash University, Clayton, Australia.
⁸⁹ NJH Cohen Family Asthma Institute, Department of Medicine, National Jewish Health, Denver, CO, USA.
⁹⁰ Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden.
⁹¹ Clinical and Experimental Sciences and Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK g.c.roberts@soton.ac.uk.

PMID: 39510551
PMCID: PMC11948419
DOI: 10.1183/13993003.00691-2024

Patient-centred composite scores as tools for assessment of response to biological therapy for paediatric and adult severe asthma

Ekaterina Khaleva et al. Eur Respir J. 2025.

. 2025 Mar 27;65(3):2400691.

doi: 10.1183/13993003.00691-2024. Print 2025 Mar.

Authors

Affiliations

¹ Clinical and Experimental Sciences and Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK.
² NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
³ Institute for Lung Health, Leicester NIHR BRC, University of Leicester, Leicester, UK.
⁴ Karl Landsteiner University of Health Sciences, Krems, Austria.
⁵ Translational Medicine Program, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada.
⁶ Department of Immunology, University of Toronto, Toronto, ON, Canada.
⁷ Department of Pediatric and Adolescent Medicine, University Hospital St. Pölten, St. Pölten, Austria.
⁸ Department of Pulmonology, University of Tartu and Lung Clinic, Tartu University Hospital, Tartu, Estonia.
⁹ Department of Medicine, CHUM, Montréal, QC, Canada.
¹⁰ Department of Pediatrics, CHU Ste-Justine, Montréal, QC, Canada.
¹¹ Department of Children and Adolescent Medicine, Division of Pneumology, Allergology and Cystic fibrosis, University Hospital Frankfurt, Goethe-University, Frankfurt, Germany.
¹² Karolinska Severe Asthma Center, Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Huddinge, Sweden.
¹³ Division for Lung and Airway Research, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
¹⁴ PhyMedExp, University of Montpellier, Montpellier, France.
¹⁵ Department of Respiratory Medicine, Medical Centre Leeuwarden, Leeuwarden, The Netherlands.
¹⁶ Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium.
¹⁷ Department of Allergology "Carol Davila", University of Medicine and Pharmacy, Bucharest, Romania.
¹⁸ Department of Allergology "Carol Davila", Nephrology Clinical Hospital, Bucharest, Romania.
¹⁹ Centre for Paediatrics and Child Health and National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, London, UK.
²⁰ Division of Allergy/Immunology, Morsani College of Medicine, University of South Florida, Tampa, FL, USA.
²¹ Translational Science and Experimental Medicine, Research and Early Development, Respiratory and Immunology, BioPharmaceuticals, R&D, AstraZeneca, Molndal, Sweden.
²² School of Immunology and Microbial Sciences, King's College London, London, UK.
²³ School of Infection and Immunity, University of Glasgow, Glasgow, UK.
²⁴ National Heart and Lung Institute, Imperial College London, London, UK.
²⁵ European Lung Foundation, Sheffield, UK.
²⁶ David Geffen School of Medicine, UCLA, Los Angeles, CA, USA.
²⁷ Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Huddinge, Sweden.
²⁸ Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
²⁹ Univ Lille, CHU Lille, Unité de Pneumologie et Allergologie Pédiatrique, Hôpital Jeanne de Flandre, Lille, France.
³⁰ U1019 - UMR 8204 - CIIL - Center for Infection and Immunity of Lille, Lille, France.
³¹ Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.
³² Department of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
³³ Adept Biologica Consulting Limited, London, UK.
³⁴ Faculty of Biology, Medicine and Health, School of Biological Sciences, Division of Infection, Immunity and Respiratory Medicine, The University of Manchester, Manchester, UK.
³⁵ NIHR Manchester Biomedical Research Unit and Manchester University NHS Foundation Trust, Manchester, UK.
³⁶ University of Leicester, Department of Respiratory Sciences, Leicester NIHR Biomedical Research Centre (Respiratory theme), Leicester, UK.
³⁷ Department of Pediatrics, Evangelisches Krankenhaus Düsseldorf, Düsseldorf, Germany.
³⁸ Department of Paediatric Respiratory Medicine, King's College Hospital, London, UK.
³⁹ Respiratory Medicine Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
⁴⁰ Institute for Life Sciences, University of Southampton, Southampton, UK.
⁴¹ Department of Pediatric Respiratory Medicine and Allergy, Emma Children's Hospital, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands.
⁴² Wellcome-Wolfson Centre for Experimental Medicine School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK.
⁴³ Department of Women's and Children's Health and Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden.
⁴⁴ European Federation of Allergy and Airways Diseases Patients' Associations, Brussels, Belgium.
⁴⁵ Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.
⁴⁶ King's Centre for Lung Health, King's College London, London, UK.
⁴⁷ Guy's Asthma Centre, Guy's and St Thomas' NHS Trust, London, UK.
⁴⁸ Marmara University Faculty of Medicine, Division of Pediatric Pulmonology, Istanbul, Turkey.
⁴⁹ Immunology and Allergy Unit Campbelltown Hospital and Western Sydney University Campbelltown, Sydney, Australia.
⁵⁰ Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore.
⁵¹ Duke-National University Singapore, Singapore.
⁵² University Children's Hospital of Bern, Inselspital, University of Bern, Bern, Switzerland.
⁵³ Airway Research Center North (ARCN), German Center for Lung Research (DZL), Luebeck, Germany.
⁵⁴ University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Department of Pediatric Pulmonology and Pediatric Allergology, Groningen, The Netherlands.
⁵⁵ University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, The Netherlands.
⁵⁶ Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
⁵⁷ David Hide Asthma and Allergy Centre, St Mary's Hospital, Newport, UK.
⁵⁸ Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
⁵⁹ Paul-Ehrlich-Institut, Federal Institute for Vaccines and Biomedicines, Division of Allergology, Langen, Germany.
⁶⁰ HUS Skin and Allergy Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
⁶¹ University of Exeter, Royal Devon and Exeter Hospital, Exeter, UK.
⁶² Division of Immunology, Immunity to Infection and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester, UK.
⁶³ North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.
⁶⁴ Unit of Pediatric Allergy and Pneumology, Health Research Institute La Fe, University and Polytechnic Hospital La Fe, Valencia, Spain.
⁶⁵ Department of Medicine V, University Hospital, LMU Munich, Munich, Germany.
⁶⁶ Comprehensive Pneumology Center Munich (CPC-M), member of the German Center for Lung Research (DZL), Munich, Germany.
⁶⁷ Department of Respiratory Medicine, University Children's Hospital Zurich and Childhood Research Center, Zurich, Switzerland.
⁶⁸ Department of Respiratory Medicine, Birmingham Children's Hospital, Birmingham, UK.
⁶⁹ Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.
⁷⁰ Department of Medicine, Division of Respirology, St Joseph's Healthcare and McMaster University, Hamilton, ON, Canada.
⁷¹ 3TR respiratory working group, Brussels, Belgium.
⁷² Pediatric Pulmonology and Allergy Unit, Health Research Institute, Hospital la Fe, Valencia, Spain.
⁷³ Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece.
⁷⁴ Lydia Becker Institute of Immunology and Inflammation, University of Manchester, Manchester, UK.
⁷⁵ School of Medicine, College of Medical, Veterinary, and Life Sciences, University of Glasgow, Glasgow, UK.
⁷⁶ Erasmus MC - Sophia Children's Hospital, University Medical Centre Rotterdam, Department of Paediatrics/Paediatric Respiratory Medicine and Allergology, Rotterdam, The Netherlands.
⁷⁷ Department of Paediatric Respiratory Medicine, Bristol Royal Hospital for Children, Bristol, UK.
⁷⁸ Department of Respiratory Medicine, Respiratory Research Unit, Bispebjerg Hospital, Copenhagen, Denmark.
⁷⁹ Department of Mother and Child Health, Azienda USL Toscana Nord Ovest, Pisa, Italy.
⁸⁰ Respiratory Care, Royal Alexandra Children's Hospital, Brighton, UK.
⁸¹ Imperial NIHR Biomedical Research Centre, National Lung and Heart Institute, Imperial College London, London, UK.
⁸² Division of Paediatric Pulmonology and Allergology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria.
⁸³ Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University School of Medical Sciences, Nagoya, Japan.
⁸⁴ Women and Children Division, NHS Grampian, Aberdeen, UK.
⁸⁵ Child Health, University of Aberdeen, Aberdeen, UK.
⁸⁶ Frazer Institute, The University of Queensland, Brisbane, Australia.
⁸⁷ Princess Alexandra Hospital, Brisbane, Australia.
⁸⁸ School of Translational Medicine, Monash University, Clayton, Australia.
⁸⁹ NJH Cohen Family Asthma Institute, Department of Medicine, National Jewish Health, Denver, CO, USA.
⁹⁰ Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden.
⁹¹ Clinical and Experimental Sciences and Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK g.c.roberts@soton.ac.uk.

