Phenotypes and endotypes of uncontrolled severe asthma: new treatments

J Investig Allergol Clin Immunol. 2013;23(2):76-88; quiz 1 p. follow 88.


Severe asthma is a heterogeneous disease that affects only 5%-10% of asthmatic patients, although it accounts for a significant percentage of the consumption of health care resources. Severe asthma is characterized by the need for treatment with high doses of inhaled corticosteroids and includes several clinical and pathophysiological phenotypes. To a large extent, this heterogeneity restricts characterization of the disease and, in most cases, hinders the selection of appropriate treatment. In recent years, therefore, emphasis has been placed on improving our understanding of the various phenotypes of severe asthma and the identification of biomarkers for each of these phenotypes. Likewise, the concept of the endotype has been gaining acceptance with regard to the various subtypes of the disease, which are classified according to their unique functional or pathophysiological mechanism. This review discusses the most relevant aspects of the clinical and inflammatory phenotypes of severe asthma, including severe childhood asthma and the various endotypes of severe asthma. The main therapeutic options available for patients with uncontrolled severe asthma will also be reviewed.

Publication types

  • Review

MeSH terms

  • Adolescent
  • Adrenal Cortex Hormones / pharmacology
  • Adrenal Cortex Hormones / therapeutic use*
  • Adult
  • Anti-Asthmatic Agents / pharmacology
  • Anti-Asthmatic Agents / therapeutic use*
  • Anti-Bacterial Agents / pharmacology
  • Anti-Bacterial Agents / therapeutic use*
  • Antibodies, Monoclonal / pharmacology
  • Antibodies, Monoclonal / therapeutic use*
  • Asthma / classification
  • Asthma / drug therapy*
  • Asthma / physiopathology
  • Biomarkers / metabolism
  • Bronchodilator Agents / pharmacology
  • Bronchodilator Agents / therapeutic use*
  • Child
  • Child, Preschool
  • Humans
  • Infant
  • Phenotype
  • Severity of Illness Index


  • Adrenal Cortex Hormones
  • Anti-Asthmatic Agents
  • Anti-Bacterial Agents
  • Antibodies, Monoclonal
  • Biomarkers
  • Bronchodilator Agents