Severe Asthma Management Strategies
Summary
Severe asthma represents a heterogeneous subgroup of patients who remain symptomatic or experience frequent exacerbations despite high‐dose inhaled corticosteroids plus additional controller therapies. Contemporary management prioritises precise phenotyping, often guided by inflammatory biomarkers, to stratify patients into T2-high and non-T2 endotypes. T2-high disease, characterised by eosinophilic inflammation and elevated exhaled nitric oxide, is commonly treated with targeted biologic agents directed against interleukins IL-5, IL-4/IL-13 or IgE. Non-T2 phenotypes, less responsive to these agents, may benefit from alternative approaches such as macrolide antibiotics, bronchial thermoplasty or emerging small molecules. A treatable-traits paradigm underpins modern care by addressing modifiable factors—airflow limitation, airway hyperresponsiveness, comorbidities and adherence. Optimisation of inhaler technique, personalised follow-up schedules and registry-informed decision making enhance real-world outcomes. Preventing exacerbations and achieving sustained control remain core goals, with remission increasingly recognised as an attainable target in selected patients. Global registries and collaborative networks support standardised data collection, enabling health-economic analyses and the identification of predictors for clinical response. The future of severe asthma management lies in integrating multidimensional assessment, novel biomarkers and adaptive treatment algorithms to deliver truly individualised care.
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Severe Asthma Management Strategies publication trend
The graph below shows the total number of articles in severe asthma management strategies across all publications each year (not limited to Nature Index journals).
Technical terms
Biologic therapy: Treatment with monoclonal antibodies targeting specific cytokines or immunoglobulins involved in airway inflammation.
Type 2 inflammation: An immune response driven by Th2 cells and innate lymphoid cells producing IL-4, IL-5 and IL-13, often linked to eosinophilic airway disease.
Clinical remission: A composite outcome denoting absence of exacerbations, no maintenance oral corticosteroids, good symptom control and preserved lung function.
Eosinophilic asthma: A phenotype characterised by elevated eosinophil counts in blood or airway samples, responsive to IL-5-targeted therapies.
Asthma Control Questionnaire (ACQ): A standardised patient-reported tool measuring symptom burden and control over recent weeks.
References
- Clinical remission in severe asthma with biologic therapy: an analysis from the UK Severe Asthma Registry. European Respiratory Journal (2023).
- Remission outcomes in severe eosinophilic asthma with mepolizumab therapy: Analysis of the REDES study. Frontiers in Immunology (2023).
- International severe asthma registry (ISAR): protocol for a global registry. BMC Medical Research Methodology (2020).
- Characterization of T2-Low and T2-High Asthma Phenotypes in Real-Life. Biomedicines (2021).
- Moving towards a Treatable Traits model of care for the management of obstructive airways diseases. Respiratory Medicine (2021).
About these summaries
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