Objectives:Fraciton of exhaled nitric oxide (FeNO) and blood eosinophil counts (b-EOS) are recognized as the predictors for effectiveness of biologics to ?ype 2 severe asthma. Previously, we reported asthma exacerbation (AE) was most frequent in severe asthma patients with the high FeNO/low b-EOS among four subgroups of those who were treated with biologics except for dupilumab or no biologics and divided by FeNO and b-EOS (Front Pharmacol. 2022;13:836635). Here, we further examined the frequency of acute exacerbation in severe asthma patients receiving omalizumab, mepolizumab, benralizumab, or dupilumab.

Methods:One hundred twenty one severe asthma patients were classified into 4 four subgroups based on FeNO (27ppb) and b-EOS (265/?l). Annual frequency of AEs and prevalence of four biologics was evaluated in the 4 subgroups.

Results:The high FeNO/high b-EOS, high FeNO/low b-EOS, low FeNO/high b-EOS, and low FeNO/low b-EOS subgroup had 32, 30, 28, and 31of patients, respectively.There was no significant difference in the number of AEs between the four groups (p=0.054).

Biologic use rates differed among the four groups?p=0.02?, showing a higher rate of dupilumab use (33%) in the high FeNO/low b-EOS.

Conclusion:Dupilumab use might contribute to the reduction of AEs observed with the high FeNO/low b-EOS subgroup.