Biomarkers for Severe Asthma: Lessons From Longitudinal Cohort Studies

Area of Science:

• Pulmonology
• Immunology
• Biomarker Discovery

Background:

• Severe asthma (SA) is a complex, heterogeneous respiratory disease.
• Advances in understanding SA pathophysiology have led to targeted biologic therapies, primarily for type 2-high asthma.
• Type 2 inflammatory biomarkers (e.g., IgE, IL-4, IL-5, IL-13, eosinophils, FeNO) are crucial for diagnosis and predicting treatment response.

Purpose of the Study:

• To explore the heterogeneity of severe asthma, including type 2-low and mixed phenotypes.
• To investigate novel biomarkers for severe asthma.
• To highlight the value of real-world cohort studies in addressing unmet needs in SA research.

Main Methods:

• Review of cross-sectional studies, randomized clinical trials, and real-world cohort studies.
• Analysis of type 2 inflammatory biomarkers and their correlation with SA characteristics.
• Investigation into non-type 2 asthma phenotypes.

Main Results:

• Type 2 biomarkers are established predictors of inflammation, symptoms, exacerbations, and treatment efficacy in SA.
• Type 2-low and mixed asthma phenotypes contribute significantly to SA heterogeneity.
• Real-world cohort studies are emerging as valuable tools for SA research.

Conclusions:

• Understanding SA heterogeneity, including non-type 2 phenotypes, is critical.
• Continued research into novel biomarkers is necessary to address the unmet needs in severe asthma management.
• Real-world evidence complements clinical trials in advancing SA knowledge.