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2015 ; 192
(6
): 660-8
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Evolving Concepts of Asthma
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Gauthier M
; Ray A
; Wenzel SE
Am J Respir Crit Care Med
2015[Sep]; 192
(6
): 660-8
PMID26161792
show ga
Our understanding of asthma has evolved over time from a singular disease to a
complex of various phenotypes, with varied natural histories, physiologies, and
responses to treatment. Early therapies treated most patients with asthma
similarly, with bronchodilators and corticosteroids, but these therapies had
varying degrees of success. Similarly, despite initial studies that identified an
underlying type 2 inflammation in the airways of patients with asthma, biologic
therapies targeted toward these type 2 pathways were unsuccessful in all
patients. These observations led to increased interest in phenotyping asthma.
Clinical approaches, both biased and later unbiased/statistical approaches to
large asthma patient cohorts, identified a variety of patient characteristics,
but they also consistently identified the importance of age of onset of disease
and the presence of eosinophils in determining clinically relevant phenotypes.
These paralleled molecular approaches to phenotyping that developed an
understanding that not all patients share a type 2 inflammatory pattern. Using
biomarkers to select patients with type 2 inflammation, repeated trials of
biologics directed toward type 2 cytokine pathways saw newfound success,
confirming the importance of phenotyping in asthma. Further research is needed to
clarify additional clinical and molecular phenotypes, validate predictive
biomarkers, and identify new areas for possible interventions.
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