PMID: 39510551
PMCID: PMC11948419
DOI: 10.1183/13993003.00691-2024

Abstract

Background: We have previously developed Core Outcome Measures sets for Severe Asthma (COMSA) by multi-stakeholder consensus. There are no patient-centred tools to quantify response to biological therapies for severe asthma. We aimed to develop paediatric and adult CompOsite iNdexes For Response in asthMa (CONFiRM) incorporating clinical parameters and patient-reported quality of life.

Methods: International expert healthcare professionals and patients with severe asthma were invited to 1) develop consensus levels of clinically relevant changes for each outcome measure within COMSA, 2) use multicriteria decision analysis to develop the CONFiRM scores and 3) assess their internal validity. A separate group of healthcare professionals evaluated CONFiRM's external validity.

Results: Five levels of change for each COMSA outcome were agreed. Severe exacerbations and maintenance oral corticosteroid use were rated as the most important in determining both paediatric and adult CONFiRM scores. There was strong agreement between healthcare professionals and patients, although patients assigned greater importance to quality of life. The CONFiRM score quantified response to a biologic from -31 (deterioration) to 69 (best possible response). Paediatric and adult CONFiRMs had good discriminative ability for a sufficient (area under the curve ≥0.92) and a substantial (area under the curve ≥0.95) response to biologics. Both CONFiRMs demonstrated excellent external validity (Spearman correlation coefficients 0.9 and 0.8 for paediatric and adult, respectively; p<0.0001).

Conclusions: We have developed novel patient-centred paediatric and adult CONFiRMs that include quality of life measures. CONFiRMs should allow a more holistic understanding of response for the patient and a standardised assessment of the effectiveness of biologics between studies. Further research is needed to prospectively validate CONFiRM scores.

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Conflict of interest statement

