Assessment of long-term safety and efficacy of dupilumab in children with asthma (LIBERTY ASTHMA EXCURSION): an open-label extension study

Update in paediatric asthma

PURPOSE OF REVIEW

The field of paediatric asthma is rapidly moving, with the advent of new biologicals for severe asthma and increased understanding of preschool wheeze amongst other developments and insights.

RECENT FINDINGS

There is increasing evidence of efficacy in children for biologics directed against Type 2 inflammation (especially mepolizumab and dupilumab) as well encouraging evidence that Tezepelumab may be effective against Type 2 low phenotypes. The importance of airway remodelling and infection in the pathophysiology of preschool wheeze is increasingly appreciated. The treatment of preschool wheeze is moving from symptom-based to biomarker driven therapies. Other important areas are prediction of risk of asthma attacks, the SMART regime, the importance of climate change and reducing greenhouse gas emissions from inhalers while ensuring adequate therapy for young children, the association of early adverse environmental factors including childhood poverty and deprivation and the switch to race-neutral lung function equations.

SUMMARY

We are increasingly moving towards personalized medicine and the use of biomarkers to guide treatment of wheeze at all ages, but we need to move from counting cells to determining their functional status. Airway wall structural changes rather than inflammation may drive the progression of preschool wheeze to school age asthma.

Management of severe asthma in children: current insights and future directions

INTRODUCTION

Severe pediatric asthma represents a critical challenge in respiratory medicine, affecting a small but significant subset of children with disproportionate morbidity and healthcare burden. Its complexity arises from diverse phenotypes, endotypes, and inflammatory pathways that complicate diagnosis and management. Recent advances in precision medicine, particularly biologic therapies targeting Type 2 inflammation, offer new opportunities for improved outcomes.

AREAS COVERED

This review synthesizes current knowledge on severe pediatric asthma, emphasizing the pathophysiology, clinical phenotypes, and therapeutic advancements. It explores the role of biomarkers and endotypes in guiding personalized therapy and critically examines challenges such as non-Type 2 inflammation, barriers to biologic access, and variability in treatment response. A comprehensive literature search was conducted, focusing on biologic therapies, diagnostic innovations, and emerging care models.

EXPERT OPINION

Despite progress, challenges remain in achieving standardized treatment response definitions, validating biomarkers, and addressing cost barriers. Early biologic initiation in high-risk children and multidisciplinary care are critical to advancing outcomes. Future efforts should prioritize predictive algorithms, innovative therapies, and equitable access to shift from symptom control to disease prevention, potentially redefining the pediatric asthma care paradigm.

What We Know to Date About Early Treatment With Biologics in Severe Asthma: A Scoping Review About the Use of Biologics in Severe Asthma and Possible Parallels With Early Rheumatoid Arthritis

Introduction

Theoretically, an early intervention with biologics in severe asthma (SA) patients may attenuate inflammatory processes and potentially halt disease progression and remodeling. Changing the approach to a more preventive one could alter the course of the disease, avoid its progression, and improve the likelihood of achieving clinical remission. The aims of this study were to gather scientific evidence on this topic, to draw a parallel between SA and rheumathoid arthritis (RA) and to analyze the potential benefits of establishing early treatment in SA.

Material and methods

A systematic scoping review, conducted in accordance with the methodological guidance of the Arksey and O'Malley framework and focusing on early treatment intervention with biological drugs in SA and RA is presented.

Results

Evidence supports the early intervention with biologics in RA to improve outcomes. Evidence regarding early intervention with biologics in SA is scarce. To date, the literature reviewed suggests that better clinical condition of the patient and more preserved lung function at the onset of biological treatment, together with a shorter duration of asthma, are associated with better response to biologics.

Conclusions

Data suggests that the more preventive approach may lead to improved results. The scarcity of scientific evidence highlights the importance of pursuing this line of research.

