Page 111 - Škrgat, Sabina, ed. 2022. Severe Asthma - Basic and Clinical Views. Koper: University of Primorska Press. Severe Asthma Forum, 1
P. 111
re is no clinical trial data available for in- management of these risk factors may con- 111
tervention in asthma. tribute to improved asthma outcome36.
t2-low asthma
Nebulized IFN‐β treatment at the on- Conclusion
set of viral upper respiratory tract infections
shown to improve morning peak flow, in- Lately, the heterogeneity of asthma pheno-
crease in serum CXCR10 and reduced spu- types is recognised and the treatment options
tum CCL4 concentrations which suggest- are tailored according to those differences.
ed this treatment might improve outcomes of T2-low asthma is still less well defined with
URTI induced asthma exacerbations. different subtypes characterized by the low
expression of T2 inflammatory markers and
Imatinib inhibits tyrosine kinase of KIT, normal to low eosinophils.
induces mast cell apoptosis and reduces bone
marrow mast cell burden. It can reduce air- Several treatment options for T2-high
way mast cell burden and improve AHR in asthma have been developed and some of
severe asthma. those treatments like new anti-TSLP mon-
oclonal antibody tezepelumab are effective
5‐lipoxygenase‐activating protein (FLAP) also in T2-low asthma. The results of ongoing
inhibitors can reduce the sputum LTB4 levels trials with sophisticated transcriptomic and
but there are no significant effects on sputum proteomic characterisations of different T2-
neutrophil counts. low asthma patients will provide us tools to
better characterise these patients and choose
Modification of airway dysbiosis: Several the precise therapeutic approaches.
novel approaches beyond antibiotics that may
modify dysbiosis, including phage therapies, References
prebiotic nutrients, microbe-derived products
(bacterial extracts, immune stimulants), and 1. Kuruvilla ME, Lee FE, Lee GB. Un-
specific live microbial species (probiotics) may derstanding Asthma Phenotypes, En-
represent novel therapeutic avenues35. dotypes, and Mechanisms of Dis-
ease. Clin Rev Allergy Immunol. 2019
Targeting Mucus Hypersecretion: Quan- Apr;56(2):219-33.
titative imaging has been applied using com-
puted tomography to develop validated mu- 2. Busse WW. Biological treatments
cus plugging scores in severe asthma. Novel for severe asthma: A major advance
inhaled and oral mucolytics and biologics in asthma care. Allergol Int. 2019
that target IL-13–driven goblet cell metapla- Apr;68(2):158-66.
sia could help solve that problem.
3. Sze E, Bhalla A, Nair P. Mechanisms
Treating Comorbidities and therapeutic strategies for non-T2
asthma. Allergy. 2020 Feb;75(2):311-25.
A number of comorbid diseases, including
rhinitis, rhinosinusitis, gastroesophageal re- 4. Ricciardolo FLM, Sprio AE, Baro-
flux, and obstructive sleep apnea, are associ- so A, et al. Characterization of T2-
ated with severe or difficult-to-treat T2-low Low and T2-High Asthma Phenotypes
asthma. If present and untreated, these con- in Real-Life. Biomedicines. 2021 Nov
ditions may adversely affect asthma control, 13;9(11):1684. doi: 10.3390/biomedi-
quality of life, and/or lung function, despite cines9111684.
adequate treatment with step-up asthma con-
troller therapy. Failure to recognize these co- 5. Hudey SN, Ledford DK, Cardet JC.
morbidities may divert appropriate care and Mechanisms of non-type 2 asthma.
increase disease burden. Assessment and Curr Opin Immunol. 2020 Oct;66:123-
8.
tervention in asthma. tribute to improved asthma outcome36.
t2-low asthma
Nebulized IFN‐β treatment at the on- Conclusion
set of viral upper respiratory tract infections
shown to improve morning peak flow, in- Lately, the heterogeneity of asthma pheno-
crease in serum CXCR10 and reduced spu- types is recognised and the treatment options
tum CCL4 concentrations which suggest- are tailored according to those differences.
ed this treatment might improve outcomes of T2-low asthma is still less well defined with
URTI induced asthma exacerbations. different subtypes characterized by the low
expression of T2 inflammatory markers and
Imatinib inhibits tyrosine kinase of KIT, normal to low eosinophils.
induces mast cell apoptosis and reduces bone
marrow mast cell burden. It can reduce air- Several treatment options for T2-high
way mast cell burden and improve AHR in asthma have been developed and some of
severe asthma. those treatments like new anti-TSLP mon-
oclonal antibody tezepelumab are effective
5‐lipoxygenase‐activating protein (FLAP) also in T2-low asthma. The results of ongoing
inhibitors can reduce the sputum LTB4 levels trials with sophisticated transcriptomic and
but there are no significant effects on sputum proteomic characterisations of different T2-
neutrophil counts. low asthma patients will provide us tools to
better characterise these patients and choose
Modification of airway dysbiosis: Several the precise therapeutic approaches.
novel approaches beyond antibiotics that may
modify dysbiosis, including phage therapies, References
prebiotic nutrients, microbe-derived products
(bacterial extracts, immune stimulants), and 1. Kuruvilla ME, Lee FE, Lee GB. Un-
specific live microbial species (probiotics) may derstanding Asthma Phenotypes, En-
represent novel therapeutic avenues35. dotypes, and Mechanisms of Dis-
ease. Clin Rev Allergy Immunol. 2019
Targeting Mucus Hypersecretion: Quan- Apr;56(2):219-33.
titative imaging has been applied using com-
puted tomography to develop validated mu- 2. Busse WW. Biological treatments
cus plugging scores in severe asthma. Novel for severe asthma: A major advance
inhaled and oral mucolytics and biologics in asthma care. Allergol Int. 2019
that target IL-13–driven goblet cell metapla- Apr;68(2):158-66.
sia could help solve that problem.
3. Sze E, Bhalla A, Nair P. Mechanisms
Treating Comorbidities and therapeutic strategies for non-T2
asthma. Allergy. 2020 Feb;75(2):311-25.
A number of comorbid diseases, including
rhinitis, rhinosinusitis, gastroesophageal re- 4. Ricciardolo FLM, Sprio AE, Baro-
flux, and obstructive sleep apnea, are associ- so A, et al. Characterization of T2-
ated with severe or difficult-to-treat T2-low Low and T2-High Asthma Phenotypes
asthma. If present and untreated, these con- in Real-Life. Biomedicines. 2021 Nov
ditions may adversely affect asthma control, 13;9(11):1684. doi: 10.3390/biomedi-
quality of life, and/or lung function, despite cines9111684.
adequate treatment with step-up asthma con-
troller therapy. Failure to recognize these co- 5. Hudey SN, Ledford DK, Cardet JC.
morbidities may divert appropriate care and Mechanisms of non-type 2 asthma.
increase disease burden. Assessment and Curr Opin Immunol. 2020 Oct;66:123-
8.