Conflict of interest: E. Khaleva reports support for the present study from 3TR European Union IMI 2 and Asthma, Allergy and Inflammation Research (AAIR) Charity. C. Brightling reports support for the present study from 3TR and Leicester NIHR BRC; grants from GSK, AstraZeneca, Sanofi, Regeneron, Roche, Genentech, Novartis, Chiesi and Mologic; and consultancy fees from GSK, AstraZeneca, Sanofi, Regeneron, Roche, Genentech, Novartis, Chiesi and Mologic. T. Eiwegger reports grants from ALK and Greer Stallergen; consultancy fees from ALK; payment or honoraria for lectures, presentations, manuscript writing or educational events from Aimune, ThermoFisher, Nutricia/Danone, ALK and Novartis; payment for expert testimony from Aimune; participation on a data safety monitoring board or advisory board with ALK, Aimune and Nutricia/Danone; leadership roles with EAACI (Chair WG Biologicals and Board Immunology Section) and Allergy – European Journal of Allergy and Clinical Immunology (Associate Editor); and receipt of equipment, materials, drugs, medical writing, gifts or other services from MADX and Novartis. A. Altraja reports consultancy fees from AstraZeneca, Boehringer Ingelheim, GSK and Sanofi; payment or honoraria for lectures, presentations, manuscript writing or educational events from AstraZeneca, Berlin-Chemie Menarini, Boehringer Ingelheim, Norameda, GSK, Sanofi and Zentiva; payment for expert testimony from AstraZeneca, Boehringer Ingelheim, GSK and Sanofi; support for attending meetings from AstraZeneca, Berlin-Chemie Menarini, Boehringer Ingelheim and Norameda; participation on a data safety monitoring board or advisory board with AstraZeneca, Boehringer Ingelheim, GSK and Sanofi; and receipt of equipment, materials, drugs, medical writing, gifts or other services from Berlin-Chemie and Menarini. P. Bégin reports grants from Novartis, DBV Technologies, Sanofi and Regeneron; consultancy fees from Pfizer, Sanofi and DBV Technologies; and payment or honoraria for lectures, presentations, manuscript writing or educational events from ALK, Sanofi, Pfizer, AstraZeneca and Bausch Health. K. Blumchen reports grants from Novartis Pharma GmbH, Allergy Therapeutics, Aimmune Therapeutics, DBV Technologies and Hipp GmbH; consultancy fees from Novartis Pharma GmbH, Allergy Therapeutics, Aimmune Therapeutics and DBV Technologies; payment or honoraria for lectures, presentations, manuscript writing or educational events from Novartis Pharma GmbH, Allergy Therapeutics, Aimmune Therapeutics, DBV Technologies, ALK Bausch, Lomb, Allergopharma and ThermoFisher; support for attending meetings from DBV Technologies and Aimmune Therapeutics; participation on a data safety monitoring board or advisory board with Novartis Pharma GmbH, DBV Technologies and Aimmune Therapeutics; and a leadership role with West German Working Group for Pediatric Pneumology and Allergology (Board member). A. Bossios reports grants from AstraZeneca; payment or honoraria for lectures, presentations, manuscript writing or educational events from AstraZeneca, GSK, Novartis and Teva; support for attending meetings from Novartis; participation on a data safety monitoring board or advisory board with AstraZeneca, GSK, Novartis, Teva and Sanofi; and leadership roles with Severe Heterogeneous Asthma Research collaboration, Patient-centred (SHARP) (member of steering committee), Swedish National Airway Register (steering committee member), Nordic Severe Asthma Network (NSAN) (vice-chair), and ERS (Head of Assembly 5). A. Bourdin reports grants from AstraZeneca and Boehringer Ingelheim; consultancy fees from AstraZeneca, Boehringer Ingelheim, GSK, Novartis, Amgen, Regeneron, Sanofi, Chiesi and AB Science; payment or honoraria for lectures, presentations, manuscript writing or educational events from AstraZeneca, Boehringer Ingelheim, GSK, Novartis, Amgen, Regeneron, Sanofi, Chiesi and AB Science; support for attending meetings from AstraZeneca, Boehringer Ingelheim, GSK, Novartis, Amgen, Regeneron, Sanofi, Chiesi and AB Science; participation on a data safety monitoring board or advisory board with AB Science; and is a member of the GINA scientific committee. A. Ten Brinke reports grants from GSK, TEVA and AstraZeneca; payment or honoraria for lectures, presentations, manuscript writing or educational events from GSK, TEVA, AstraZeneca and Sanofi; participation on a data safety monitoring board or advisory board with GSK, Sanofi, TEVA, AstraZeneca, Boehringer Ingelheim and Sterna; and