T2-"Low" Asthma: Overview and Management Strategies

J Allergy Clin Immunol Pract. 2020 Feb;8(2):452-463. doi: 10.1016/j.jaip.2019.11.006.


Although the term "asthma" has been applied to all patients with airway lability and variable chest symptoms for centuries, phenotypes of asthma with distinct clinical and molecular features that may warrant different treatment approaches are well recognized. Patients with type 2 (T2)-"high" asthma are characterized by upregulation of T2 immune pathways (ie, IL-4 and IL-13 gene sets) and eosinophilic airway inflammation, whereas these features are absent in patients with T2-"low" asthma and may contribute to poor responsiveness to corticosteroid treatment. This review details definitions and clinical features of T2-"low" asthma, potential mechanisms and metabolic aspects, pediatric considerations, and potential treatment approaches. Priority research questions for T2-"low" asthma are also discussed.

Keywords: Asthma; Asthma in children; Asthma management; Biomarker; Endotype; Eosinophil; Neutrophil; Phenotype; Sensitization; Type 2 inflammation.

Publication types

  • Review

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use
  • Asthma* / diagnosis
  • Asthma* / drug therapy
  • Child
  • Eosinophilia*
  • Humans
  • Phenotype
  • Respiratory System


  • Adrenal Cortex Hormones