Eosinophilic Asthma

Asthma endotypes are constantly evolving. Currently, there are no universally accepted criteria to define endotypes. The TH2-high endotype can have either allergic or nonallergic underpinnings and is typically characterized by some degree of eosinophilic airway inflammation. Unbiased clustering analyses have led to the identification of pediatric and adult phenotypes characterized by TH2 inflammation and associated endotypes with eosinophilic inflammation. Aspirin-exacerbated respiratory disease has also long been recognized as a unique asthma phenotype. An approach to identify these groups with biomarkers and subsequently choose a targeted therapeutic modality, particularly in severe disease requiring biologic agents, is outlined. Asthma endotypes are constantly evolving. Currently, there are no universally accepted criteria to define endotypes. The TH2-high endotype can have either allergic or nonallergic underpinnings and is typically characterized by some degree of eosinophilic airway inflammation. Unbiased clustering analyses have led to the identification of pediatric and adult phenotypes characterized by TH2 inflammation and associated endotypes with eosinophilic inflammation. Aspirin-exacerbated respiratory disease has also long been recognized as a unique asthma phenotype. An approach to identify these groups with biomarkers and subsequently choose a targeted therapeutic modality, particularly in severe disease requiring biologic agents, is outlined. Precision Medicine in Asthma—Using Phenotypes to Understand Endotypes That Lead Us to New Therapeutic OptionsThe Journal of Allergy and Clinical Immunology: In PracticeVol. 8Issue 2PreviewAs Fitzpatrick et al1 point out, “phenotypes” of asthma have been reported in the literature since the early 1940s. It is now well recognized that the term “asthma” identifies a group of disorders with distinct clinical features. This recognition, combined with an ability to analyze large multicenter datasets,2,3 has allowed identification of additional asthma clusters/phenotypes. Some of these phenotypes can be linked to an underlying biologic process (endotype) that can then drive a targeted treatment approach. Full-Text PDF