leadership roles with the Dutch Severe Asthma Registry: RAPSODI (Chair) and ERS CRC SHARP (National Lead for the Netherlands). G. Brusselle reports payment or honoraria for lectures, presentations, manuscript writing or educational events from AstraZeneca, Boehringer Ingelheim, Chiesi, GSK, Novartis and Sanofi. R.S. Bumbacea reports grants from AstraZeneca; consultancy fees from AstraZeneca, Chiesi and Novartis; payment or honoraria for lectures, presentations, manuscript writing or educational events from AstraZeneca, Chiesi and Novartis; support for attending meetings from AstraZeneca; participation on a data safety monitoring board or advisory board with AstraZeneca and Novartis; and a leadership role with Romanian Society of Allergy and Clinical Immunology (past president). T.B. Casale reports consultancy fees from Genentech, Novartis, Sanofi and Regeneron; and payment or honoraria for lectures, presentations, manuscript writing or educational events from Sanofi and GSK. G.W. Clarke reports support for the present study from AstraZeneca (employment, study funding, article processing charges, medical writing) and stock (or stock options) with AstraZeneca. R. Chaudhuri reports grants from AstraZeneca; payment or honoraria for lectures, presentations, manuscript writing or educational events from GSK, AstraZeneca, Teva, Chiesi and Sanofi; support for attending meetings from Chiesi and Sanofi; and participation on a data safety monitoring board or advisory board with GSK, AstraZeneca and Celltrion. K.F. Chung grants from the Medical Research Council (MRC), Engineering and Physical Sciences Research Council and GSK; payment or honoraria for lectures, presentations, manuscript writing or educational events from Novartis, AstraZeneca and Merck; and participation on a data safety monitoring board or advisory board with GSK, AstraZeneca, Novartis, Roche, Merck, Rickett-Beckinson, Nocion, Shionogi and Clean Breathing Institute (supported by Haleon). C. Coleman reports support for the present study from IMI (funding received to support this work by European Lung Foundation from European Commission's IMI 2 JU under grant agreement number 831434 (3TR)). J. Corren reports grants from AstraZeneca and Regeneron/Sanofi; consultancy fees from AstraZeneca and Regeneron/Sanofi; payment or honoraria for lectures, presentations, manuscript writing or educational events from AstraZeneca and Regeneron/Sanofi; and stock (or stock options) with Allakos Pharmaceutical. S-E. Dahlén reports support for the present study from 3TR IMI; consultancy fees from AstraZeneca, Cayman Co, GSK, Novartis, Regeneron, Sanofi and Teva; and payment or honoraria for lectures, presentations, manuscript writing or educational events from AstraZeneca and Sanofi. A. Deschildre reports payment or honoraria for lectures, presentations, manuscript writing or educational events from Novartis, GSK, Sanofi, Regeneron, AstraZeneca, Aimmune Therapeutics, DBV Technologies, Nestle Health Science, ALK, Stallergènes-Greer and Viatris; support for attending meetings from Novartis, GSK, Sanofi, Regeneron, AstraZeneca, Aimmune Therapeutics, DBV Technologies, Nestle Health Science, ALK, Stallergènes-Greer and Viatris; and participation on a data safety monitoring board or advisory board with Novartis, GSK, Sanofi, Regeneron, AstraZeneca, Aimmune Therapeutics, DBV Technologies, Nestle Health Science, ALK, Stallergènes-Greer and Viatris. R. Djukanovic reports support for the present study from ERS, TEVA, GSK, Novartis, Sanofi and Chiesi; consultancy fees from Synairgen; payment or honoraria for lectures, presentations, manuscript writing or educational events from GSK; participation on a data safety monitoring board or advisory board with Kymab (Cambridge); and stock (or stock options) with Synairgen. A. Exley reports stock (or stock options) with GSK (belonging to family). L. Fleming reports consultancy fees from Sanofi/Regeneron and AstraZeneca; and payment or honoraria for lectures, presentations, manuscript writing or educational events from Novartis and AstraZeneca. E.A. Gaillard reports grants from Gilead, Chiesi and Adherium and Helicon Health; payment or honoraria for lectures, presentations, manuscript writing or educational events from Circassia and Sanofi; support for attending meetings from Sanofi; leadership role with ERS (Secretary of Group 07.02); and receipt of equipment, materials, drugs, medical writing, gifts or other services from Propeller Health. M. Gappa reports payment or