“We have inhalers that can save lives in seconds and biologics that can change the course of the disease—so why are millions still wheezing in emergency rooms (ERs)?”

A Global Paradox in Respiratory Health

Asthma today stands at the intersection of remarkable scientific progress and sobering real-world stagnation. Medical advances have transformed it from a dangerous, sometimes fatal illness into a condition that, on paper, is highly manageable. Yet in practice, effective control remains the exception rather than the norm. In 2024, over 56 million individuals across major markets were living with diagnosed asthma, with nearly 26 million in the United States alone. And still, more than 60% of patients report poor symptom control, frequent rescue inhaler use, and recurring exacerbations.

This chronic condition continues to send millions to emergency rooms, drive school and work absenteeism, and diminish quality of life across age groups and geographies. The paradox deepens when one realizes this persistent burden is not due to a lack of effective therapies—but due to systemic, behavioral, and informational disconnects, in fact asthma presents a significant burden on health care costs in the United States, resulting in yearly estimates of ~USD 50 billion in medical costs and ~USD 3 billion in losses from missed work and school days.

“We have the tools—smart inhalers, biologics, decision support — but our fragmented care system rewards rescue, not prevention. Asthma remains a reactive disease in a country built on reactive care.”

— Dr. Angela Ruiz, Professor of Pulmonology, Mayo Clinic, USA

The Invisible Burden: Underdiagnosed, Undervalued, and Misunderstood

Globally, asthma affects an estimated 262 million people and remains one of the most common chronic conditions across all age groups. Although industrialized nations like the US, the UK, and Germany account for a substantial portion of diagnosed cases, the highest mortality and morbidity are disproportionately concentrated in low- and middle-income countries.

The 2024 data show that asthma prevalence is no longer rising rapidly, but severe, uncontrolled asthma remains stubbornly persistent, especially among underdiagnosed populations in rural or socioeconomically disadvantaged settings. In Japan, for instance, retrospective analyses suggested lower asthma prevalence, but emerging prospective data point toward substantial underdiagnosis driven by poor spirometry access and low symptom recognition. Meanwhile, regions such as the UK have seen an uptick in asthma-related healthcare utilization, likely linked to rising environmental allergen exposure and widening healthcare disparities.

Beyond the statistics, there are stories of resilience that illuminate the human spirit. Consider “Kent,” who grew up in California with asthma as his lifelong companion. As a child, sports felt like a battlefield—one moment he’d dash ahead on the soccer field, the next he’d be gasping, sidelined, struggling to keep up. A heartbreak early in life came when his beloved nine-year-old cousin tragically died from an asthma attack—an event that made every sprint and jump carry a shadow of fear. But Kent’s family refused to let asthma define him. Guided by his parents, he learned to balance caution with confidence, mastering breathing techniques, nutrition, mental resilience, and the art of pacing himself. As he matured, his attacks became less frequent, and he thrived for years in sports: four years of soccer, a decade of football, and today even competes in MMA. Asthma remains a part of his life, but it’s no longer in the driver’s seat. Kent’s journey is a testament not just to managing asthma, but to overcoming it.

Adherence: The Achilles Heel of Asthma Management

Despite having some of the most efficacious therapies in modern medicine, asthma remains a disease riddled with preventable crises—largely driven by poor adherence to treatment.

Data reveal that nearly 70–90% of asthma patients misuse inhalers, and only about 30% consistently use daily controller therapies. Patients often abandon their maintenance medications because they feel “fine”—until they do not. Others are overwhelmed by the complexity of multiple inhalers or do not understand the difference between a reliever and a preventer.

Efforts like the SMART (Single Maintenance and Reliever Therapy) approach, now endorsed by GINA, offer a smarter path forward. Using ICS-formoterol as both maintenance and rescue therapy simplifies regimens and improves outcomes. Yet, uptake has been uneven, hindered by limited awareness among providers, inconsistent payer coverage, and inertia in clinical practice.

