Asthma endotypes and theratypes

The model of asthma as a single entity has now been replaced by a much more complex biological network of distinct and interrelating inflammatory and tissue driven pathways. Individual disease manifestations (phenotypes), pathogenetic pathways (endotypes) and response to therapy (theratypes) are discussed here in the context of current stratified management of asthma in the clinic based on biomarkers measured at the point-of-care. As the current classification criteria result in significant overlaps among phenotypes, endotypes and theratypes, this paper further describes the advantage of combining precision immunology, imaging and the digital biomarkers in an unbiased approach offered by machine learning. The new European Academy of Allergy and Clinical Immunology (EAACI) nomenclature for hypersensitivity reaction is detailed as a basis for the stratified asthma management with a special focus on tissue-driven mechanisms (type V asthma), metabolic/microbiome/epigenetic/neurogenic mechanisms (type VI asthma) and direct cellular activation (type VII asthma).