honoraria for lectures, presentations, manuscript writing or educational events from Aimmune, ALK, Berlin Chemie, GSK, HAL Allergy, Nestle, Novartis, Omron and Sanofi/Regeneron; and participation on a data safety monitoring board or advisory board with Aimmune, ALK, GSK, Nestle, Novartis and Sanofi. A. Gupta reports grants from GSK; and payment or honoraria for lectures, presentations, manuscript writing or educational events from Boehringer Ingelheim, GSK, Novartis and AstraZeneca. L.G. Heaney reports grants from AstraZeneca, Medimmune, Novartis UK, Roche/Genentech and GSK; payment or honoraria for lectures, presentations, manuscript writing or educational events from AstraZeneca, Novartis, Roche/Genentech, Sanofi, Circassia, GSK, Chiesi and Teva; support for attending meetings from AstraZeneca, Chiesi, Novartis, Boehringer Ingelheim, Sanofi, Teva and GSK; and participation on a data safety monitoring board or advisory board with AstraZeneca, Novartis, GSK, Chiesi, Teva, Theravance and Vectura. M. Henderson reports grants from Novartis, Pfizer, AstraZeneca, Chiesi Farmaceutici, GSK, AbbVie, LeoPharma, Boehringer Ingelheim, Sanofi, Regeneron, OM Pharma, MSD, Roche and DBV Technologies; and support for attending meetings from Novartis. D.J. Jackson reports grants from AstraZeneca; consultancy fees from AstraZeneca, GSK and Sanofi Regeneron; and payment or honoraria for lectures, presentations, manuscript writing or educational events from AstraZeneca, GSK and Sanofi Regeneron. B. Karadag reports payment or honoraria for lectures, presentations, manuscript writing or educational events from Vem Ilac, Sandoz and GSK; and a leadership role with GSK Turkey Severe Asthma Advisory Group. M.S. Koh reports grants from AstraZeneca; and payment or honoraria for lectures, presentations, manuscript writing or educational events from GSK, AstraZeneca, Novartis, Sanofi and Boehringer Ingelheim. M.V. Kopp reports grants from Bundesministerium für Bildung & Forschung (BMBF) (Grant für das Deutsche Zentrum für Lungenfroschung); consultancy fees from Allergopharma GmbH and Sanofi Aventis GmbH; payment or honoraria for lectures, presentations, manuscript writing or educational events from Allergopharma GmbH, Sanofi Aventis GmbH, ALKAbello, Chiesi GmbH, Infectopharm GmbH, Novartis Pharma GmbH and Vertex GmbH; participation on a data safety monitoring board or advisory board with Allergopharma GmbH, and a leadership role with Society “Gesellschaft für Pädiatrische Pneumologie” GPP e.V. (past president). G.H. Koppelman reports grants from Netherlands Lung Foundation, European Union, Ubbo Emmius Foundation, GSK, Vertex, TEVA the Netherlands and Zon MW (VICI grant); consultancy fees from GSK, Pure IMS and AstraZeneca; and payment or honoraria for lectures, presentations, manuscript writing or educational events from Sanofi, Boehringer Ingelheim and AstraZeneca. E. Melén reports consultancy fees from ALK, AstraZeneca, Chiesi, Novartis and Sanofi. K. Milger reports grants from BMBF, Stiftung Atemweg, Janssen, Novartis and AstraZeneca; consultancy fees from AstraZeneca, GSK, Janssen and Sanofi; payment or honoraria for lectures, presentations, manuscript writing or educational events from AstraZeneca, GSK, Sanofi, Janssen and Novartis; and leadership roles with DGP Section allergy and immunology (Vice Chair) and German Asthma Net eV (Scientific Advisory Board). A. Moeller reports grants from Vertex Inc.; consultancy fees from Vertex Inc.; payment or honoraria for lectures, presentations, manuscript writing or educational events from Vertex Inc.; participation on a data safety monitoring board or advisory board with Vertex Inc.; and a leadership role with ERS (Head of Assembly 7). C.S. Murray reports grants from NIHR, Asthma UK and MRC; payment or honoraria for lectures, presentations, manuscript writing or educational events from GSK, Novartis and ThermoFisher; and support for attending meetings from Sanofi. P. Nagakumar reports grants from NIHR; consultancy fees from Sanofi and AstraZeneca; and payment or honoraria for lectures, presentations, manuscript writing or educational events from GSK and Novartis. P. Nair reports grants from AstraZeneca, Teva, Sanofi, Foresee and Cyclomedica; consultancy fees from Arrowhead Pharma; payment or honoraria for lectures, presentations, manuscript writing or educational events from AstraZeneca, Teva and GSK; and participation on a data safety monitoring board or advisory board with Sanofi, Equillium and GSK. A. Nieto