“In Germany, adherence is not always about cost — it is about skepticism. Patients often doubt the need for daily therapy once symptoms improve. We need to reframe asthma as a silent, smoldering fire.”

— Prof. Klaus Reinhardt, Head of Respiratory Medicine, Charité – Universitätsmedizin Berlin

There is also a psychological element—because asthma is largely invisible between flares, the urgency to prevent exacerbations is lost. Many patients perceive asthma as episodic rather than chronic, which makes proactive care harder to enforce.

Biologics: Precision Medicine Meets Practical Barriers

Over the past decade, biologics have ushered in a new era for patients with severe, eosinophilic, or Type 2-high asthma—a group representing roughly 5–10% of all asthma patients. Of these, about 60–70% exhibit Type 2 inflammation, making them prime candidates for targeted biologic therapy.

Current asthma treatment market heavyweights include FASENRA (benralizumab), DUPIXENT (dupilumab), NUCALA (mepolizumab), TEZSPIRE (tezepelumab), and CINQAIR (reslizumab). These precision medicines target specific inflammatory pathways, anti-IL-5, anti-IL-4Rα, or anti-TSLP, reducing exacerbations, improving lung function, and, in some cases, enabling sustained remission.

At ATS 2025, clinical insights underscored their transformative potential:

• FASENRA delivered a 307 mL FEV₁ boost in moderate-to-severe asthma regardless of eosinophil count, signaling broad phenotype efficacy.
• DUPIXENT achieved a 40% complete mucus-plug resolution rate over 16 weeks, translating into better airway clearance and fewer flare-ups.
• NUCALA demonstrated clinical remission in 38% of patients at one year, rising to 59% by year two in real-world European data.

Yet real-world adoption remains disappointingly low. High costs, specialist referral delays, payer restrictions, and slow uptake in primary care mean that many eligible patients never access these therapies. Moreover, those with non-Type 2 asthma (~30%) still have limited targeted options—leaving a significant unmet need.

The 2024 Asthma Treatment Market Pulse: Growth Meets Innovation

In 2024, the asthma drug market reached a valuation of USD 27 billion among major markets, with the US accounting for a dominant 80% share. Growth is driven by a surge in moderate-to-severe cases, expanding use of digital tools, and a steady pipeline of high-cost precision therapies. While the market is mature in many respects, it is also ripe for disruption.

One such disruptor is Depemokimab, GSK’s next-gen anti-IL-5 biologic, projected to be a blockbuster by 2030. With Q26W (biannual) dosing, a strong safety profile, and high efficacy in eosinophilic asthma, it offers a compelling alternative to current monthly or bi-monthly injections. Experts believe it could redefine treatment expectations by offering both clinical impact and convenience—two things that matter deeply to both patients and payers. 

Beyond biologics, smart inhalers and integrated adherence platforms are gaining traction. These devices track usage patterns, flag technique errors, and feed real-world data into digital dashboards, allowing clinicians to intervene before symptoms spiral. But digital alone can not fix asthma—it needs to be embedded within a larger continuum of care.

GSK and AstraZeneca: The Asthma Treatment Heavyweights 

Two pharmaceutical giants continue to dominate the asthma treatment landscape: GlaxoSmithKline (GSK) and AstraZeneca.

GSK, with a legacy portfolio including NUCALA, ARNUITY ELLIPTA, and TRELEGY ELLIPTA, has long set the standard in both inhaled and injectable asthma care. With Depemokimab on the horizon, they are doubling down on eosinophilic asthma and long-acting, adherence-friendly interventions.

AstraZeneca, meanwhile, has cemented its leadership through a trio of innovations: FASENRA, TEZSPIRE, and BREZTRI AEROSPHERE. Notably, AIRSUPRA (albuterol and budesonide), the first FDA-approved inhaled corticosteroid/short-acting beta-agonist (ICS/SABA) rescue inhaler, marks a paradigm shift in mild asthma management. By supporting SMART-style, as-needed therapy, it moves care away from SABA overreliance and toward proactive inflammation control.

