title: Personalised medicine in asthma: from curative to preventive medicine.
abstract: The concept of asthma has changed substantially in recent years. Asthma is now recognised as a heterogeneous entity that is complex to treat. The subdivision of asthma, provided by "cluster" analyses, has revealed various groups of asthma patients who share phenotypic features. These phenotypes underlie the need for personalised asthma therapy because, in contrast to the previous approach, treatment must be tailored to the individual patient. Determination of the patient's asthma phenotype is therefore essential but sometimes challenging, particularly in elderly patients with a multitude of comorbidities and a complex exposure history. This review first describes the various asthma phenotypes, some of which were defined empirically and others through cluster analysis, and then discusses personalisation of the patient's diagnosis and therapy, addressing in particular biological therapies and patient education. This personalised approach to curative medicine should make way in the coming years for personalised preventive and predictive medicine, focused on subjects at risk who are not yet ill, with the aim of preventing asthma before it occurs. The concept of personalised preventive medicine may seem a long way off, but is it really?
authors.affiliation: Dept of Pulmonary Medicine, Reunion Island University Hospital/South Reunion Island Hospital Group, Saint-Pierre, France laurent.guilleminault@chu-reunion.fr.|INSERM, UMR 1188 Diabetes-Atherothrombosis Therapies Reunion Island Indian Ocean (DéTROI), Reunion Island Indian Ocean Cyclotron (CYROI) Platform, Sainte-Clotilde, France.|University of Reunion Island, UMR 1188, Sainte-Clotilde, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Guilleminault
authors.affiliation: Dept of Pulmonary Medicine, Angers University Hospital, Angers, France.
authors.forename: Hakima
authors.initials: H
authors.lastname: Ouksel
authors.affiliation: Dept of Pulmonary Medicine, Rennes University Hospital, Rennes, France.
authors.forename: Chantal
authors.initials: C
authors.lastname: Belleguic
authors.affiliation: Dept of Pulmonary Medicine, Rennes University Hospital, Rennes, France.|Pulmonary Medicine Practice, St Grégoire Private Hospital, Saint-Grégoire, France.
authors.forename: Yannick
authors.initials: Y
authors.lastname: Le Guen
authors.affiliation: Nantes University Hospital, Nantes-Roscoff National Cystic Fibrosis Reference Centre, Nantes, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Germaud
authors.affiliation: Novartis Pharma, Scientific Operations, Rueil-Malmaison, France.
authors.forename: Emilie
authors.initials: E
authors.lastname: Desfleurs
authors.affiliation: European University of Brittany, University of Brest, EA3878, IFR148, Dept of Internal and Respiratory Medicine, La Cavale Blanche Hospital, Brest, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Leroyer
authors.affiliation: Nantes University Hospital, Nantes-Roscoff National Cystic Fibrosis Reference Centre, Nantes, France.|UMR_S 1087 CNRS UMR_6291, L'Institut du Thorax, University of Nantes, Nantes, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Magnan
mesh_terms: D018927:Anti-Asthmatic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control*; D001688:Biological Products / Q000009:adverse effects / Q000627:therapeutic use*; D016000:Cluster Analysis; D015897:Comorbidity; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008168:Lung / Q000187:drug effects* / Q000503:physiopathology; D010353:Patient Education as Topic; D018579:Patient Selection; D010641:Phenotype; D057285:Precision Medicine / Q000379:methods*; D011237:Predictive Value of Tests; D011315:Preventive Medicine / Q000379:methods*; D011379:Prognosis; D012307:Risk Factors
chemical_list: D018927:Anti-Asthmatic Agents; D001688:Biological Products