reports consultancy fees from ASAC Pharma; payment or honoraria for lectures, presentations, manuscript writing or educational events from Novartis, Immunotek and Uriach; and support for attending meetings from Immunotex. N.G. Papadopoulos reports grants from Capricare, Nestle, Numil and Vianex; and consultancy fees from Abbott, Abbvie, AstraZeneca, GSK, HAL, Medscape, Menarini/Faes Farma, Mylan, Novartis, Nutricia, OM Pharma and Regeneron/Sanofi. M.W. Pijnenburg reports consultancy fees from Sanofi; payment or honoraria for lectures, presentations, manuscript writing or educational events from Novartis and Abbvie; support for attending meetings from ERS; and a leadership role with ERS (Head of Assembly 7). K.C. Pike reports consultancy fees from Respiri and Adherium; payment or honoraria for lectures, presentations, manuscript writing or educational events from Sanofi; and support for attending meetings from GSK. C. Porsbjerg reports grants from AstraZeneca, GSK, Novartis, TEVA, Sanofi, Chiesi and ALK; consultancy fees from AstraZeneca, GSK, Novartis, TEVA, Sanofi, Chiesi and ALK; payment or honoraria for lectures, presentations, manuscript writing or educational events from AstraZeneca, GSK, Novartis, TEVA, Sanofi, Chiesi and ALK; and participation on a data safety monitoring board or advisory board with AstraZeneca, Novartis, TEVA, Sanofi and ALK. A. Rattu reports support for the present study from 3TR European Union IMI 2. H. Rupani reports grants from GSK and AstraZeneca; payment or honoraria for lectures, presentations, manuscript writing or educational events from GSK, AstraZeneca and Chiesi; and support for attending meetings from AstraZeneca. P. Seddon reports grants from NIHR; participation on a data safety monitoring board or advisory board with WAVE Study (sponsor and funder Inspiration Healthcare Limited); and receipt of equipment, materials, drugs, medical writing, gifts or other services from Vapotherm Inc. S. Siddiqui reports payment or honoraria for lectures, presentations, manuscript writing or educational events from AstraZeneca, GSK, Chiesi, WebMD, Areteia Therapeutics; participation on a data safety monitoring board or advisory board with AstraZeneca, GSK, Chiesi, WebMD, Areteia Therapeutics and MRC; leadership role with ERS Science Council; and stock (or stock options) with Eupnoos Ltd (co-founder and holds a 5% equity stake). F. Singer reports grants from Medical University of Graz and LungenLiga Bern; payment or honoraria for lectures, presentations, manuscript writing or educational events from Novartis Pharma Switzerland, Vertex Pharmaceuticals Switzerland and Vertex Pharmaceuticals Austria; and support for attending meetings from Chiesi Pharmaceuticals Austria. J.W. Upham reports payment or honoraria for lectures, presentations, manuscript writing or educational events from AstraZeneca, GSK and Sanofi; and a leadership role with Thoracic Society of Australia & New Zealand (president). S.J.H. Vijverberg reports grants from Lung Foundation Netherlands, ERA-PerMed and ZonMW; and leadership role with ERS (ECMC member). P.A.B. Wark reports a leadership role with National Asthma Council of Australia. M.E. Wechsler reports consultancy fees from Amgen, Areteia Therapeutics, AstraZeneca, Avalo Therapeutics, Boehringer Ingelheim, Celldex Cellergy Pharma, Cerecor, Cytoreason, Eli Lilly, Equillium, GSK, Incyte, Kinaset, Merck, Novartis, Om Pharma, Overtone Therapeutics/Foresite Labs, Phylaxis, Pulmatrix, Rapt Therapeutics, Regeneron, Roche/Genentech, Sanofi/Genzyme, Sentien, Sound Biologics, Tetherex Pharmaceuticals, Teva, Upstream Bio and Verona Pharma; payment or honoraria for lectures, presentations, manuscript writing or educational events from Amgen, Areteia Therapeutics, AstraZeneca, Avalo Therapeutics, Boehringer Ingelheim, Celldex Cellergy Pharma, Cerecor, Cytoreason, Eli Lilly, Equillium, GSK, Incyte, Kinaset, Merck, Novartis, Om Pharma, Overtone Therapeutics/Foresite Labs, Phylaxis, Pulmatrix, Rapt Therapeutics, Regeneron, Roche/Genentech, Sanofi/Genzyme, Sentien, Sound Biologics, Tetherex Pharmaceuticals, Teva, Upstream Bio and Verona Pharma; and participation on a data safety monitoring board or advisory board with Sentien. V. Yasinska reports participation on a data safety monitoring board or advisory board with AstraZeneca and GSK. G. Roberts reports support for the present study from EU IMI, and consultancy fees from AstraZeneca. The remaining authors have no potential conflicts of interest to disclose.

