Simon Couillard, MD, FRCPC, MSc, from Université de Sherbrooke.



Simon Couillard, 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.

New research found dupilumab nearly doubled the likelihood of achieving clinical remission in patients with moderate-to-severe 

, particularly among those with high eosinophils and elevated fractional exhaled nitric oxide (FeNO).

 in Orlando, Florida, investigator Simon Couillard, MD, FRCPC, MSc, from the Université de Sherbrooke, presented findings of the win ratio analysis of QUEST, a randomized, phase 3, placebo-controlled trial. The study evaluated dupilumab across key asthma remission domains, including exacerbation reduction, lung function improvement, and symptom control.

“What's really amazing about this analysis is we identified a subgroup of patients with a lot of inflammation that do beautifully well with this anti-inflammatory therapy,” Couillard said. “They get 4-fold more wins on the remission outcomes.”

The analysis focused on patients with type 2 inflammation, defined by blood eosinophils ≥ 150 cells/μL or FeNO ≥ 25 parts per billion, populations previously shown to benefit from dupilumab. However, Couillard emphasized that patients with both eosinophils ≥ 300 cells/μL and FeNO ≥ 35 parts per billion—what he referred to as “hot-hot” patients—demonstrated the strongest responses.

“We can identify a group of patients that do exquisitely well with the drug dupilumab, but not well at all with placebo,” he said. “Let's go after them and identify…and treat them earlier.”

The win ratio framework prioritized outcomes hierarchically based on clinical importance: exacerbation elimination first, followed by lung function stability or improvement, then clinically meaningful symptom improvement. Couillard noted the approach may provide a more comprehensive assessment of biologic benefit than analyzing endpoints independently.

According to Couillard, asthma attacks remain the most clinically meaningful endpoint because of their long-term impact on morbidity, healthcare utilization, and lung injury.

“Each additional asthma attack leaves a scar on your lungs and generates costs for the healthcare system,” he said.

The findings also reinforce the growing importance of biomarker-driven asthma management in clinical practice. Couillard encouraged pulmonologists to routinely evaluate blood eosinophils and FeNO when assessing patients for biologic eligibility and treatment expectations.

Couillard added that remission should increasingly become a treatment target in asthma care, similar to approaches used in rheumatology and inflammatory bowel disease. However, he cautioned that remission with biologics currently represents remission on treatment rather than sustained disease resolution after therapy discontinuation.

“With the biologics long term, we haven't been able to stop the biologics, unfortunately, in asthma, because patients will relapse,” he said.

Still, he argued remission-focused endpoints may help clinicians better communicate the multidimensional benefits of biologic therapy to both patients and healthcare systems.

The findings also support ongoing research into remission-focused asthma trials, including the upcoming HOT-HOT trial evaluating dupilumab in patients with highly elevated type 2 inflammatory biomarkers.

“The win ratio is widely used in cardiovascular disease and critical care, so it only makes sense that we try to adopt this endpoint in asthma now,” he said. “It’ll be exciting to see how the HOT-HOT trial, but also other analyses, play out in this field,” he said.

Couillard S, Petousi N, Pavord I, et al. 

. Dupilumab Doubles the Likelihood of Achieving Clinical Asthma Remission in Patients with Moderate-To-Severe Type 2 Asthma: Win Ratio Analysis of Quest. Poster presented at ATS 2026 in Orlando, Florida, on May 18.

At ATS 2026, Couillard discussed a win ratio analysis showing dupilumab significantly improved remission outcomes, particularly among patients with elevated eosinophils and FeNO.

Simon Couillard, MD

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