Biologic Therapies for Severe Asthma in School-Age Children

Children with severe asthma incur substantial disease-related morbidity. Despite treatment with inhaled corticosteroids and additional controller medications, many patients continue to experience recurrent exacerbations, impaired lung function, and diminished quality of life. Most children with severe asthma demonstrate evidence of a phenotype consistent with ongoing type 2 inflammation. Fortunately, the advent of biologic therapies, monoclonal antibodies that target specific pathways relevant to asthma pathogenesis, has allowed most children with severe asthma to experience marked improvements in disease control and clinical outcomes. Four biologic medications that target various aspects of type 2 inflammation-specifically omalizumab, mepolizumab, benralizumab, and dupilumab-are currently approved by the United States Food and Drug Administration for use in children 6-11 years of age with specific phenotypes of severe asthma. The selection of the most appropriate biologic for a patient's phenotype is driven by a biomarker-based approach, including assessments of blood eosinophil counts, fraction of exhaled nitric oxide levels, and allergic sensitization and total immunoglobulin E levels. These biologic medications have been demonstrated to significantly reduce the rates of asthma exacerbations between 27% and 59% relative to placebo, although they vary in their impact on lung function. The overall safety profiles of these biologics have been reassuring. This review discusses the role of biologics in childhood asthma, including the strategy for phenotyping patients, summarizes the data supporting the efficacy and safety of biologics in this population, and presents an approach for choosing a biologic and monitoring patient outcomes.

Detection of Breath Nitric Oxide at Ppb Level Based on Multiperiodic Spectral Reconstruction Neural Network

As breath nitric oxide (NO) is a biomarker of respiratory inflammation, reliable techniques for the online detection of ppb-level NO in exhaled breath are essential for the noninvasive diagnosis of respiratory inflammation. Here, we report a breath NO sensor based on the multiperiodic spectral reconstruction neural network. First, a spectral reconstruction method that transforms a spectrum from the wavelength domain to the intensity domain is proposed to remove noise and interference signals from the spectrum. Different from the traditional spectral processing method based on the wavelength domain, the method enhances the absorption characteristics of a target gas in the intensity domain, while discretizing noise and interference signals. This facilitates the extraction of the target gas spectrum. Then, a neural network is built to detect the concentration of breath NO. Laboratory-based results show that the sensor enables online detection of NO (1.63-846.68 ppb) with mean absolute error (MAE), mean absolute percentage error (MAPE), and detection accuracy of 0.31 ppb, 0.96% and 0.63%, respectively. Furthermore, an actual exhalation experiment proved that the sensor is capable of distinguishing breath NO of healthy people from that of simulated patients, which provides a reliable way to realize exhaled breath detection based on optical methods in the medical field.

Severe Asthma in School-Age Children: An Updated Appraisal on Biological Options and Challenges in This Age Group

This review examines the growing role of biological therapies in managing severe asthma in children aged 6-11 years. Severe asthma, characterized by persistent symptoms and frequent exacerbations, presents significant challenges in pediatric care. Biologic treatments, including mepolizumab, omalizumab, and dupilumab, provide targeted interventions for patients with high eosinophilic inflammation or allergic asthma (T2-high asthma). Alongside their therapeutic benefits, the review evaluates the safety profiles of these biologics, highlighting potential side effects and the necessity for monitoring during long-term use. Cost considerations and treatment adherence also emerge as important challenges that need to be addressed in clinical practice. Additionally, the review emphasizes the need for identifying patients who would derive the most benefit from biologic therapies, advocating for the development of biomarkers to aid in treatment decisions. Emerging biologics, such as tezepelumab, are introduced as promising alternatives with the potential to target upstream inflammatory pathways, offering hope for treating T2-low asthma forms, which currently lack effective treatment options in children.

Eosinophilic esophagitis in the "atopic march": dupilumab as an "umbrella" strategy for multiple coexisting atopic diseases

Dupilumab is a monoclonal antibody targeting interleukin-4 and interleukin-13, approved for the treatment of multiple T2 diseases and more recently for Eosinophilic Esophagitis (EoE). EoE is a chronic T2 inflammatory disease, believed to be a member of the "atopic march", due to multiple similarities with other atopic diseases, ranging from epidemiology to genetics and pathophysiology. Although often co-existing in the same patient, these diseases are still treated as separated entities by different specialists, resulting in polypharmacy and chronic use of steroids. Thus, a shared-decision approach by a multidisciplinary team composed of different specialists might improve clinical management and outcomes. Yet, prospective data on the effectiveness of dupilumab as a single agent for multiple T2 inflammatory diseases are lacking, since only few case reports and small studies have been published so far reporting outcomes in patients affected by multiple T2 diseases. The purpose of this review is to illustrate the rationale and clinical evidence supporting the possibility of using dupilumab as a single therapeutic agent in those patients affected by multiple T2 diseases in addition to EoE.

