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Evolving Concepts of Asthma.
Am J Respir Crit Care Med. 2015 Jul 10;
Authors: Gauthier M, Ray A, Wenzel SE
Abstract
Our understanding of asthma has evolved over time from a singular disease to a complex of various phenotypes, with varied natural histories, physiologies and responses to treatment. Early therapies treated most asthmatic patients similarly with bronchodilators and corticosteroids, but saw varying degrees of success. Similarly, despite initial studies identifying an underlying Type 2 inflammation in the airways of asthmatics, biologic therapies targeted towards these Type 2 pathways were unsuccessful in all-comers. These observations led to increased interest in phenotyping asthma. Clinical approaches, both biased and later unbiased/statistical approaches to large asthma patient cohorts, identified a variety of patient characteristics but consistently identified the importance of age of onset of disease and the presence of eosinophils in determining clinically relevant phenotypes. These paralleled molecular approaches to phenotyping that developed an understanding that not all patients share a Type 2 inflammatory pattern. Using biomarkers to select for patients with Type 2 inflammation, repeated trials of biologics directed towards Type 2 cytokine pathways saw new found success, confirming the importance of phenotyping in asthma. Further research is needed to clarify additional clinical and molecular phenotypes, validate predictive biomarkers and identify new areas for possible interventions.
PMID: 26161792 [PubMed - as supplied by publisher]