HCPLive Five: Asthma Updates at ATS 2026

Asthma research took center stage at the 2026 American Thoracic Society (ATS) International Conference in Orlando, Florida, with new data challenging long-held assumptions about who benefits from biologic therapy and how to measure that benefit.

In this HCPLive Five, 5 physician experts share findings that expand the treatment conversation beyond traditional phenotypes: tezepelumab demonstrating efficacy in active smokers and patients with comorbid chronic obstructive pulmonary disease (COPD), dupilumab pushing toward remission in high-inflammation type 2 disease, and a first look at periconception eosinophils as a pregnancy risk biomarker. Rounding out the lineup, new oral corticosteroid (OCS) reduction data from phase 3 SUNRISE and an analysis on depression and asthma control underscore how much of the disease burden still goes unaddressed in routine clinical practice.

Depression Doubles Poorly Controlled Asthma Odds but Goes Unscreened

Depression and Poor Asthma Control Call for Mental Health Attention, With Brittany Duchene, MD

Depressive symptoms were associated with twice the odds of poorly controlled asthma yet showed no significant differences in exacerbation rates or spirometry, according to research presented at ATS 2026 by Brittany Duchene, MD, of the University of Vermont Medical Center. The cross-sectional analysis pooled data from three American Lung Association cohorts (n = 741) using PHQ-9 and CES-D screening tools. BMI emerged as an independent predictor of urgent healthcare utilization, with data suggesting even 5% body weight reduction improves asthma outcomes. Duchene called the depression-asthma control discordance an important and underrecognized gap warranting routine mental health screening in asthma management.

Tezepelumab Reduces Severe Asthma Exacerbations in Smokers and Comorbid COPD Patients: PASSAGE

Tezepelumab Reduced Severe Asthma Across Phenotypes in Phase 4 PASSAGE, With Njira Lugogo, MD

Tezepelumab reduced annualized asthma exacerbation rates by 70% over 52 weeks in the phase 4 PASSAGE study, with consistent reductions of 54 to 77% across phenotypes, including active smokers, patients with comorbid COPD, and those with low eosinophil counts, according to data presented at ATS 2026. Njira Lugogo, MD, director of the asthma program at the University of Michigan, highlighted that these traditionally underrepresented populations showed treatment effects comparable to the broader cohort. Patient-reported outcomes improved significantly across ACQ-6, AIRQ, and SGRQ measures. Lugogo noted the findings challenge the common clinical practice of withholding biologics from patients who have not yet stopped smoking.

Dupilumab Nearly Doubles Remission Odds in Type 2 Asthma With Elevated Eosinophils and FeNO

Dupilumab Nearly Doubled Remission Odds in Type 2 Asthma, With Simon Couillard, MD

Dupilumab nearly doubled the odds of achieving clinical remission in moderate-to-severe type 2 asthma, with patients showing both elevated eosinophils (≥ 300 cells/μL) and high FeNO (≥ 35 ppb) demonstrating 4-fold greater remission wins, according to a win ratio analysis of the phase 3 QUEST trial presented at ATS 2026. Simon Couillard, MD, of the Université de Sherbrooke, applied a hierarchical endpoint framework prioritizing exacerbation elimination, lung function, and symptom control. Couillard advocated for routine eosinophil and FeNO biomarker screening to identify optimal biologic candidates earlier and called remission an achievable, though currently treatment-dependent, target in asthma care.

Periconception Eosinophil Counts Predict Asthma Exacerbations During Pregnancy

Periconception Eosinophil Counts Predict Asthma Exacerbations in Pregnancy, With Christian Cardillo, MD

Periconception eosinophil counts were independently associated with increased asthma exacerbation frequency during pregnancy, with each 100 cells/µL increase linked to 0.20 additional exacerbations (P <.001), according to late-breaking data presented at ATS 2026 by Christian Cardillo, MD, of Lewis Katz School of Medicine at Temple University Hospital. The single-center study of 31 pregnant patients suggests eosinophils, already part of routine CBC testing around 8–12 weeks’ gestation, could serve as a scalable biomarker for identifying high-risk type 2 inflammatory asthma phenotypes earlier in pregnancy. Cardillo called findings exploratory but noted prospective validation could support earlier pulmonology or maternal-fetal medicine referrals.

Tezepelumab Cuts Oral Corticosteroid Use by Nearly Two-Thirds in Severe OCS-Dependent Asthma: SUNRISE

Phase 3 SUNRISE: Tezepelumab Shows Meaningful OCS Reduction in Severe Asthma, With Michael E. Wechsler, MD

Phase 3 SUNRISE trial data presented at ATS 2026 showed tezepelumab-treated patients were nearly 3 times more likely to achieve meaningful oral corticosteroid (OCS) reduction versus placebo (cumulative OR 2.93; P =.003) in severe OCS-dependent asthma, with 36% discontinuing OCS entirely. Michael Wechsler, MD, of National Jewish Health, noted the findings align with prior SOURCE trial and real-world Wayfinder data, reinforcing tezepelumab's consistent evidence base.

Beyond OCS reduction, tezepelumab improved pre-bronchodilator FEV1 and asthma control scores. Wechsler highlighted the drug's upstream TSLP-blocking mechanism—inhibiting IL-4, IL-5, and IL-13 pathways—as key to its broad, phenotype-spanning efficacy.

Looking for more ATS 2026 coverage? Don't miss our HCPLive Five on late-breaking phase 3 pulmonology data featuring expert interviews on AD109 for OSA, ralinepag for PAH, ALIS for MAC lung disease, and more.

Editor’s note: Disclosures include GlaxoSmithKline, GENZYME CORPORATION, SANOFI-AVENTIS US, AstraZeneca Pharmaceuticals, Regeneron Pharmaceuticals, and Incyte Corporation for Lugogo; AstraZeneca Pharmaceuticals and GlaxoSmithKline for Cardillo; and SANOFI-AVENTIS US, GENZYME CORPORATION, GlaxoSmithKline, Merck Sharp & Dohme, AstraZeneca Pharmaceuticals for Wechsler. Duchene and Couillard have no reported disclosures.