Phenotyping Patients With Severe Asthma: Check Those Biomarkers!

Phenotyping Patients With Severe Asthma: Check Those Biomarkers! Posted By:
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Asthma affected approximately 262 million people globally in 2019, and an estimated 5% to 10% of these people had severe asthma—a chronic lung disease that remains uncontrolled despite maximum use of inhaled corticosteroids and/or other controller medications. In patients with uncontrolled symptoms, stepping up to targeted biologic therapy is the next appropriate approach to care. 

There are now 6 biologic therapies for asthma available. Each of these treatments, when used in appropriate patients, has been shown to reduce exacerbations, hospitalizations, and healthcare utilization; improve symptoms overall and asthma-related quality of life; decrease oral and/or inhaled corticosteroid use; and some agents positively affect lung function by some parameters. However, given the heterogeneity of asthma, it is important to determine the underlying phenotype in those with severe asthma, as this aids healthcare professionals (HCPs) in selecting the most appropriate biologic agents and improving outcomes. In asthma, HCPs can use biomarkers to determine underlying disease phenotypes and predict response and probable success with the various biologic agents available. Phenotyping patients, or checking for biomarkers, is therefore crucial to improve patient outcomes. 

In general, there are 2 major types of asthma: type 2 high inflammation (T2-high) and type 2 low inflammation (T2-low). Currently, there are no commercially useful biomarkers to assess for T2-low asthma. However, for T2-high asthma, there are several biomarkers—blood eosinophils, serum total immunoglobulin E (IgE), fractional exhaled nitric oxide (FeNO), and allergen-specific IgE levels—and biologic agents available for diagnosing and managing severe asthma. These agents’ respective targets and related biomarkers are shown below (Table).

Table. Severe Asthma Biologic Agents and Their Targets, Endotypes, and Biomarkers

Biomarkers are important not only for phenotyping asthma, but also for aiding the accurate diagnosis, disease severity, and exacerbation risk; selection of the proper biologic therapy; and observation of treatment response. Furthermore, many patients have mixed phenotypes; therefore, assessing their biomarker status is an important step to determine how to best proceed with their care. Assessing biomarkers allows for personalized treatment tailored to each patient’s unique presentation. Improving patient outcomes, symptom control, and quality of life are all crucial aspects of chronic disease management. Prompt referral of all patients with severe, uncontrolled, or difficult-to-manage asthma to allergy/immunology or pulmonology specialists is crucial for managing and optimizing treatment outcomes.


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Filed under: Allergy/Immunology

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