Figures

None — Summary of the study. ACQ: Asthma Control Questionnaire; ACT: Asthma Control Test; COMSA: Core Outcome Measures sets for Severe Asthma; FEV₁: forced expiratory volume in 1 s; HCP: healthcare professional; OCS: oral corticosteroid; PAQLQ: Paediatric Asthma Quality of Life Questionnaire; SAQ: Severe Asthma Questionnaire.

**FIGURE 1**
Flow diagram of the study. Words in italics indicate differences between steps. COMSA: Core Outcome Measures for Severe Asthma; CONFiRM: CompOsite iNdex For Response in asthMa; HCP: healthcare professional; MCDA: multicriteria decision analysis; PP: patient profile.

**FIGURE 2**
Example of patients. a) Scenarios generated by 1000minds in step 2. b) Patient profiles presented in steps 3 and 4. Similar scenarios and patient profiles were presented for the paediatric surveys. Emoji were used to help participants in rating the scenarios. Severe asthma exacerbations are defined as per the European Respiratory Society/American Thoracic Society guideline [13]. Maintenance (regular) oral corticosteroid (OCS) use is defined as daily or alternate day use of OCS. ACQ: Asthma Control Questionnaire; COMSA: Core Outcome Measures for Severe Asthma; FEV₁: forced expiratory volume in 1 s; SAQ: Severe Asthma Questionnaire.

