Asthma Phenotypes and Biomarkers

Area of Science:

• Immunology and Pulmonology
• Translational Medicine
• Clinical Phenotyping

Background:

• Asthma presents diverse phenotypes in adults and children, with severe cases exhibiting persistent symptoms despite treatment.
• Research focuses on severe asthma heterogeneity, leading to the identification of type 2-high and type 2-low inflammatory profiles.
• Type 2-high asthma involves specific immune pathways and eosinophilic inflammation, while type 2-low asthma is less understood and corticosteroid-resistant.

Purpose of the Study:

• To review the pathobiology of adult and pediatric asthma phenotypes.
• To discuss phenotype-based treatment strategies for severe asthma, including biologic therapies.
• To explore clinical phenotyping for guiding outpatient management and identify potential high-risk pediatric phenotypes.

Main Methods:

• Review of existing literature on asthma pathobiology, phenotypes, and treatment.
• Analysis of classification methods including supervised and unsupervised approaches.
• Evaluation of biomarker panels for guiding biologic selection in severe asthma.

Main Results:

• Severe asthma is classified into type 2-high and type 2-low phenotypes based on inflammatory markers.
• Biologics targeting type 2-high inflammation show promise in reducing exacerbations.
• Biomarker panels (blood eosinophils, IgE, FeNO) aid in selecting appropriate biologic therapies.

Conclusions:

• Understanding asthma phenotypes is crucial for personalized treatment strategies.
• Biologic therapies offer targeted options for severe asthma, particularly type 2-high.
• Further research is needed to fully characterize type 2-low asthma and identify high-risk pediatric phenotypes, including those requiring ICU admission.