Christian Cardillo, MD, from Lewis Katz School of Medicine at Temple University Hospital.

Christian Cardillo, MD

HCPLive Five at Asthma Updates at ATS 2026

HCPLive Five: Asthma Updates at ATS 2026

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.

 — Tezepelumab: 70% exacerbation reduction across phenotypes including smokers and comorbid COPD (PASSAGE).

 — Dupilumab: nearly 2x remission odds; 4x wins in "hot-hot" eosinophil/FeNO patients (QUEST win ratio analysis).

 — Tezepelumab: 2.93x greater OCS reduction vs placebo; 36% discontinued OCS entirely (SUNRISE).

 — Periconception eosinophils: each 100 cells/µL increase linked to 0.20 additional exacerbations (P <.001).

 — Depression: 2x odds of poorly controlled asthma independent of BMI, race, and socioeconomic status.

Expert interviews from ATS 2026, Orlando.

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 (

 <.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; 

 =.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. 

Videos

5 interviews. 5 minutes. The asthma data from ATS 2026 your patients will be asking about.

Periconception Eosinophil Counts Predict Asthma Exacerbations in Pregnancy

Periconception eosinophil counts were independently associated with increased 

exacerbation frequency during pregnancy, according to late-breaking findings presented at the 

2026 American Thoracic Society (ATS) International Conference 

in Orlando, Florida. The findings suggest that a routinely available biomarker obtained at or near conception may help identify higher-risk patients earlier in gestation.

In an interview at ATS 2026, Christian Cardillo, MD, from Temple University Hospital, said asthma control during pregnancy remains highly variable, creating challenges for clinicians trying to anticipate which patients will deteriorate.

“We should all be aware that the physiologic changes during pregnancy in relation to asthma change from patient to patient, and it’s somewhat unpredictable,” Cardillo said.

Asthma exacerbations during pregnancy are associated with significant maternal and fetal risks, including acute respiratory failure, hospitalization, prolonged hospital stays, fetal growth restriction, and small for gestational age outcomes. Cardillo emphasized that identifying higher-risk patients earlier in pregnancy could help guide closer monitoring and coordination with subspecialists.

The late-breaking study included 31 pregnant patients with physician-diagnosed asthma treated at a single academic center. Investigators found that higher periconception absolute eosinophil counts were independently associated with increased exacerbation frequency during pregnancy.

Each 100 cells/µL increase in eosinophil count was associated with 0.20 additional exacerbations during pregnancy (adjusted β = 0.20; 95% CI, 0.12-0.28; 

 <.001) after adjusting for age, BMI, smoking status, controller therapy use, and prior exacerbation history. Cardillo noted that eosinophils are already part of routine clinical testing, making them a potentially scalable tool for risk assessment.

The analysis also suggested that greater eosinophil counts, particularly around 300 cells/µL, may better identify patients with type 2 inflammatory asthma phenotypes at higher risk for exacerbations during pregnancy. This threshold was consistent with prior retrospective data presented in 2025.

Cardillo said the findings remain exploratory but could eventually support earlier intervention strategies if validated in larger prospective studies. Future work will focus on more diverse cohorts and incorporation of objective pulmonary measures such as spirometry to strengthen risk prediction models.

“Most patients will obtain a CBC somewhere around 8 to 12 weeks,” he said. “While I don't think it's practice-changing at this very point in time, if we perform…more prospective studies…[it may become] a reflex cutoff where the patient will get hooked up with either [pulmonologists] or MFM [specialists] to have their asthma either taken a closer look at in terms of management or potentially get them started on new medications that can help them prevent exacerbations.”

Editor’s note: Relevant disclosures for Cardillo include AstraZeneca Pharmaceuticals and GlaxoSmithKline.

Cardillo C, Shenoy K, Karanam A, et al. (

) Periconception Eosinophil Count Is Independently Associated With Asthma Exacerbations During Pregnancy. Late-breaking poster presented at ATS 2026 in Orlando, Florida, on May 17.

Periconception eosinophils may serve as a biomarker to identify asthma risk in gestation, according to Christian Cardillo, MD, who presented late-breaking data at ATS 2026.

Christian Cardillo, MD

Articles