T0 means before dupilumab administrations, T6 after 6 months of therapy, T12 after one year of administration. P-value was calculated between T12 and T0 (statistical analysis used was linear regression done with Jamovi vers 2.6.23). FEV1: forced expiratory volume in one second; FeNO: fractional exhaled nitric oxide
Declarations
Acknowledgments
During the preparation of this work, authors used ChatGPT for generating the bronchus picture of Figure 2, while the mucus plugs, muscle, and the remaining part of the picture were done by the authors themselves. After using the tool, authors reviewed and edited the content as needed and take full responsibility for the content of the publication.
Author contributions
DB, RP, and BB: Conceptualization, Investigation, Writing—original draft. VC, ET, and CM: Supervision, Validation. FB: Supervision, Validation, Writing—review & editing. All authors read and approved the submitted version.
Conflicts of interest
Diego Bagnasco who is the Editorial Board Member of Exploration of Asthma & Allergy, Fulvio Braido who is the Associate Editor of Exploration of Asthma & Allergy, had no involvement in the decision-making or the review process of this manuscript. The other authors declare that there are no conflicts of interest.
Ethical approval
The study was approved by the Genoa Ethics Committee (EC 2017, ID 3663) and complies with the Declaration of Helsinki.
Consent to participate
Informed consent to participate in the study was obtained from the patient.
Consent to publication
Informed consent to publication was obtained from relevant participants.
Availability of data and materials
The data of this manuscript could be available from the corresponding author upon reasonable request.
Open Exploration maintains a neutral stance on jurisdictional claims in published institutional affiliations and maps. All opinions expressed in this article are the personal views of the author(s) and do not represent the stance of the editorial team or the publisher.
References
Dharmage SC, Perret JL, Custovic A. Epidemiology of Asthma in Children and Adults.Front Pediatr. 2019;7:246. [DOI] [PubMed] [PMC]
Bagnasco D, Povero M, Pradelli L, Brussino L, Rolla G, Caminati M, et al.; SANI Network (Severe Asthma Network Italy). Economic impact of mepolizumab in uncontrolled severe eosinophilic asthma, in real life.World Allergy Organ J. 2021;14:100509. [DOI] [PubMed] [PMC]
Canonica GW, Bagnasco D, Bondi B, Varricchi G, Paoletti G, Blasi F, et al.; SANI study group. SANI clinical remission definition: a useful tool in severe asthma management.J Asthma. 2024;61:1593–600. [DOI] [PubMed]
Mailhot-Larouche S, Celis-Preciado C, Heaney LG, Couillard S. Identifying super-responders: A review of the road to asthma remission.Ann Allergy Asthma Immunol. 2025;134:31–45. [DOI] [PubMed]
Anai M, Yoshida C, Izumi H, Muramoto K, Saruwatari K, Tomita Y, et al. Successful treatment with dupilumab for mucus plugs in severe asthma.Respirol Case Rep. 2023;11:e01074. [DOI] [PubMed] [PMC]
Chan R, Duraikannu C, Lipworth B. Clinical Associations of Mucus Plugging in Moderate to Severe Asthma.J Allergy Clin Immunol Pract. 2023;11:195–9.e2. [DOI] [PubMed]
Lundberg M, Voutilainen H, Lyly A, Karjalainen J, Huhtala H, Laidlaw TM, et al. Adult-onset asthma, allergy, and aspirin hypersensitivity associate with self-reported food avoidance.Eur Clin Respir J. 2024;11:2347073. [DOI] [PubMed] [PMC]
Dunican EM, Elicker BM, Gierada DS, Nagle SK, Schiebler ML, Newell JD, et al.; National Heart Lung and Blood Institute (NHLBI) Severe Asthma Research Program (SARP). Mucus plugs in patients with asthma linked to eosinophilia and airflow obstruction.J Clin Invest. 2018;128:997–1009. [DOI] [PubMed] [PMC]
Papi A, Castro M, Porsbjerg C, Lugogo NL, Brightling CE, González-Barcala FJ, et al. Early treatment response to dupilumab on airway inflammation, airway dynamics, and mucus plugging in VESTIGE.Eur Respir J. 2024;64:PA3933. [DOI]
