Evolving Concepts of Asthma

Severe asthma in humans and mouse model suggests a CXCL10 signature underlies corticosteroid-resistant Th1 bias

“…This observation was insightful, drawing attention to both Th2 and non-Th2/non-type 2 mechanisms affecting lung function, which did not respond to standard inhaled CS therapy. While disease severity in these CS-unresponsive subjects was not discussed in the study, it is well known that 5%-10% of asthma patients suffering from SA do not respond adequately to CS therapy (2,8). These subjects experience frequent exacerbations and poor disease control, and they typically bear 50% of healthcare burden for all asthma (8,(34)(35)(36).…”

“…These subjects experience frequent exacerbations and poor disease control, and they typically bear 50% of healthcare burden for all asthma (8,(34)(35)(36). It is now generally accepted that asthma is not a single entity, but a collection of multiple phenotypes, each with its own natural history, pathobiology, and unique response to therapy (2,8). Our understanding of the mechanisms underlying poor response to steroid-refractory disease is limited, and it was investigated in the present study.…”

“…It is increasingly recognized that asthma is a disease with multiple phenotypes, each with its own unique molecular mechanisms, natural history, and response to therapy (2,3). Corticosteroids (CS) have remained the mainstay of therapy, but for many patients, these therapies are ineffective (4), and research of underlying mechanisms may give insight into the etiologies of CS resistance and identify future therapeutic targets.…”

Clinical and biological characteristics of the French COBRA cohort of adult subjects with asthma

“…During the past decade, severe asthma has been identified as a heterogeneous disease, manifesting as several distinct clinical phenotypes that develop through a variety of mechanisms [4,5]. In particular, the presence or absence of increased numbers of eosinophils defines a pathophysiologically and clinically distinct subset of the disease [6].…”

Improving the diagnosis of eosinophilic asthma

“…In each asthma subtype, unique pathophysiologic mechanisms drive symptoms, airway smooth muscle contraction and mucosal inflammation, that influence the response to conventional therapies [2]. One subtype that has gained increasing attention in recent times is the 'eosinophilic asthma' subtype [3].…”