Mechanisms and treatments for severe, steroid-resistant allergic airway disease and asthma

Immunol Rev. 2017 Jul;278(1):41-62. doi: 10.1111/imr.12543.


Severe, steroid-resistant asthma is clinically and economically important since affected individuals do not respond to mainstay corticosteroid treatments for asthma. Patients with this disease experience more frequent exacerbations of asthma, are more likely to be hospitalized, and have a poorer quality of life. Effective therapies are urgently required, however, their development has been hampered by a lack of understanding of the pathological processes that underpin disease. A major obstacle to understanding the processes that drive severe, steroid-resistant asthma is that the several endotypes of the disease have been described that are characterized by different inflammatory and immunological phenotypes. This heterogeneity makes pinpointing processes that drive disease difficult in humans. Clinical studies strongly associate specific respiratory infections with severe, steroid-resistant asthma. In this review, we discuss key findings from our studies where we describe the development of representative experimental models to improve our understanding of the links between infection and severe, steroid-resistant forms of this disease. We also discuss their use in elucidating the mechanisms, and their potential for developing effective therapeutic strategies, for severe, steroid-resistant asthma. Finally, we highlight how the immune mechanisms and therapeutic targets we have identified may be applicable to obesity-or pollution-associated asthma.

Keywords: infection; novel therapies; obesity; pollution; severe asthma; steroid resistance.

Publication types

  • Review
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Air Pollution
  • Animals
  • Anti-Asthmatic Agents / therapeutic use*
  • Asthma / diagnosis*
  • Asthma / etiology
  • Asthma / metabolism
  • Asthma / therapy*
  • Diet, High-Fat
  • Disease Models, Animal
  • Drug Resistance*
  • Gene Expression Regulation / drug effects
  • Humans
  • Obesity / complications
  • Respiratory Hypersensitivity / diagnosis*
  • Respiratory Hypersensitivity / etiology*
  • Respiratory Hypersensitivity / therapy*
  • Risk Factors
  • Severity of Illness Index
  • Signal Transduction / drug effects
  • Steroids / therapeutic use*
  • Treatment Outcome


  • Anti-Asthmatic Agents
  • Steroids