Jaramillo AM, Vladar EK, Holguin F, Dickey BF, Evans CM. Emerging cell and molecular targets for treating mucus hypersecretion in asthma.Allergol Int. 2024;73:375–81. [DOI] [PubMed] [PMC]
Frøssing L, Von Bülow A, Porsbjerg C. Bronchiectasis in severe asthma is associated with eosinophilic airway inflammation and activation.J Allergy Clin Immunol Glob. 2023;2:36–42. [DOI] [PubMed] [PMC]
Matsumoto H. Bronchiectasis in severe asthma and asthmatic components in bronchiectasis.Respir Investig. 2022;60:187–96. [DOI] [PubMed]
Kang HR, Choi GS, Park SJ, Song YK, Kim JM, Ha J, et al. The effects of bronchiectasis on asthma exacerbation.Tuberc Respir Dis (Seoul). 2014;77:209–14. [DOI] [PubMed] [PMC]
Juliusson G, Gudmundsson G. Diagnostic imaging in adult non-cystic fibrosis bronchiectasis.Breathe (Sheff). 2019;15:190–7. [DOI] [PubMed] [PMC]
Maselli DJ, Diaz AA. Imaging to Advance Bronchiectasis Phenotyping.Am J Respir Crit Care Med. 2024;210:15–6. [DOI] [PubMed] [PMC]
Varricchi G, Brightling CE, Grainge C, Lambrecht BN, Chanez P. Airway remodelling in asthma and the epithelium: on the edge of a new era.Eur Respir J. 2024;63:2301619. [DOI] [PubMed] [PMC]
Audousset C, Swaleh S, Olivenstein R, Vameghestahbanati M, Kirby M, Semionov A, et al. Mucus plugs in the airways of asthmatic subjects and smoking status.Respir Res. 2024;25:52. [DOI] [PubMed] [PMC]
Svenningsen S, Kjarsgaard M, Haider E, Venegas C, Konyer N, Friedlander Y, et al. Effects of Dupilumab on Mucus Plugging and Ventilation Defects in Patients with Moderate-to-Severe Asthma: A Randomized, Double-Blind, Placebo-Controlled Trial.Am J Respir Crit Care Med. 2023;208:995–7. [DOI] [PubMed]
Porsbjerg CM, Dunican E, Lugogo NL, Castro M, Papi A, Backer NV, et al. Dupilumab reduces mucus plugging and volume: phase 4 VESTIGE trial.Eur Respir J. 2024;64:OA3649. [DOI]
Cottini M, Licini A, Lombardi C, Bagnasco D, Comberiati P, Berti A. Small airway dysfunction and poor asthma control: a dangerous liaison.Clin Mol Allergy. 2021;19:7. [DOI] [PubMed] [PMC]
Papi A, Hughes R, Del Olmo R, Agusti A, Chipps BE, Make B, et al. Relationships between symptoms and lung function in asthma and/or chronic obstructive pulmonary disease in a real-life setting: the NOVEL observational longiTudinal studY.Ther Adv Respir Dis. 2024;18:17534666241254212. [DOI] [PubMed] [PMC]
Soremekun S, Heaney LG, Skinner D, Bulathsinhala L, Carter V, Chaudhry I, et al. Asthma exacerbations are associated with a decline in lung function: a longitudinal population-based study.Thorax. 2023;78:643–52. [DOI] [PubMed] [PMC]
Domínguez-Sosa MS, Cabrera-Ramírez MS, Marrero-Ramos MDC, Dávila-Quintana D, Cabrera-López C, González Cuervo H, et al. Efficacy of dupilumab on chronic rhinosinusitis with nasal polyps and concomitant asthma in biologic-naive and biologic-pretreated patients.Ann Med. 2024;56:2411018. [DOI] [PubMed] [PMC]
Mocellin D, Ioppi A, Gaglio G, Pennacchi A, Bertolini M, Tirrito A, et al. Severe chronic rhinosinusitis treated with dupilumab, a real-life analysis of early effectiveness.Eur Rev Med Pharmacol Sci. 2023;27:7324–36. [DOI] [PubMed]
Lombardi C, Asero R, Bagnasco D, Blasi F, Bonini M, Bussi M, et al.; ARIA Italia. ARIA-ITALY multidisciplinary consensus on nasal polyposis and biological treatments.World Allergy Organ J. 2021;14:100592. [DOI] [PubMed] [PMC]
Orlandi RR, Kingdom TT, Hwang PH, Smith TL, Alt JA, Baroody FM, et al. International Consensus Statement on Allergy and Rhinology: Rhinosinusitis.Int Forum Allergy Rhinol. 2016;6:S22–209. [DOI] [PubMed]
Bachert C, Han JK, Desrosiers M, Hellings PW, Amin N, Lee SE, et al. Efficacy and safety of dupilumab in patients with severe chronic rhinosinusitis with nasal polyps (LIBERTY NP SINUS-24 and LIBERTY NP SINUS-52): results from two multicentre, randomised, double-blind, placebo-controlled, parallel-group phase 3 trials.Lancet. 2019;394:1638–50. [DOI] [PubMed]