Severe Adult Asthmas: Integrating Clinical Features, Biology and Therapeutics to Improve Outcomes.

Severe Adult Asthmas: Integrating Clinical Features, Biology and Therapeutics to Improve Outcomes. Am J Respir Crit Care Med. 2020 Dec 16;: Authors: Wenzel SE Abstract Evaluation and effective management of asthma and in particular severe asthma remains at the core of pulmonary practice. Over the last 20-30 years, there is increasing appreciation that "severe asthma", encompasses multiple different subgroups or phenotypes each with differing presentations. Using clinical phenotyping, in combination. with rapidly advancing molecular tools and targeted monoclonal antibodies (human knock-outs), the understanding of these phenotypes and our ability to treat them have greatly advanced. Type-2 (T2) Hi and Lo severe asthmas are now easily identified. Fraction exhaled nitric oxide (FeNO) and blood eosinophil counts can be routinely employed in clinical settings to identify these phenotypes and predict responses to specific therapies, meeting the initial goals of precision medicine. Integration of molecular signals, biomarkers and clinical responses to targeted therapies has enabled identification of critical molecular pathways and in certain phenotypes advanced them to near endotype status. Despite these advances, little guidance is available to determine which class of biologic is appropriate for a given patient and current "break-through" therapies remain expensive and even inaccessible to many patients. Many of the most severe asthmas, wi...
Source: American Journal of Respiratory and Critical Care Medicine - Category: Respiratory Medicine Authors: Tags: Am J Respir Crit Care Med Source Type: research