GINA acknowledges that phenotyping is an evolving field and clinical relevance is undetermined; however, GINA suggests that patients with severe asthma may benefit from phenotyping.1
Patients with severe asthma may benefit from phenotyping into categories such as severe allergic, aspirin-exacerbated, or eosinophilic asthma. Assessment of the patient’s inflammatory phenotype includes Type 2 and non-Type 2 categories. This can help clinically in selecting individualized add-on treatment.1
Severe asthma phenotyping is still an evolving field, and consensus on the defining features of each phenotype is yet to be established.2
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Late onset non-allergic asthma is often corticosteroid-refractory1
Patient Characteristics |
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Patients with severe allergic (atopic) asthma have higher amounts of TH2 cytokines2
Patient Characteristics |
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Unlike other asthma phenotypes, patients with severe asthma with fixed obstruction often develop irreversible, persistent, and progressive obstruction6
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Patients with severe eosinophilic asthma usually experience recurrent exacerbations5
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Patients with severe neutrophilic asthma usually have systemic inflammation and reduced lung function11,12
References: 1. Global Initiative for Asthma. Global strategy for asthma management and prevention. https://ginasthma.org/gina-reports.
2.
Wenzel SE. Asthma phenotypes: the evolution from clinical to molecular approaches.
Nat Med.
2012;18(5):716-725.
3.
Wenzel S. Severe asthma in adults.
Am J Respir Crit Care Med. 2005;172(2):149-160.
4.
Shaw DE, Sousa AR, Fowler SJ, et al; Severe Asthma Workgroup of the SEAIC Asthma Committee. Clinical and inflammatory characteristics of the European U-BIOPRED adult severe asthma cohort.
Eur Respir J.
2015;46:1308-1321.
5.
Chung KF, Wenzel SE, Brozek JL, et al. International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma.
Eur Respir J.
2014;43(2):343-373.
6.
Campo P, Rodríguez F, Sánchez-Garcia S, et al; Severe Asthma Workgroup of the SEAIC Asthma Committee. Phenotypes and endotypes of uncontrolled severe asthma: new treatments.
J Investig Allergol Clin Immunol.
2013;23(2):76-88.
7.
Le Moual N, Siroux V, Pin I, Kauffmann F, Kennedy SM. Asthma severity and exposure to occupational asthmogens.
Am J Respir Crit Care Med.
2005;172(4):440-445.
8.
Moore WC, Meyers DA, Wenzel SE, et al; for the National Heart, Lung, and Blood Institute’s Severe Asthma Research Program. Identification of asthma phenotypes using cluster analysis in the Severe Asthma Research Program.
Am J Respir Crit Care Med. 2010;181(4):315-323.
9.
Haldar P, Pavord ID, Shaw DE, et al. Cluster analysis and clinical asthma phenotypes.
Am J Respir Crit Care Med. 2008;178(3):218-224.
10.
Wagener AH, de Nijs SB, Lutter R, et al. External validation of blood eosinophils, FENO
and serum periostin as surrogates for sputum eosinophils in asthma.
Thorax. 2015;70(2):115-120.
11.
Wood LG, Baines KJ, Fu J, Scott HA, Gibson PG. The neutrophilic inflammatory phenotype is associated with systemic inflammation in asthma.
Chest.
2012;142(1):86-93.
12.
Fahy JV. Eosinophilic and neutrophilic inflammation in asthma: insights from clinical studies.
Proc Am Thorac Soc.
2009;6(3):256-259.
13.
Nair P, Aziz-Ur-Rehman A, Radford K. Therapeutic implications of ‘netrophilic asthma’.
Curr Opin Pulm Med.
2015;21(1):33-38.