Redefining asthma through new immune response pattern: A clinically driven perspective

In 2023, the European Academy of Allergy and Clinical Immunology (EAACI) proposed an immune response-based classification that integrates molecular, endotypic, and clinical characteristics to define predominant and co-occurring immune response groups in asthma. Applying this framework may clarify disease heterogeneity and support personalized treatment.

To classify asthma patients according to the EAACI immune response system and describe predominant and overlapping groups together with related clinical features.

A retrospective chart review was conducted between February and April 2025 in our tertiary asthma outpatient clinic. Patients meeting ≥1 clinical criterion for an immune response type were categorized into seven EAACI-defined groups. Demographic variables, Asthma Control Test (ACT) scores, treatment steps, and disease severity were analyzed.

Among 401 patients (332 female, 69 male; mean age 53.4 ± 14 years), Type 1, 4b, 4a, 4c, 6, and 7 immune responses were present in 44.6%, 90%, 32.2%, 58.9%, 41.6%, and 15.5%, respectively, while all patients exhibited Type 5 features. The most frequent co-occurrence was among Types 4b, 4c, and 6. Step 5 treatment was more common in Type 4b (p = 0.002), whereas Step 3 predominated in Type 1 (p = 0.002). ACT scores did not differ significantly across immune response groups.

Classification based on the EAACI immune response framework is feasible and clinically meaningful. The predominance of Type 4b, often coexisting with Types 4c and 6, underscores its clinical relevance. This phenotypic-endotypic linkage may inform future personalized therapy strategies in asthma.