Asthma

As ever, the annual ERS Congress featured a wide range of advances in both the prevention and treatment of asthma. In this video, Prof Dr Guy Brusselle, respiratory physician at the Ghent University Hospital and chair of the Global Initiative for Asthma (GINA), shares his key, asthma-related takeaways from ERS 2025

Historically, prevention efforts for asthma have underperformed. At ERS 2025, however, a renewed call to action was issued. In adults, four modifiable risk factors are recognized as independent drivers of asthma development: smoking, occupational exposures, obesity, and air pollution. Among these, obesity stands out as a particularly important global factor. With the advent of effective therapies such as GLP-1 receptor agonists, there is now strong interest in investigating whether weight management could reduce the incidence of adult-onset asthma.

In children, severe RSV infections in infancy significantly increase the risk of early asthma. New preventive options, such as RSV vaccination during pregnancy to protect newborns and the use of RSV monoclonal antibodies in infants, offer an unprecedented opportunity to reduce asthma onset in childhood. While large-scale prospective studies are necessary to confirm their impact, these tools likely represent an important turning point in asthma prevention.

Turning to treatment, important updates were shared on inhaler strategies. In moderate to severe asthma, adding a long-acting muscarinic antagonist (LAMA) to ICS-LABA (triple therapy) consistently improves lung function and reduces exacerbations by about 15%. While this reduction may seem modest, it is clinically very relevant. In practice, GINA Step 4 patients with persistent symptoms but limited exacerbations and low type 2 inflammation may benefit most from this escalation. In contrast, for patients with type 2-high asthma and frequent exacerbations, stepping up to high-dose ICS-LABA is advised. If symptoms persist, biologic therapy becomes a necessity in these patients.

Currently, six biologic agents have been approved for the treatment of severe asthma, making personalized selection crucial. To guide physicians in this choice, Prof Brusselle  proposes to always consider the ‘ABCDE algorithm’:

• Age at onset (childhood vs. adult asthma)
• Biomarkers (eosinophil count, FeNO levels)
• Comorbidities (e.g., atopic dermatitis, chronic rhinosinusitis with nasal polyps)
• Dosing frequency (ranging from every 2 weeks to every 2 months)
• Exacerbation history, especially critical for IL-5 pathway biologics.

Together, these advances in prevention (targeting obesity and RSV) and personalized therapy (optimized inhaler use and biologic selection) represent major opportunities to reduce both the incidence and the global burden of asthma.