New treatments for severe treatment-resistant asthma: targeting the right patient.
Guidelines for asthma management focus on the use of combination inhaled treatment with corticosteroids and longacting β-agonists for symptomatic asthma. In more severe disease, other drugs such as leukotriene blockers and slow-release oral theophylline are added, with oral corticosteroids and anti-immunoglobulin E treatment with omalizumab for the most severe cases of asthma. Once-daily longacting β-agonists and inhaled corticosteroids are being developed. Longacting muscarinic antagonists might also provide additive benefit. New approaches are needed for the treatment of severe asthma, but patients need to be endotyped so that they can be directed for specific treatments. This Review focuses on the role of eosinophilic and neutrophilic inflammation, the attributes of chronic airflow obstruction, and the notion of corticosteroid insensitivity because potential targets for treatment have started to emerge from such analyses. How the best phenotypic or even better, the best endotypic responder with each new treatment, can be established will also be discussed. Newer treatments for asthma will emerge from better endotyping, leading to personalised medicine in asthma.
Experimental Studies, National Heart and Lung Institute, Imperial College London and Royal Brompton National Institute for Health Research Biomedical Research Unit, London, UK. Electronic address: f.chung@imperial.ac.uk.
Kian Fan
KF
Chung
D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D058666:Adrenergic beta-2 Receptor Agonists / Q000008:administration & dosage; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D000888:Antibodies, Anti-Idiotypic / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy* / Q000473:pathology*; D004351:Drug Resistance; D004802:Eosinophilia / Q000473:pathology*; D006801:Humans; D007378:Interleukins / Q000037:antagonists & inhibitors; D018942:Macrolides / Q000627:therapeutic use; D018727:Muscarinic Antagonists / Q000627:therapeutic use; D009504:Neutrophils; D000069444:Omalizumab; D018579:Patient Selection; D010641:Phenotype; D006377:T-Lymphocytes, Helper-Inducer
D000305:Adrenal Cortex Hormones; D058666:Adrenergic beta-2 Receptor Agonists; D018927:Anti-Asthmatic Agents; D000888:Antibodies, Anti-Idiotypic; D061067:Antibodies, Monoclonal, Humanized; D007378:Interleukins; D018942:Macrolides; D018727:Muscarinic Antagonists; D000069444:Omalizumab