INTRODUCTION: Treatment with biologics for severe asthma is informed by international and national guidelines and defined by national regulating bodies, but how these drugs are used in real-life is unknown. MATERIALS AND METHODS: The European Respiratory Society (ERS) SHARP Clinical Research Collaboration conducted a three-step survey collecting information on asthma biologics use in Europe. Five geographically distant countries defined the survey questions, focusing on seven end-points: biologics availability and financial issues, prescription and administration modalities, inclusion criteria, continuation criteria, switching biologics, combining biologics and evaluation of corticosteroid toxicity. The survey was then sent to SHARP National Leads of 28 European countries. Finally, selected questions were submitted to a broad group of 263 asthma experts identified by national societies. RESULTS: Availability of biologics varied between countries, with 17 out of 28 countries having all five existing biologics. Authorised prescribers (pulmonologists and other specialists) also differed. In-hospital administration was the preferred deliverance modality. While exacerbation rate was used as an inclusion criterion in all countries, forced expiratory volume in 1 s was used in 46%. Blood eosinophils were an inclusion criterion in all countries for interleukin-5 (IL-5)-targeted and IL-4/IL-13-targeted biologics, with varying thresholds. There were no formally established criteria for continuing biologics. Reduction in exacerbations represented the most important benchmark, followed by improvement in asthma control and quality of life. Only 73% (191 out of 263) of surveyed clinicians assessed their patients for corticosteroid-induced toxicity. CONCLUSION: Our study reveals important heterogeneity in the use of asthma biologics across Europe. To what extent this impacts on clinical outcomes relevant to patients and healthcare services needs further investigation.

Allergy Centre Tampere University Hospital and Faculty of Medicine and Health Technology Tampere University Tampere Finland

Centre for Experimental Medicine School of Medicine Dentistry and Biomedical Sciences Queen's University Belfast Belfast UK

Department of Allergology and Immunology Russian Medical Academy of Continuous Professional Education Moscow Russia

Department of Allergy Respiratory Medicine and Sleep Landspitali University Hospital Reykjavik Iceland University of Iceland Reykjavik Iceland

Department of Pneumology University Hospital and Charles University Faculty of Medicine Hradec Kralove Czech Republic

Department of Pulmonary Diseases Istanbul University Cerrahpasa Cerrahpasa Faculty of Medicine Istanbul Turkey

Department of Pulmonology Lithuanian University of Health Sciences Kaunas Lithuania

Department of Respiratory Medicine Amsterdam University Medical Center University of Amsterdam Amsterdam the Netherlands

Department of Respiratory Medicine and Allergy Karolinska University Hospital Stockholm Sweden

Department of Respiratory Medicine Liège University Hospital Liège Belgium

Department of Respiratory Medicine Medical Center Leeuwarden Leeuwarden the Netherlands

Department of Respiratory Medicine University Hospital of Liège Liège Belgium

Division of Internal Medicine Asthma and Allergy Barlicki University Hospital Medical University of Lodz Lodz Poland

Faculty of Medical Sciences University of Kragujevac and Clinic for Pulmonology Clinical Centre Kragujevac Serbia

Faculty of Medicine University of Southampton Southampton UK

Institute of Technology University of Tartu Tartu Estonia

Latvian Association of Allergists Center of Tuberculosis and Lung Diseases Riga Latvia

National Institute of Pneumology M Nasta Bucharest Romania

National Korányi Institute of Pulmonology Budapest Hungary

NIHR Southampton Biomedical Research Centre Southampton UK

Personalized Medicine Asthma and Allergy Humanitas Clinical and Research Center IRCCS Milan Italy

PhyMedExp Univ Montpellier CNRS INSERM CHU Montpellier Montpellier France

Pulmonology Department Hospitais da Universidade de Coimbra Centro Hospitalar e Universitário de Coimbra Coimbra Portugal

Respiratory Medicine Department and Asthma Center Athens Chest Hospital Sotiria Athens Greece

Respiratory Medicine Unit Department of Medicine Solna Campus and Center for Molecular Medicine Karolinska Institute Stockholm Sweden

Respiratory Research Unit Bispebjerg University Hospital Copenhagen Denmark

Respiratory Research Unit Complexo Hospitalario Universitario and Instituto de Investigación Biomédica de A Coruña Spain

School of Medicine University College Dublin Dublin Ireland

St Vincent's University Hospital University College Dublin Dublin Ireland

The Clinic for Lung Diseases Jordanovac University Hospital Centre Zagreb Zagreb Croatia

Universitätsmedizin Mainz Mainz Germany

University Clinic of Medicine Cantonal Hospital Basel Liestal Switzerland

University Clinic of Respiratory and Allergic Diseases Golnik Slovenia

University of Basel Basel Switzerland

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