Pharmacotherapy and Clinical Management of Asthma

Asthma is a heterogeneous chronic airway disease characterised by variable airflow obstruction, airway hyperresponsiveness and eosinophilic or non-eosinophilic inflammation. The cornerstone of pharmacotherapy remains inhaled corticosteroids (ICS) to control airway inflammation, often combined with long-acting β2-agonists (LABA) to relieve bronchoconstriction. For patients with persistent symptoms or frequent exacerbations, long-acting muscarinic antagonists (LAMA) and oral corticosteroids may be used judiciously. Advances in biologic therapies targeting key cytokines and immunoglobulins have transformed management of severe type 2-high asthma, offering steroid-sparing benefits and reduction of exacerbations. Clinical management emphasises personalised treatment plans informed by biomarker profiles, regular assessment of inhaler technique, and integration of self-management education. Emerging digital inhaler platforms and remote monitoring support adherence and enable early identification of loss of control, while multidisciplinary care addresses comorbidities and the broader impact of asthma on quality of life.

Research from Nature Portfolio

Recent studies have validated the efficacy of a monoclonal antibody directed against interleukin-33 in patients with severe eosinophilic asthma, demonstrating significant reductions in exacerbation frequency and oral steroid requirements. Biomarker analyses revealed a strong correlation between baseline periostin levels and therapeutic response, underscoring the value of precision endotyping. In parallel, innovative inhaled nanocarrier systems have been shown to enhance targeted lung delivery of budesonide, achieving equivalent anti-inflammatory effects at lower doses and markedly reducing systemic exposure in healthy volunteers and mild asthma cohorts. These findings pave the way for dose optimisation and may mitigate long-term corticosteroid adverse effects.

Pharmacotherapy and Clinical Management of Asthma publication trend

The graph below shows the total number of articles in pharmacotherapy and clinical management of asthma across all publications each year (not limited to Nature Index journals).

Technical terms

Inhaled corticosteroids (ICS): Anti-inflammatory medications delivered directly to the airways to suppress chronic inflammation.

Long-acting β2-agonists (LABA): Bronchodilators that relax airway smooth muscle for up to 12 hours, used in combination with ICS.

Type 2 inflammation: Immunological pathway driven by cytokines such as IL-4, IL-5 and IL-13, associated with eosinophilic asthma.

Biologic therapy: Monoclonal antibodies targeting specific immune mediators to reduce exacerbations and steroid dependence.

Fractional exhaled nitric oxide (FeNO): Non-invasive biomarker indicating eosinophilic airway inflammation and response to corticosteroids.

Peripheral blood eosinophil count: Marker of systemic eosinophilia used to guide biologic selection and assess exacerbation risk.

Airway hyperresponsiveness: Exaggerated bronchoconstrictive response to stimuli, assessed by bronchial provocation tests.

References

1. Comparison of adverse events associated with different spacers used with non-extrafine beclometasone dipropionate for asthma. npj Primary Care Respiratory Medicine (2019).
2. A Dose-Ranging Study of Epinephrine Hydrofluroalkane Metered-Dose Inhaler (Primatene® MIST) in Subjects with Intermittent or Mild-to-Moderate Persistent Asthma. Journal of Aerosol Medicine and Pulmonary Drug Delivery (2020).
3. Effect of Cholinergic Receptor Antagonists on the Potentiation of the Effect of Adenosine Receptor Blockers in People with Bronchial Asthma. Biomedical & Pharmacology Journal (2024).