[Uncontrolled asthma: importance of phenotypes and local and systemic eosinophilia]

Asthma is a complex chronic inflammatory disease of the airways. Eosinophilia is a recognized feature of asthma. Asthma is no more considered as a single disease, but there are several subtypes of bronchial asthma, also called phenotypes, that have therapeutic and prognostic implications. Asthmatics are now classified according to inflammatory phenotypes that allow a personalized therapy. Phenotype identification requires induced sputum analysis that is not widely available. In this context, we have identified surrogate markers for inflammatory phenotypes. An eosinophilic phenotype can lbe suspected in case of concomitant increase of exhaled nitric oxide, blood eosinophils, IgE levels and airway obstruction. We have also identified a subgroup of asthmatics exhibiting diffuse local and systemic eosinophilia. This subgroup has a more severe asthma,a lower asthma control and a higher number of exacerbations.