Beyond T2-inflammation: What Does the Future Hold for Severe Asthma?

Abstract

Asthma is a common inflammatory airways disease affecting over 300 million people. It is considered severe in 5-10% of cases, with poor disease control despite a high burden of treatment. Severe asthma encompasses a heterogeneous pathobiology reflecting host-environment interactions at all scales of disease from the genetic to organ level. Characterisation of the T2-endotype has led to significant reductions in exacerbations for patients with eosinophilic disease, however control is incomplete in some, likely due to contributing factors that may include poor adherence to current therapy and co-existence of distinct pathological processes within the individual. In this article we consider where attention should be directed in the future in severe asthma; strategies to improve the use of current licensed therapies, therapeutic targets beyond T2 inflammation, and how expectations should adapt to reflect progress in managing disease overall. (BRN Rev. 2019;5(2):74-89) Corresponding author: Christopher E. Brightling, ceb17@le.ac.uk