BACKGROUND: Severe asthma often coexists with chronic obstructive pulmonary disease (COPD), yet patients with overlapping conditions are frequently excluded from clinical trials. Consequently, evidence on the effectiveness of biologics such as tezepelumab in smokers or patients with concomitant COPD remains limited. OBJECTIVE: To evaluate the effectiveness of tezepelumab in patients with severe asthma with concomitant COPD/emphysema or a smoking-history compared with patients with asthma-only. METHODS: In this retrospective study, pulmonary function, exacerbations, oral corticosteroid (OCS) use, asthma control, and quality of life (QoL) were assessed at baseline and after at least 6 months of tezepelumab treatment in patients with different severe asthma phenotypes. RESULTS: Overall, 186 tezepelumab-treated patients (asthma-only n=68; asthma with smoking-history n=56; asthma with COPD/emphysema n=62) with a median treatment duration of 12 (IQR 7-13) months were included. Forced expiratory volume in 1 second (% predicted) improved significantly in all groups [asthma-only: 71% to 75% (p=0.014); asthma with smoking-history: 61% to 67% (p=0.036); asthma with COPD/emphysema: 44% to 45% (p=0.035)]. Asthma Control Test scores improved significantly [asthma-only: 13 to 16 (p=0.003); asthma with smoking-history: 13 to 17 (p=0.001); asthma with COPD/emphysema: 12 to 15 (p<0.001)]. Similar improvements across groups were observed for QoL, OCS dose reduction, and annualized exacerbation rates. Remission rates were comparable between groups. CONCLUSION: Tezepelumab was associated with clinically meaningful improvements in lung function, asthma control, QoL, and reduction in exacerbation rates in patients with severe asthma, irrespective of smoking-history or comorbid COPD/emphysema, supporting its use in these underrepresented populations.
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