Safety of dupilumab in Chinese pediatric patients aged 6 months and older: a prospective real-world study

Objective

This study analyzes the occurrence and characteristics of adverse drug reactions (ADRs) of dupilumab in children in a real-world setting. It aims to enhance clinical practice and minimize medication safety risks in pediatric patients.

Methods

This prospective study included children receiving dupilumab in the hospital between January 2022 and December 2023. Information on ADRs was collected and univariate and multivariate analyses were employed to identify high-risk factors for the occurrence of adverse effects in dupilumab treatment.

Results

A total of 65 ADRs occurred in 1,103 treatments in 127 patients, with an incidence of 27.56% (35/127). A total of 62 patients aged 6 or below participated in this study, accounting for 48.82%. Univariate analysis showed that gender, age, duration of medication, frequency of dupilumab use were risk factors for the occurrence of adverse effects (P < 0.05). Multivariate logistic regression analysis showed that age [odds ratio [OR]: 0.071, 95% confidence interval [CI]: 0.012-0.433; P = 0.004] and frequency of dupilumab use (OR: 3.306, 95% CI: 1.078-10.135; P = 0.036) were risk factors for adverse effects. The outcomes of ADRs were improved in 10 cases (15.38%) and completely recovered in 55 cases (84.62%).

Conclusion

Dupilumab has a good safety profile in Chinese children aged 6 months to 18 years for up to 2 years of treatment, with most adverse reactions being mild to moderate, and no serious ocular adverse reactions were reported. Age and frequency of dupilumab use were risk factors for adverse effects. Younger age and higher frequency of dupilumab use were associated with higher odds of ADRs.

Mechanistic modelling of allergen-induced airways disease in early life

Asthma affects approximately 300 million individuals worldwide and the onset predominantly arises in childhood. Children are exposed to multiple environmental irritants, such as viruses and allergens, that are common triggers for asthma onset, whilst their immune systems are developing in early life. Understanding the impact of allergen exposures on the developing immune system and resulting alterations in lung function in early life will help prevent the onset and progression of allergic asthma in children. In this study, we developed an in silico model describing the pulmonary immune response to a common allergen, house dust mite, to investigate its downstream impact on the pathophysiology of asthma, including airway eosinophilic inflammation, remodelling, and lung function. We hypothesised that altered epithelial function following allergen exposure determines the onset of airway remodelling and abnormal lung function, which are irreversible with current asthma therapies. We calibrated the in silico model using age appropriate in vivo data from neonatal and adult mice. We validated the in silico model using in vivo data from mice on the effects of current treatment strategies. The in silico model recapitulates experimental observations and provides an interpretable in silico tool to assess airway pathology and the underlying immune responses upon allergen exposure. The in silico model simulations predict the extent of bronchial epithelial barrier damage observed when allergen sensitisation occurs and demonstrate that epithelial barrier damage and impaired immune maturation are critical determinants of reduced lung function and asthma development. The in silico model demonstrates that both epithelial barrier repair and immune maturation are potential targets for therapeutic intervention to achieve successful asthma prevention.

Pediatric pulmonology 2023 year in review: Asthma

Caring for children with asthma continues to be an essential responsibility of the pediatric pulmonologist. In this Pediatric Pulmonology Year in Review, we summarize the significant publications focused on pediatric asthma that have been published over the last year. Articles were selected from Pediatric Pulmonology and other relevant medical journals that historically publish in the field of pediatrics, and more specifically, pediatric asthma. Our aim was to highlight publications that may impact or change clinical practice. Once articles were collected, specific themes were chosen to best orient the reader to particular interests. In this review, we will discuss new findings that assist in the diagnosis and evaluation of pediatric asthma, highlight risk factors and social determinants that impact successful care, and discuss new interventions and treatment modalities for acute exacerbations and maintenance control. We hope this review can provide new insights and guidance for implementation into clinical practice within the field of pediatric asthma.

The assessment of dupilumab in children with moderate-to-severe asthma and comorbid type 2 inflammatory diseases

BACKGROUND

Dupilumab inhibiting the signaling of interleukin(IL)-4 and IL-13 was recommended for the treatment of severe asthma in children ≥ 6 years old according to the Global Initiative for Asthma (GINA,2024).This study aimed to analyse the efficacy and safety of dupilumab in paediatric patients with moderate-to-severe asthma and comorbid type 2 inflammatory disease in a real-world population.

