Precision medicine in asthma: endotype stratification, biomarker-guided biologics, and emerging therapeutic...

Asthma is a disease that has a high morbidity and health care burden impacting more than 300 million people worldwide, but the heterogeneity of the disease cannot be adequately handled through conventional stepwise management using inhaled corticosteroids and bronchodilators. This critical review explores the changing face of asthma care with a particular focus on precision medicine with endotype-informed stratification and biomarker-targeted choice of therapies. The existing traditional therapies, such as inhaled corticosteroids, long-acting beta-agonists, and leukotriene modifiers, are still considered baseline but have limited effects in moderate-to-severe cases with heterogeneous inflammatory phenotypes. Groundbreaking biologic therapies based on type-2 inflammatory pathways have changed the management outcomes. Guided by biomarkers such as blood eosinophils, fractional exhaled nitric oxide, and serum IgE levels, anti-IgE, anti-IL-5/IL-5R, anti-IL-4/IL-13, and anti-TSLP agents show significant reductions in exacerbations and oral corticosteroid-sparing effects. A combination of accurate endotype typing algorithms with biomarker-based treatment selection guidelines will allow optimization of personalized therapy and forecasting of biologic response. New treatments of IL-33, JAK-STAT, and new delivery models will lead to better outcomes regardless of patient phenotypes. Nevertheless, constraint heterogeneity of treatment, safety in particular groups, high-cost barriers, and improper adherence limit other applications to the real world. This review is a synthesis of the existing knowledge and future perspectives, with the main focus being put upon personalized medicine approaches, combination strategies, and novel drug delivery systems as the key factors in the enhancement of long-term performance, minimization of disease burden, as well as clinical remission in asthma patients.