Introduction

Definitions of severe asthma Super Responders (SR) usually encompass clinical stability or symptoms improvement after biologic therapy. Recently, an international consensus defined SR according to a set of major and minor criteria including an Asthma Control Test (ACT) ? 20 and an ACT improvement ? 6 points after a complete course of treatment. However, biologic therapies can be also prescribed in patients with a baseline clinical stability, decreasing the impact of these ACT-based criteria on SR assessment.

Aims and objectives

To assess SR features according to their baseline ACT score.

Methods

We enrolled 71 patients with severe asthma treated with monoclonal antibodies. SR were defined according to the following criteria:

Major

·No exacerbations;

·No OCS administration;

·ACT improvement ? 6 points.

Minor

·Exacerbations decrease ? 75% from baseline;

·ACT ? 20 points;

·FEV1 improvement ? 500 ml from baseline

SR were defined when fulfilling ? 3 features with at least 2 major criteria after 6 months of biologic therapy.

Results

53 patients (74.6%) were classified as SR, with 39 of them reporting an ACT<20, while 26.4% had already an ACT ?20. The latter group showed lower mean doses of administered OCS (P=0.008), higher FeNO (P=0.02) and blood eosinophils (P=0.02), as well a greater number of comorbidities (P=0.02), such as EGPA (P=0.02), Eosinophilic pneumonia (P=0.01) and CRwNP (P=0.006). Using multivariate logistic regression, EGPA and CRwNP resulted associated with SR showing an ACT ?20 (P=0.001).

Conclusions

SR patients with baseline ACT ?20 show a different inflammatory profile compared with patients with ACT<20,with a higher impact of comorbidities in their severe asthma management.