METHODS

We evaluated the medical records of paediatric patients with moderate-to-severe asthma and comorbid type 2 inflammatory diseases, such as atopic dermatitis (AD) and allergic rhinitis (AR), receiving dupilumab treatment.

RESULTS

Twenty-five children (16 boys; mean age, 9.32 ± 2.58 years) were included. All the patients were diagnosed with moderate-to-severe asthma, 92% (23/25) with AR, and 64.0% (16/25) with AD. Among the 25 patients, no severe adverse reactions occurred, the times of severe asthma exacerbation were significantly lower, and the Asthma Control Test (ACT) / Child-Asthma Control Test (C-ACT) scores were significantly higher than those before the 24-week dupilumab treatment (all P = 0.00). The Patient-Oriented Eczema Measure(POEM) and Peak Pruritus Numerical Rating Scale(NRS), Rhinitis Four-point, and Rhinitis Visual Analogue Scale(VAS) scores were significantly lower than those at baseline (all P < 0.05). After receiving 24-week dupilumab treatment, the serum total immunoglobulin E (tIgE) and fractional exhaled nitric oxide (FeNO) level were reduced by 56.54% and 70.47% respectively at the 24th week (P = 0.00); the lung function parameters including large airways such as percent predicted forced expiratory volume in one second (FEV1% pred) and small airways like percent predicted forced expiratory flow at 25-75%, were significantly higher than those before dupilumab (all P < 0.05).

CONCLUSIONS

Dupilumab reduced asthma exacerbations and improved symptom control without severe adverse reactions in paediatric patients with moderate-to-severe asthma and comorbid type 2 inflammatory diseases. It also decreased biomarkers of type 2 inflammation and improved lung function parameters, including both large and small airways. Considering the racial diversity, a large real-world study in China is required to confirm the role of dupilumab in paediatric patients with moderate-to-severe asthma and comorbid type 2 inflammatory diseases.

Dupilumab Efficacy in Children With Type 2 Asthma Receiving High- to Medium-Dose Inhaled Corticosteroids (VOYAGE)

BACKGROUND

In phase 3 VOYAGE (NCT02948959; Evaluation of Dupilumab in Children With Uncontrolled Asthma), dupilumab showed clinical efficacy with an acceptable safety profile in children aged 6 to 11 years with uncontrolled moderate to severe type 2 asthma (blood eosinophils ≥150 cells/μL or FeNO ≥20 ppb).

OBJECTIVE

We analyzed dupilumab's efficacy in children with type 2 asthma by high- or medium-dose inhaled corticosteroids (ICS) at baseline.

METHODS

Children were randomized to receive add-on dupilumab 100/200 mg (by body weight ≤30 kg/>30 kg) every 2 weeks or placebo for 52 weeks and stratified by high- or medium-dose ICS at baseline. End points were annualized severe exacerbation rate, changes from baseline in percent predicted FEV1, and seven-item Asthma Control Questionnaire-Interviewer Administered (ACQ-7-IA) score, proportions of ACQ-7-IA responders (improvement ≥0.5), and biomarker changes.

RESULTS

In children receiving high-dose (n = 152) or medium-dose (n = 195) ICS at baseline, dupilumab versus placebo reduced severe exacerbation rates by 63% (P < .001) and 59% (P = .003), respectively. At week 52, dupilumab improved percent predicted FEV1 by least squares mean difference versus placebo of 5.7 percentage points (P = .02) and 9.35 points (P < .001), and reduced ACQ-7-IA scores by 0.53 points (P < .001) and 0.40 points (P < .001), respectively. No significant treatment interactions between ICS subgroups were detected at week 52. Significant improvements were observed in ACQ-7-IA responder rates and most type 2 biomarker levels.

CONCLUSION

Dupilumab reduced severe exacerbation rates and improved lung function and asthma control in children with uncontrolled moderate to severe type 2 asthma regardless of ICS dose at baseline.

The new biologic drugs: Which children with asthma should get what?

