Precision Medicine for Asthma: Tailored to its Severity and Endotype/Phenotype

Asthma is a chronic respiratory disease affecting more than 300 million people globally and remains a major cause of morbidity, mortality, and healthcare burden. Traditionally, asthma has been managed using a stepwise treatment algorithm focused on inhaled corticosteroids, bronchodilators, and add-on therapies. While this approach provides a broad framework for care, it does not adequately account for the heterogeneity of the disease, which encompasses diverse clinical phenotypes, underlying endotypes, and variable treatment responses. Many patients with moderate-to-severe asthma continue to experience poor control, frequent exacerbations, and impaired quality of life despite standard therapies. Precision medicine offers an alternative strategy by identifying and targeting specific "treatable traits" across pulmonary, extrapulmonary, and behavioral domains. Advances in biomarker profiling-including blood eosinophils, fractional exhaled nitric oxide, volatile organic compounds, and transcriptomics-have enabled more accurate risk prediction and patient stratification. Imaging techniques, such as high-resolution computed tomography and hyperpolarized magnetic resonance imaging, are improving the ability to detect small airways dysfunction, mucus plugging, and other key disease mechanisms. Biologic therapies directed at type 2 inflammation pathways, including anti-immunoglobulin E, anti-interleukin (IL)5, anti-IL4Rα, and anti-thymic stromal lymphopoietin agents, have significantly reduced exacerbation rates and improved lung function, although biomarker variability, high treatment costs, and limited accessibility remain barriers to widespread use. Emerging oral, inhaled, and long-acting biologics further expand the therapeutic landscape. Looking forward, the integration of multi-omics, deep phenotyping, and artificial intelligence promises to transform asthma management by enabling personalized therapy tailored to individual patient profiles. This narrative review examines the limitations of the conventional stepwise approach, highlights recent advances in phenotyping and targeted treatment, and explores the role of novel technologies in shaping the future of asthma care. By moving beyond the one-size-fits-all model, precision medicine has the potential to improve long-term outcomes, safety, and quality of life for patients with asthma.