New therapeutic options for severe asthma have recently emerged, mostly in the form of monoclonal antibodies (“biologicals”) targeting relevant inflammatory pathways. Currently available agents target different aspects of “Type 2” immunity, and their indications often include overlapping patient groups. We present a round‐table discussion that took place during the Annual Meeting of the Respiratory Effectiveness Group (REG), on the reasoning behind the use of different add‐on medications for severe asthma, and crucially, on selection strategies. The proposed rational is based on current evidence, including real‐life studies, as well as on the appreciation of the relevant complexities. Direct head‐to‐head comparisons of biologicals are lacking; therefore, algorithms for initial choice and potential switch between agents should be based on understanding the key characteristics of different options and the development of a clear plan with predefined targets and shared decision‐making, in a structured way.

中文翻译：

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重症哮喘生物选择的进化算法

最近出现了针对严重哮喘的新治疗选择，主要以针对相关炎症通路的单克隆抗体（“生物制剂”）的形式出现。目前可用的药物针对“2 型”免疫的不同方面，它们的适应症通常包括重叠的患者群体。我们提出了在呼吸有效性小组 (REG) 年会期间举行的圆桌讨论，讨论使用不同附加药物治疗严重哮喘的原因，以及至关重要的选择策略。提出的理由基于当前的证据，包括现实生活中的研究，以及对相关复杂性的理解。缺乏对生物制品的直接头对头比较；所以，