Novel biologics (targeted antibody therapies) have revolutionized the management of severe childhood asthma. However, it is important that the right biologic is selected for the right patient, and understanding the evidence base for each biologic is crucial. Currently, four biologics (all monoclonal antibodies) are licensed in the UK for the treatment of children with severe asthma - omalizumab (Xolair), mepolizumab (Nucala), and dupilumab (Dupixent) in children aged 6 years and over; and tezepelumab (Tezspire), only in children aged 12 years and over. Tezepelumab is the only licensed biological that may be beneficial in severe asthma without evidence of Type 2 inflammation. All have a good safety profile but varying degrees of clinical efficacy in children, with wide variation in treatment responsiveness between individual patients. When selecting biologics for severe asthma, it is essential to remember the limitations of the current pediatric evidence. At present, there are no results from randomized, head-to-head trials of biologics in severe asthma. TREAT is an ongoing trial comparing omalizumab to mepolizumab and will be one of the first to provide such evidence. We must be especially aware of the dangers of extrapolating data from adults to children, because the pathophysiology and role of biomarkers may differ significantly from adult asthma. Given the current level of knowledge, even after treatment has been initiated, children should be regularly reviewed to determine the efficacy of treatment, side-effect profile and consideration of when treatment with the biologic should be discontinued.

Evaluating Severe Therapy-Resistant Asthma in Children: Diagnostic and Therapeutic Strategies

Introduction: Worldwide, asthma is the most common non-communicable respiratory disease and causes considerable morbidity and mortality. Most people with asthma can be treated effectively with low-dose medications if these are taken correctly and regularly. Around 10% of people with asthma have an uncontrolled form of the disease or can only achieve control with high-dose medications, incurring disproportionately high health care costs. Areas Covered: PubMed and personal archives were searched for relevant articles on the definition, management and pharmacotherapy of severe asthma. The WHO classification of severe asthma and the treatment levels encompassed in the definition are discussed. Most children and young people referred for consideration of 'beyond-guidelines therapy' can in fact be managed on standard treatment after a multi-disciplinary team assessment focusing on ensuring correct basic management, and these steps are described in detail. Options for those with true therapy-resistant asthma are described. These include monoclonal antibodies, most of which target type 2 inflammation. Expert Opinion: Getting the basics right is still the most important aspect of asthma care. For those with severe, therapy-resistant asthma, an increasing number of life-transforming monoclonals have been developed, but there is still little understanding of, and a paucity of treatment options for, non-eosinophilic asthma.

Dupilumab 200 mg was efficacious in children (6-11 years) with moderate-to-severe asthma for up to 2 years: EXCURSION open-label extension study

BACKGROUND

The phase 3 VOYAGE (NCT02948959) and open-label extension EXCURSION (NCT03560466) studies evaluated dupilumab in children (6-11 years) with uncontrolled moderate-to-severe asthma. This post hoc analysis assessed the efficacy and safety of add-on dupilumab 200 mg every 2 weeks (q2w), the largest dose cohort in both studies, in children from VOYAGE who participated in EXCURSION.

METHODS

Annualized rate of severe asthma exacerbations (AERs), change in prebronchodilator percent predicted forced expiratory volume in 1 s (ppFEV1), and treatment-emergent adverse events were assessed in children with moderate-to-severe asthma who received dupilumab 200 mg q2w in VOYAGE and EXCURSION (dupilumab/dupilumab arm) and those who received placebo in VOYAGE and dupilumab 200 mg q2w in EXCURSION (placebo/dupilumab arm). These endpoints were also assessed in children with moderate-to-severe type 2 asthma (defined as blood eosinophil count ≥150 cells/µL or FeNO ≥20 ppb at the parent study baseline [PSBL]).

RESULTS

In the overall population, dupilumab reduced AER and improved prebronchodilator ppFEV1 in the dupilumab/dupilumab arm (n = 158) for up to 2 years. Children receiving placebo/dupilumab (n = 85) showed similar reductions after initiation of dupilumab 200 mg q2w in EXCURSION. Similar results were observed for children with type 2 asthma at PSBL. The safety profile was consistent with the known safety profile of dupilumab.

CONCLUSION

In children (6-11 years) with uncontrolled moderate-to-severe type 2 asthma, dupilumab 200 mg reduced exacerbation rates and improved lung function for up to 2 years and showed safety consistent with the known dupilumab safety profile.

Continued contribution to atopic innovation with dupilumab

PURPOSE OF REVIEW

Dupilumab is an emerging medication that has shown efficacy for multiple atopic conditions. This review provides insight into the common conditions that are treated, mechanism of action, and continued innovation with the medication.

