## 1 Introduction  
Asthma affects more than 300 million patients worldwide, and about 5-10% of these subjects complain of poorly controlled disease [1]. Severe asthma has been defined by an international consensus, jointly stated by the European Respiratory Society (ERS) and the American Thoracic Society (ATS), as a respiratory disorder that requires high dosages of inhaled corticosteroids (ICS), associated with long-acting beta\({}_{2}\)-adrenergic agonists (LABA) for its control [2]. Moreover, long-acting muscarinic antagonists (LAMA), leukotriene modifiers, oral corticosteroids (OCS), and biologics might be also used as additional therapies for some patients [3, 4]. Several biologics are currently available in Italy as add-on therapies for severe asthma, including monoclonal antibodies targeting IgE (omalizumab), interleukin (IL)-5 (mepolizumab), IL-5 receptor (bentalizumab), and IL-4/13 receptors (dupilumab) [5]. Patients treated with biologics for severe asthma often require periodic access to health facilities to receive drug administration, as well as clinical and functional monitoring, occurring in a specialized professional setting.  
The routes of administration of anti-asthma drugs are crucial to maintain and improve adherence to the treatment of asthmatic patients [6, 7]. In this regard, providing drug formulations that are suitable for self-administration may improve adherence to therapy [8]. The above-mentioned monoclonal antibodies can be self-administered through appropriate devices, including auto-injectable pens and prefilled syringes [9]. Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), rapidly escalated to a pandemic, thus representing a dramatic public health emergency worldwide [10, 11]. SARS-CoV-2 is an extremely contagious virus, and social distancing plays a key role in reducing the chances of viral transmission [10]. Consequently, the health system required quick adjustments, including strict limitation of hospital access to critical cases only, as well as the implementation of remote services and telemedicine [12]. Based on a relevant update of international guidelines for asthma management, the COVID-19 pandemic has induced several changes in allergy and immunology care modalities, with the aim of delaying elective procedures, reducing nebulizers and spirometry, and maintaining adherence to prescribed therapies [4]. Therefore, the practice of self-administration of biologics has been recently favored by the lockdown imposed by the Italian government, which noticeably restricted patient contact with doctors and nurses [13].  
According to current evidence, both asthma and allergic diseases are not usually associated with the most severe expressions of SARS-CoV-2 infection [14, 15, 16]. However, careful attention should be paid to reduce the risk of potential infectious contacts in patients with severe asthma. Therefore, concomitantly with the outbreak of the COVID-19 pandemic, we encouraged the treatment shift of many severe asthmatic subjects from hospital-based management to home-care settings. Within this context, the recent changes in the management of severe asthma led to significant decreases in the numbers of medical visits, functional and hematological tests [13].  
In the present study, carried out in a group of severe asthmatic patients treated with biologics, we evaluated the different attitudes induced by the COVID-19 pandemic and the related lockdown, with respect to asthma exacerbations, symptom control, and adherence to therapy. In particular, the main aim of this study was to assess the impact of the COVID-19 lockdown policy on patient access to health facilities, asthma control, and safety of biological therapies.