{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T13:24:40Z","timestamp":1786973080578,"version":"build-2736575974"},"reference-count":25,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T00:00:00Z","timestamp":1786924800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004045","name":"Karadeniz Technical University","doi-asserted-by":"publisher","award":["11138"],"award-info":[{"award-number":["11138"]}],"id":[{"id":"10.13039\/501100004045","id-type":"DOI","asserted-by":"publisher"}]},{"award":["11138"],"award-info":[{"award-number":["11138"]}],"id":[{"id":"https:\/\/ror.org\/03z8fyr40","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background\/Objectives: Tissue-level markers of treatment response are lacking in severe asthma. Transthoracic ultrasound (TUS) non-invasively detects pleural-line and subpleural abnormalities that have been linked to small-airway disease, but it has not been evaluated as a marker of response to biologic therapy. The primary objective was to determine whether mean pleural-line thickness in the right and left hemithoraces changed between baseline and week 16 of biologic therapy. The secondary objectives were to describe the accompanying changes in pleural-line regularity, lung function, symptom control, and quality of life, and to examine whether the ultrasound changes are related to the clinical and functional response. Methods: In this prospective, single-center study, 41 adults with severe asthma who were starting omalizumab (n = 18), mepolizumab (n = 12), or benralizumab (n = 11) underwent standardized 14-zone TUS, spirometry, the Asthma Control Test (ACT), and the Asthma Quality of Life Questionnaire (AQLQ) at baseline and after 16 weeks. Pleural-line thickness and pleural-line regularity score were the primary TUS measures. Paired and between-group tests and Spearman rank correlations were used. Results: At week 16, 20 patients (48.8%) were complete responders. The mean ACT score increased from 13.2 \u00b1 4.1 to 22.6 \u00b1 2.9, the mean AQLQ total score from 3.6 \u00b1 1.2 to 4.9 \u00b1 1.2, FEV1 from 86.0 \u00b1 24.8% to 99.0 \u00b1 20.9% predicted, and FEF25\u201375 from 61.4 \u00b1 35.0% to 81.2 \u00b1 33.4% predicted (all p \u2264 0.001), whereas the blood eosinophil count fell from a median of 400 (0\u20131990) to 80 (0\u2013330) cells\/\u00b5L (p &lt; 0.001). Median pleural-line thickness decreased from 1.27 to 0.94 mm in the right hemithorax and from 1.31 to 0.97 mm in the left hemithorax (both p &lt; 0.001), and the pleural-line regularity score increased on both sides (both p &lt; 0.001). Pleural-line thickness decreased significantly in all three biologic groups (all p \u2264 0.001), with no evidence of a differential treatment effect. Changes in pleural-line thickness did not correlate with \u0394ACT, \u0394AQLQ, \u0394FEV1, or \u0394FEF25\u201375 (all p &gt; 0.05). Conclusions: After 16 weeks of biologic therapy, pleural-line thickness was reduced and the pleural-line regularity score had improved on TUS. Because these pleural changes did not correlate with the symptomatic or spirometric response, TUS may capture a complementary, tissue-level dimension of the treatment effect. As the study was an uncontrolled single-arm design, the changes cannot be attributed to the biologic agent itself, and prospective controlled validation is required before TUS can be proposed as a marker of response.<\/jats:p>","DOI":"10.3390\/jcm15166346","type":"journal-article","created":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T12:01:26Z","timestamp":1786968086000},"page":"6346","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Biologic Therapy Is Associated with Reduced Pleural-Line Thickness in Severe Asthma: A Prospective Transthoracic Ultrasound Study"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3948-7007","authenticated-orcid":false,"given":"M\u00fcge","family":"Erbay","sequence":"first","affiliation":[{"name":"Section of Immunology and Allergy Diseases, Department of Chest Diseases, Medical Faculty, Karadeniz Technical University, 61080 Trabzon, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6680-1156","authenticated-orcid":false,"given":"Sel\u00e7uk","family":"Akkaya","sequence":"additional","affiliation":[{"name":"Department of Radiology, Medical Faculty, Karadeniz Technical University, 61080 Trabzon, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Funda","family":"\u00d6ztuna","sequence":"additional","affiliation":[{"name":"Department of Chest Diseases, Medical Faculty, Karadeniz Technical University, 61080 Trabzon, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0039-9408","authenticated-orcid":false,"given":"Hatice","family":"Tayar","sequence":"additional","affiliation":[{"name":"Department of Radiology, Medical Faculty, Karadeniz Technical University, 61080 Trabzon, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,17]]},"reference":[{"key":"ref_1","unstructured":"Global Initiative for Asthma (2024, July 12). 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