Type 2 Inflammation Management in Severe Asthma
Summary
Type 2 inflammation underlies a high-risk phenotype of severe asthma, driven by interleukin-4 (IL-4), IL-5 and IL-13 secretion from T helper 2 cells and type 2 innate lymphoid cells. This pathway promotes eosinophilic airway infiltration, goblet cell metaplasia, smooth muscle hyperresponsiveness and IgE production. Clinical management begins with high-dose inhaled corticosteroids and long-acting bronchodilators, but refractory patients often depend on systemic corticosteroids with attendant morbidities. Precision therapies targeting type 2 mediators have transformed care: anti-IgE (omalizumab), anti-IL-5 (mepolizumab, reslizumab, benralizumab) and dual IL-4/IL-13 receptor blockade (dupilumab) reduce exacerbations, improve lung function and permit oral corticosteroid tapering. Biomarkers such as blood eosinophil count, fractional exhaled nitric oxide (FeNO) and serum IgE guide treatment selection and reveal heterogeneity within type 2 asthma. Emerging strategies include non-invasive delivery of cytokine inhibitors, biomarker-driven combination regimens and real-world evaluation of economic impact. Ongoing research seeks to optimise phenotype-specific algorithms, extend global access and address long-term safety, thereby advancing a personalised approach to severe asthma care.
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Type 2 Inflammation Management in Severe Asthma publication trend
The graph below shows the total number of articles in type 2 inflammation management in severe asthma across all publications each year (not limited to Nature Index journals).
Technical terms
Type 2 inflammation: Immune response dominated by IL-4, IL-5 and IL-13 that drives eosinophilic airway disease.
Eosinophil: White blood cell involved in allergic inflammation and tissue remodelling.
Monoclonal antibody: Laboratory-engineered protein that specifically binds a target molecule, such as a cytokine or its receptor.
FeNO: Fraction of exhaled nitric oxide, a non-invasive biomarker of airway eosinophilic inflammation.
Nanobody: Small, single-domain antibody fragment capable of targeting epitopes with high affinity and tissue penetration.
References
- Non-invasive strategy: Developing a topical IL-4Rα-specific nanobody for the treatment of allergic airway diseases. Materials Today Bio (2024).
- Real-life effects of dupilumab in patients with severe type 2 asthma, according to atopic trait and presence of chronic rhinosinusitis with nasal polyps. Frontiers in Immunology (2023).
- Effectiveness and economic impact of Dupilumab in asthma: a population-based cohort study. Respiratory Research (2023).
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