New Therapies for Emerging Endotypes of Asthma

Annu Rev Med. 2020 Jan 27;71:289-302. doi: 10.1146/annurev-med-041818-020630. Epub 2019 Nov 5.

Abstract

The presentation, pathobiology, and prognosis of asthma are highly heterogeneous and challenging for clinicians to diagnose and treat. In addition to the adaptive immune response that underlies allergic inflammation, innate immune mechanisms are increasingly recognized to be critical mediators of the eosinophilic airway inflammation present in most patients with asthma. Efforts to classify patients by severity and immune response have identified a number of different clinical and immune phenotypes, indicating that the innate and adaptive immune responses are differentially active among patients with the disease. Advances in the detection of these subgroups using clinical characteristics and biomarkers have led to the successful development of targeted biologics. This has moved us to a more personalized approach to managing asthma. Here we review the emerging endotypes of asthma and the biologics that have been developed to treat them.

Keywords: T2 inflammation; airway inflammation; airway remodeling; asthma; biologics; clustering analysis; endotypes; phenotype; sputum; transcriptomics.

Publication types

  • Review

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use*
  • Asthma / diagnosis
  • Asthma / genetics*
  • Asthma / immunology
  • Asthma / therapy*
  • Biological Therapy / methods
  • Biological Therapy / trends*
  • Bronchial Provocation Tests
  • Bronchodilator Agents / therapeutic use
  • Bronchoscopy / methods
  • Cytokines / metabolism*
  • Female
  • Forecasting
  • Humans
  • Male
  • Prognosis
  • Respiratory Function Tests
  • Risk Assessment
  • Severity of Illness Index
  • Treatment Outcome

Substances

  • Adrenal Cortex Hormones
  • Bronchodilator Agents
  • Cytokines