RECENT FINDINGS

There continues to be applicability of dupilumab in treating a growing number of atopic conditions. Increasingly younger patient populations with eosinophil based conditions are being approved for this therapy. It is also considered as an additional option treatment for patients who cannot tolerate oral therapy or have adverse effects from other agents. Patients with more severe conditions are finally finding symptom stability while also being able to reduce reliance on corticosteroids. Patients as young as 6 months of age have benefited from treatment.

SUMMARY

As atopic conditions become more prevalent, dupilumab has been shown to be successful in inducing remission of symptoms. Overall, it continues to be a promising treatment for reducing the burden of disease severity as well as improving the quality of life of affected children.

Type 2 Inflammation and Asthma in Children: A Narrative Review

Increased understanding of the underlying pathophysiology has highlighted the heterogeneity of asthma and identified that most children with asthma have type 2 inflammation with elevated biomarkers, such as blood eosinophils and/or fractional exhaled nitric oxide. Although in the past most of these children may have been categorized as having allergic asthma, identifying the type 2 inflammatory phenotype provides a mechanism to explain both allergic and non-allergic triggers in pediatric patients with asthma. Most children achieve control with low to medium doses of inhaled corticosteroids. However, in a small but significant proportion of children, asthma remains uncontrolled despite maximum conventional treatment, with an increased risk of severe exacerbations. In this review, we focus on the role of type 2 inflammation and allergic processes in children with asthma, together with evidence of the efficacy of available treatment options for those who experience severe symptoms.

An Updated Reappraisal of Dupilumab in Children and Adolescents with Severe Asthma

Severe asthma (SA) is still a demanding challenge in clinical practice. Type 2 inflammation is the most common phenotype in children and adolescents with SA. As a result, anti-inflammatory drugs, mainly corticosteroids (CSs), represent the first choice to reduce type 2 inflammation. However, SA patients may require high inhaled and oral CS doses to achieve and maintain asthma control. Some SA patients, despite the highest CS dosages, can even display uncontrolled asthma. Therefore, the biological era constituted a breakthrough in managing this condition. Dupilumab is a monoclonal antibody directed against the IL-4 receptor α-subunit (IL-4Rα), antagonizing against both IL-4 and IL-13, and has been approved for pediatric severe type 2 asthma. This review presents and discusses the most recent published studies on dupilumab in children and adolescents with SA. There is convincing evidence that dupilumab is a safe and effective option in managing SA as it can reduce asthma exacerbations, reduce CS use, and improve lung function, asthma control, and quality of life, also for caregivers. However, a thorough diagnostic pathway is mandatory, mainly concerning phenotyping. In fact, the ideal eligible candidate is a child or adolescent with a type 2 allergic phenotype.

Biological treatments in childhood asthma

PURPOSE OF REVIEW

The aim is to update the information currently available for the use of biologics in severe asthma in children, in order to facilitate their prescription as far as possible.

RECENT FINDINGS

The appearance of biologics for the treatment of severe asthma has meant a revolutionary change in the therapeutic approach to this disease. Currently, five biologics have been approved for severe asthma in children and/or adolescents by the regulatory agencies: omalizumab, mepolizumab, benralizumab, dupilumab and tezepelumab. But despite their positive results in terms of efficacy, there are still relevant points of debate that should induce caution when selecting the most appropriate biologic in a child with severe asthma. Indeed, safety is essential and, for several of the existing treatments, the availability of medium-term to long-term data in this regard is scarce.

SUMMARY

The use of biologics can facilitate the therapeutic paradigm shift from pleiotropic treatments to personalized medicine. However, the choice of the most appropriate biologics remains a pending issue. On the other hand, to the extent that several of the biologics have been available for a relatively short time, the most robust evidence in terms of efficacy and safety in children is that of omalizumab.

The Evolution of Scientific Knowledge in Childhood Asthma over Time: A Surprising History

Asthma is a disease that has been described since the times of Hammurabi. However, it is only since the 1960s that effective therapeutic strategies have been available. Pathogenic mechanisms underlying the disease have been deeply studied, contributing to creating a "patient-specific asthma" definition. Biological drugs have been approved over the last twenty years, improving disease management in patients with severe asthma via a "precision medicine-driven approach". This article aims to describe the evolution of scientific knowledge in childhood asthma, focusing on the most recent biological therapies and their indications for patients with severe asthma.