Together, these companies are not just producing therapies—they are shaping the clinical conversation, redefining endpoints, and investing in education to improve treatment adoption.

Developmental Asthma Pipeline: Targeting the Unmet Need

The asthma pipeline is dynamic, with over a dozen therapies in late-stage development addressing both T2-high and T2-low subtypes. Key candidates include

• Dexpramipexole (Areteia Therapeutics): An oral eosinophil-lowering agent showing promise in reducing exacerbation frequency.
• Amlitelimab (Sanofi): A novel OX40-ligand blocker with early signals of efficacy in steroid-dependent asthma.
• Rilzabrutinib (Sanofi): A BTK inhibitor being explored for T2-low and steroid-unresponsive asthma, with potential to modulate multiple inflammatory pathways.
• Rademikibart (CBP-201) (Connect Biopharma): An IL-4Rα antagonist aiming to disrupt upstream cytokine signaling, potentially extending biologic benefits to broader patient populations.

What sets these agents apart is their ambition to reach under-addressed asthma phenotypes—especially the T2-low group that remains poorly served by current biologics. Some are exploring oral or long-interval dosing, which could further improve adherence and access.

The development asthma pipeline reflects a broader shift in asthma treatment philosophy—from reactive to proactive, from symptom suppression to disease modification, and from monolithic protocols to phenotype-driven care. 

The Roadblocks in Asthma Treatment We Must Confront

If asthma control remains elusive, it is not because we lack the tools. The failure lies in fragmented systems and misaligned incentives. Consider these recurring barriers

• Inadequate patient education around inhaler use and treatment goals
• Delayed or missed referrals for biologic-eligible patients
• Disparities in healthcare access, especially in underserved communities
• Payer resistance to guideline-backed innovations like SMART or biologics

Even digital health solutions, while promising, struggle to bridge the gap when unaccompanied by human support and system-level accountability. Insurance formularies still often prioritize cheaper but less effective regimens, and patients frequently switch plans—disrupting long-term care continuity.

“The asthma care pathway in Spain is overly reliant on primary care, where time is limited and training on biologics is still uneven. We need multidisciplinary integration—not just new drugs.”

— Dr. Laura Morales, Clinical Immunologist, Hospital Clínic de Barcelona

Meanwhile, the reimbursement environment remains patchy. While value-based care is gaining traction, many asthma therapies, especially biologics, remain outside bundled payment models. This fragmentation undermines long-term planning and care team collaboration. 

Looking Ahead in Asthma Treatment: Remission is no Longer a Fantasy

Perhaps the most exciting shift in asthma care is conceptual—clinical remission is no longer aspirational; it is increasingly observable. Recent ATS 2025 data show remission rates of 38–58% in severe asthma patients treated with biologics like mepolizumab and dupilumab, suggesting that a disease once managed can now, in some cases, be silenced.

Emerging asthma therapies such as Lunsekimig (SAR443765), Sanofi’s novel anti-IL-33 antibody currently in late-stage trials, are expanding the horizon further, with the potential to address both T2-high and T2-low asthma phenotypes, offering hope for patients who remain underserved by existing biologics. Ongoing Phase II trials (AIRLYMPUS, AIRPHRODITE, AIRCULES) will further validate its role in high-risk and moderate-to-severe asthma populations, potentially addressing an underserved segment not eligible for current biologics.

But biologics alone will not rewrite the future. The next frontier lies in synchronizing medical innovation with systemic reform—where precision medicine, real-world data, primary care training, and payer cooperation are not afterthoughts but core pillars of care delivery.

Asthma control today is not a matter of medicine, it is a matter of momentum. We have the molecules. What we lack is alignment. Until health systems, clinicians, and patients move in unison, this silent epidemic will persist, quiet in name, but thunderously loud in impact.