{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T13:18:33Z","timestamp":1783084713670,"version":"3.54.6"},"reference-count":20,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T00:00:00Z","timestamp":1783036800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPM"],"abstract":"<jats:p>Background: Biologic therapies have transformed severe asthma management, but real-world evidence comparing phenotypes, lung function trajectories, and persistence across biologic classes remains limited. Objective: To characterize a real-world cohort of biologic-treated severe asthma patients, focusing on baseline phenotypes, longitudinal post-bronchodilator spirometry (including a spirometric surrogate suggestive of small airways involvement), and discontinuation\/switching patterns. Methods: In this retrospective observational study at a tertiary referral center, adults with severe asthma treated with benralizumab, mepolizumab, omalizumab, or tezepelumab were included. Demographic, clinical, biomarker, and functional data were collected at baseline and follow-up. Post-bronchodilator FEV1 and FEF25\u201375 (% predicted) were assessed at baseline, 6 months, 12 months, and 24\u201336 months when available. Longitudinal outcomes were analyzed using multivariable linear mixed-effects models; discontinuation and switching were recorded. Results: Eighty-seven patients were included (benralizumab n = 13, omalizumab n = 10, mepolizumab n = 30, tezepelumab n = 34), representing 10.9% of the clinic\u2019s population. Most had long-standing disease, elevated body mass index, and a T2-high profile. Baseline characteristics were generally similar across groups, with expected differences in total IgE (p = 0.007) and blood eosinophils (p &lt; 0.001). The primary endpoint (FEV1 % predicted change from baseline to 12 months) showed adjusted mean changes of +12.46 (95% CI +1.63 to +19.29; p = 0.020) with benralizumab, +15.82 (+8.35 to +23.64; p &lt; 0.001) with mepolizumab, +16.65 (+1.58 to +31.71; p &lt; 0.001) with omalizumab, and +15.69 (+6.52 to +24.87; p = 0.030) with tezepelumab; trajectories differed by biologic class (time \u00d7 biologic p = 0.019). Although the interaction term indicated heterogeneous temporal patterns, these adjusted findings should be interpreted as associative in the context of biomarker-driven treatment selection and not as evidence of comparative superiority of any biologic class. Discontinuation occurred in 15\/87 (17.2%), with switching most commonly due to inadequate control. Conclusions: Real-world severe asthma patients demonstrate heterogeneous phenotypes and spirometric trajectories on biologics. Integrating biomarkers with longitudinal lung function monitoring, including small-airway spirometric surrogates, supports individualized management.<\/jats:p>","DOI":"10.3390\/jpm16070362","type":"journal-article","created":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T11:39:11Z","timestamp":1783078751000},"page":"362","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Real-World Phenotypic Profiles and Longitudinal Lung Function Outcomes in Severe Asthma Treated with Biologic Therapies"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5219-6971","authenticated-orcid":false,"given":"Ourania S.","family":"Kotsiou","sequence":"first","affiliation":[{"name":"Laboratory of Human Pathophysiology, Department of Nursing, University of Thessaly, Gaiopolis, 41500 Larissa, Greece"},{"name":"Department of Respiratory Medicine, University of Thessaly, Biopolis, 41110 Larissa, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-7416-7765","authenticated-orcid":false,"given":"Georgios I.","family":"Barkas","sequence":"additional","affiliation":[{"name":"Laboratory of Human Pathophysiology, Department of Nursing, University of Thessaly, Gaiopolis, 41500 Larissa, Greece"},{"name":"Department of Respiratory Medicine, University of Thessaly, Biopolis, 41110 Larissa, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9541-1010","authenticated-orcid":false,"given":"Konstantinos I.","family":"Gourgoulianis","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, University of Thessaly, Biopolis, 41110 Larissa, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1058-9125","authenticated-orcid":false,"given":"Zoe","family":"Daniil","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, University of Thessaly, Biopolis, 41110 Larissa, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1164\/rccm.202109-2205PP","article-title":"Global Initiative for Asthma Strategy 2021: Executive Summary and Rationale for Key Changes","volume":"205","author":"Reddel","year":"2022","journal-title":"Am. 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