Targeting Type 2 and Non-type 2 Asthma: Emerging Biologics and Personalized Strategies

Asthma continues to pose a serious global health issue affecting billions of people and causing significant morbidity. It is immunologically heterogeneous disease, classified as Type 2 (Th2/ILC2-mediated, eosinophilic) or Type 1 (Th1-mediated, neutrophilic, steroid-resistant) inflammation. This review aims to evaluates current biologic therapies, emerging strategies, and challenges in asthma management and highlights the challenges and future directions in personalized asthma management.

Current biologics for Type 2 asthma like anti-IgE (omalizumab), anti-IL-5 (mepolizumab, reslizumab, benralizumab), anti-IL-4/IL-13 (dupilumab) and anti-TSLP (tezepelumab) were effectively controlling severe eosinophilic asthma. Emerging therapies for Type 1 and mixed phenotypes include anti-TNF-α agents, CXCR2 antagonists, IL-17 blockers, JAK-STAT inhibitors and microbiome-based approaches and upstream epithelial cytokine-targeting therapies such as anti-TSLP agents. Dual or broad-spectrum strategies, such as bispecific antibodies and endotype-guided biologic selection offer more targeted interventions. Despite these advances, challenges persist regarding high costs, limited accessibility, absence of robust biomarkers, and potential risks of immunosuppression. Biologics have transformed severe Type 2 asthma management, but effective treatments for Type 1 and steroid-resistant asthma remain limited. Future directions involve multi-omics, machine learning and gene therapy to optimize personalized therapy and develop inclusive strategies for the diverse inflammatory endotypes.