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Expert Review

Severe Asthma: Characterization for Individualized Therapy

Respirology 2017

Chapter 1: Severe Asthma Phenotypes

Richard Leigh, MD, PhD
Professor of Medicine, University of Calgary, Calgary, Alberta

It is now well accepted that the characteristic airway inflammation of asthma develops from multiple and distinct molecular processes. This heterogeneity is captured in the description of phenotypes, which are categorizations based on empirical observations. Differences in apparent triggers, age of onset, response to therapy, and other disease features support the hypothesis that the term asthma encompasses a set of clinical syndromes rather than a single disease entity. As an approach to diagnosis and treatment of severe asthma, phenotyping represents a fundamental reorientation to the presumption that a stepwise treatment algorithm can be uniformly applied to all asthma cases. In severe asthma poorly responsive to standard therapies, phenotyping has been the basis for understanding disease heterogeneity and to seek options for individualizing treatment. Most recently, phenotyping has been driving efforts to identify differences in immune modulators active in mediating airway inflammation. Progress in this area can be credited with a growing number of targeted therapies for severe disease.

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