Current status of biological therapy use for older adults with severe asthma

Introduction: The management of severe asthma in older adults is an increasingly important clinical challenge. Aging-associated structural, functional, and immunological changes contribute to a distinct geriatric asthma phenotype, often marked by mixed inflammation, comorbidities, and reduced treatment responsiveness. Areas covered: This review provides an overview of current biologic therapies approved for severe asthma and examines existing clinical evidence regarding efficacy, safety, and real-world outcomes in geriatric patients. Clinical challenges include the heterogeneity of asthma phenotypes in this age group, and the impact of multimorbidity and polypharmacy on treatment outcomes. Expert opinion: A geriatric-centered approach to severe asthma is essential, emphasizing early initiation of biologic therapies, individualized risk-benefit analysis, and improved inclusion in research. The modulation of systemic inflammation, while carefully monitored, may bring also systemic benefits that may go beyond respiratory system. Achieving asthma remission in older adults is now a feasible goal, contingent upon proactive, tailored treatment strategies supported by more inclusive evidence.