Difficult-to-treat and severe asthma in adults: towards a new treatment paradigm

Background: Asthma is a common yet complex airway disorder, comprising diverse phenotypes and pathophysiology. According to the Australian Institute of Health and Welfare, asthma affects 11% of the Australian population. Despite the availability of effective therapies and a national medicines subsidy scheme, a significant burden of disease still exists in Australia, with high mortality by international standards. Objective: This article discusses the challenges in managing patients with difficult-to-treat and severe asthma in primary care, how to distinguish between difficult-to-treat and severe asthma, when to refer, and the role of biologic therapy. Discussion: Asthma that remains uncontrolled despite treatment with high-dose preventive therapies is not only challenging for clinicians but also imposes long-term, debilitating burdens on patients' quality of life. Recent advances in evidence-based guidelines for severe asthma, increasing evidence about phenotypic patterns and asthma biomarkers, and the availability of targeted biologic therapies offer hope for improving patient outcomes.