The reclassification of asthma based on subphenotypes.
OBJECTIVE
Despite asthma being widely regarded as a heterogeneous disease, a consensus for an accurate system of classification has not been agreed. Recent studies have suggested that the recognition of subphenotypes of asthma based on the pattern of airway inflammation may be particularly useful in increasing our understanding of the disease. The present review discusses the important literature in this field, placing current work in its historical context.


RESULTS
The use of noninvasive markers of airway inflammation has suggested the presence of four distinct phenotypes: eosinophilic, neutrophilic, mixed inflammatory and paucigranulocytic asthma. Recent studies suggest that these subgroups may differ in their aetiology, immunopathology and response to treatment. Several studies have focused on refractory asthma as a distinct phenotype with evidence of a more distal pattern of airway inflammation and of upregulation of the tumour necrosis factor-alpha axis. Finally, novel treatment approaches targeted at specific patterns of airway inflammation are emerging, making an appreciation of subphenotypes particularly relevant.


CONCLUSIONS
The present review will discuss limitations to current classification systems, identify key current studies based on identifying inflammatory subphenotypes and provide suggestions for a novel approach that may further improve our understanding in this area.
Green
Ruth H
RH
Department of Respiratory Medicine, Glenfield Hospital, Groby Road, Leicester, UK. ruth.green@uhl-tr.nhs.uk
Brightling
Chris E
CE
Bradding
Peter
P
D000818:Animals; D001249:Asthma / Q000145:classification* / Q000473:pathology / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D010641:Phenotype