Asthma: From Diagnosis to Endotype to Treatment.

18 May 2018

Aaron S et al. Re-evaluation of diagnosis in adults with physician-diagnosed asthma. JAMA (1) Reviewed by Akhilesh Jha Asthma diagnosis is based on classical symptoms together with variable airflow limitation (2). Accuracy is essential to ensure appropriate long-term medication; misdiagnosis can lead to unnecessary drug-related adverse effects and medical expenditure. Lefaudeux D et al. U-BIOPRED clinical adult asthma clusters linked to a subset of sputum omics. J Allergy Clin Immunol (6) Reviewed by Martin Knolle Recent advances in asthma phenotyping (7-9) have enabled more effective and targeted asthma treatments. However, a mechanistic understanding of these inflammatory endotypes remains limited. To this end, the ‘Unbiased Biomarkers for the Prediction of Respiratory Disease Outcomes’ (U-BIOPRED) consortium has applied ‘multi-omics’ approaches to well-characterised asthma patient cohorts (10). Nair P et al. Oral glucocorticoid-sparing effect of benralizumab in severe asthma. N Engl J Med (15) Reviewed by Katharine M Lodge Patients with treatment-refractory asthma account for a large proportion of asthma healthcare costs and suffer substantial glucocorticoid-induced co-morbidities (16, 17). Type 2 immune response-driven eosinophilia is associated with severe and uncontrolled asthma (18). Interleukin 5 (IL-5), a pro-inflammatory cytokine produced by Th2 cells, promotes eosinophil recruitment and survival, and represents an important therapeutic target (19). Monoclonal antibodies against IL-5 (mepolizumab and reslizumab) or the IL-5 receptor (benralizumab) reduce exacerbation frequency in severe eosinophilic asthma, with potential for lung function and quality of life improvement (20-22).