| Summary: | <i>Introduction</i>: The co-presence of bronchiectasis (BE) in severe eosinophilic asthma (SEA) is common. Data about the effectiveness of benralizumab in patients with SEA and BE (SEA + BE) are lacking. <i>Aim</i>: The aim of this study was to evaluate the effectiveness of benralizumab and remission rates in patients with SEA compared to SEA + BE, also according to BE severity. <i>Methods</i>: We conducted a multicentre observational study, including patients with SEA who underwent chest high-resolution computed tomography at baseline. The Bronchiectasis Severity Index (BSI) was used to assess BE severity. Clinical and functional characteristics were collected at baseline and after 6 and 12 months of treatment. <i>Results</i>: We included 74 patients with SEA treated with benralizumab, of which 35 (47.2%) showed the co-presence of bronchiectasis (SEA + BE) with a median BSI of 9 (7–11). Overall, benralizumab significantly improved the annual exacerbation rate (<i>p</i> < 0.0001), oral corticosteroids (OCS) consumption (<i>p</i> < 0.0001) and lung function (<i>p</i> < 0.01). After 12 months, significant differences were found between SEA and SEA + BE cohorts in the number of exacerbation-free patients [64.1% vs. 20%, OR 0.14 (95% CI 0.05–0.40), <i>p</i> < 0.0001], the proportion of OCS withdrawal [−92.6% vs. −48.6, <i>p</i> = 0.0003], and the daily dose of OCS [−5 mg (0 to −12.5) vs. −12.5 mg (−7.5 to −20), <i>p</i> = 0.0112]. Remission (zero exacerbations + zero OCS) was achieved more frequently in the SEA cohort [66.7% vs. 14.3%, OR 0.08 (95% CI 0.03–0.27), <i>p</i> < 0.0001]. Changes in FEV<sub>1</sub>% and FEF<sub>25–75%</sub> were inversely correlated with BSI (<i>r</i> = −0.36, <i>p</i> = 0.0448 and <i>r</i> = −0.41, <i>p</i> = 0.0191, respectively). <i>Conclusions</i>: These data suggest that benralizumab exerts beneficial effects in SEA with or without BE, although the former achieved less OCS sparing and fewer respiratory-function improvements.
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