**FIGURE 3**
Maximal weights for each core outcome measure in the CompOsite iNdex For Response in asthMa (CONFiRMs). a) Paediatric CONFiRM. b) Adult CONFiRM. Spider plots describe the maximal mean weight assigned to Core Outcome Measures set for paediatric and adult Severe Asthma (COMSA) [12] outcome measure. The panel assumed that Asthma Control Test (ACT) and Childhood-ACT have the same weighting in the paediatric CONFiRM. Severe asthma attacks are defined as per the European Respiratory Society/American Thoracic Society guideline [13]. Maintenance oral corticosteroid (OCS) use is defined as daily or alternate day use of OCS. ACQ: Asthma Control Questionnaire; FEV₁: forced expiratory volume in 1 s (% predicted); PAQLQ: Paediatric Asthma Quality of Life Questionnaire; SAQ: Severe Asthma Questionnaire.

**FIGURE 4**
CompOsite iNdex For Response in asthMa (CONFiRM) score in step 3 (internal validation). a) Paediatric CONFiRM. b) Adult CONFiRM. Magnitude of response was most frequently selected (modal) by healthcare professionals and patient advocates for 50 patient profiles. Definitions of overall magnitude of response used in the study are presented in box 1. Total score for these patient profiles was calculated based on weights for each outcome measure assigned in step 2. The analysis was weighted by case frequency. The CONFiRM score for each patient case is represented by box and whisker plots (box: median with 25th and 75th centiles; lines represent 2.5 to 97.5 centiles). The CONFiRM scores for each overall magnitude of change (deleterious to super-response) were significantly different for both the paediatric (Kruskal–Willis χ²=2623.1, p<0.0001; χ²=2506.5, p<0.0001; χ²=2657.1, p<0.0001 for all participants, patient advocates and healthcare professionals, respectively) and adult (χ²=2974.7, p<0.0001; χ²=2854.3, p<0.0001; χ²=3216.3, p<0.0001) CONFiRMs.

**FIGURE 5**
CompOsite iNdex For Response in asthMa (CONFiRM) score in step 4 (external validation). a) Paediatric CONFiRM. b) Adult CONFiRM. Magnitude of response was most frequently selected (modal) by healthcare professionals for 15 patient profiles. Definitions of magnitude of response used in the study are presented in box 1. Total score for these patient profiles was calculated based on relative weights for each outcome measure assigned at step 2. The analysis was weighted by case frequency. The CONFiRM score for each patient case is represented by box and whisker plots (box: median with 25th and 75th centiles; lines represent 2.5 to 97.5 centiles). CONFiRM scores for each overall magnitude of change (deleterious to super-response) were significantly different for both the paediatric (Kruskal–Willis χ²=502.7, p<0.0001) and adult (χ²=648.5, p<0.0001) CONFiRMs. Similar results were found for adult patient profiles where maintenance oral corticosteroid was not used at baseline (supplementary figure S11).

**FIGURE 6**
Ranking of the 15 patient profiles in order of improvement on biologics from 1st (worsening) to 15th (largest improvement) in stage 4. a) Paediatric patient profiles. b) Adult patient profiles. Ranks for each patient profile are represented by box and whisker plots (box: median with 25th and 75th centiles; lines represent 2.5 to 97.5 centiles). Weighting of each patient profile in the dataset was calculated based on the number of patient profiles per cluster. Both CompOsite iNdex For Response in asthMa (CONFiRM) tools demonstrated excellent external validity (Spearman correlation coefficients r=0.9 and 0.8 for paediatric and adult patient profiles, respectively; p<0.0001).

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Advancing patient-centred care in measuring response to biologics in severe asthma.
Bellou V. Bellou V. Eur Respir J. 2025 Mar 27;65(3):2402113. doi: 10.1183/13993003.02113-2024. Print 2025 Mar. Eur Respir J. 2025. PMID: 40147860 No abstract available.

References

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1. Coleman C, Khaleva E, Rattu A, et al. . Narrative review to capture patients’ perceptions and opinions about non-response and response to biological therapy for severe asthma. Eur Respir J 2023; 61: 2200837. doi:10.1183/13993003.00837-2022 - DOI - PMC - PubMed
1. Anderson WC, 3rd, Szefler SJ. Cost-effectiveness and comparative effectiveness of biologic therapy for asthma: to biologic or not to biologic? Ann Allergy Asthma Immunol 2019; 122: 367–372. doi:10.1016/j.anai.2019.01.018 - DOI - PubMed
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Patient-centred composite scores as tools for assessment of response to biological therapy for paediatric and adult severe asthma

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Patient-centred composite scores as tools for assessment of response to biological therapy for paediatric and adult severe asthma

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