Page 115 - Škrgat, Sabina, ed. 2022. Severe Asthma - Basic and Clinical Views. Koper: University of Primorska Press. Severe Asthma Forum, 1
P. 115
inophilic and Allergic Asthma Phenotype 5.3
and Therapeutic Possibilities
Ljiljana Bulat Kardum¹,²
Abstract 1 Clinic of Internal Medicine,
Despite optimal treatment according to GINA guidelines, some patients with asthma have an Clinical Hospital Centre Rijeka,
uncontrolled, severe disease with significantly reduced lung function, an increased risk of ex- Rijeka, Croatia
acerbations and disproportionate use of asthma-related health resources. The identification
of specific phenotypes of asthma with unique pathophysiologic mechanisms such as T2-high 2 Faculty of Medicine,
and T2-low immunological pathways and clinical characteristics enabled the discovery of new University of Rijeka,
and more effective treatments for severe asthma. The emergence of novel biologic treatments, Rijeka, Croatia
including monoclonal antibodies as anti-IgE, anti IL-5/anti IL-5Rα and anti IL-4/IL-13 are
has led to an enhanced understanding of the pathogenesis of asthma and highlighted the im-
portance of patient-specific treatment dependent on phenotypic characteristics.
Keywords: severe asthma, phenotypes, T2 asthma, non-T2 asthma, biologic treatment, an-
ti-IgE, anti IL-5/anti IL-5Rα, anti IL-4/IL-13
More than 300 million people worldwide with an increased risk of exacerbations and
suffer from asthma and it is estimated that
400 million people will suffer from asth- overuse of asthma-related health resourc-
ma by 2025. It is present in all regions of the
world regardless of their socioeconomic lev- es including frequent hospital care and sig-
el, although its prevalence varies. In the Unit-
ed States, the prevalence of asthma is 7.6% nificantly reduced lung function with a risk
and 8.4% for adults and children, respective- of further deterioration over time.3 In this
ly; in the European Union the prevalence is
about 8.2% and 9.4%, respectively.1,2,3 Most group of patients, it is necessary to identi-
patients can achieve good disease control
and a satisfactory quality of life with conven- fy those who manifest uncontrolled asthma
tional treatment according to international
guidelines such as the Global Asthma Initi- and in whom accurate diagnosis or adequate
ative (GINA)3.
treatment will significantly improve the cur-
How Common is Severe Asthma?
rent control of the disease (“difficult-to-treat
Despite optimal treatment, some patients
with asthma have uncontrolled severe asthma asthma”). It is estimated that about 24% of
asthma patients have GINA treatment of 4th
or 5th step, 17% of all asthma patients have
“difficult to treat asthma”, while 3.7% of
asthma patients have severe asthma.4. The
systematic review of 195 articles reporting
on severe asthma studies found the preva-
lence of severe uncontrolled asthma to be as
high as 87.4%.5
https://doi.org/10.26 493/978 -961-293 -157-5.115 -123
and Therapeutic Possibilities
Ljiljana Bulat Kardum¹,²
Abstract 1 Clinic of Internal Medicine,
Despite optimal treatment according to GINA guidelines, some patients with asthma have an Clinical Hospital Centre Rijeka,
uncontrolled, severe disease with significantly reduced lung function, an increased risk of ex- Rijeka, Croatia
acerbations and disproportionate use of asthma-related health resources. The identification
of specific phenotypes of asthma with unique pathophysiologic mechanisms such as T2-high 2 Faculty of Medicine,
and T2-low immunological pathways and clinical characteristics enabled the discovery of new University of Rijeka,
and more effective treatments for severe asthma. The emergence of novel biologic treatments, Rijeka, Croatia
including monoclonal antibodies as anti-IgE, anti IL-5/anti IL-5Rα and anti IL-4/IL-13 are
has led to an enhanced understanding of the pathogenesis of asthma and highlighted the im-
portance of patient-specific treatment dependent on phenotypic characteristics.
Keywords: severe asthma, phenotypes, T2 asthma, non-T2 asthma, biologic treatment, an-
ti-IgE, anti IL-5/anti IL-5Rα, anti IL-4/IL-13
More than 300 million people worldwide with an increased risk of exacerbations and
suffer from asthma and it is estimated that
400 million people will suffer from asth- overuse of asthma-related health resourc-
ma by 2025. It is present in all regions of the
world regardless of their socioeconomic lev- es including frequent hospital care and sig-
el, although its prevalence varies. In the Unit-
ed States, the prevalence of asthma is 7.6% nificantly reduced lung function with a risk
and 8.4% for adults and children, respective- of further deterioration over time.3 In this
ly; in the European Union the prevalence is
about 8.2% and 9.4%, respectively.1,2,3 Most group of patients, it is necessary to identi-
patients can achieve good disease control
and a satisfactory quality of life with conven- fy those who manifest uncontrolled asthma
tional treatment according to international
guidelines such as the Global Asthma Initi- and in whom accurate diagnosis or adequate
ative (GINA)3.
treatment will significantly improve the cur-
How Common is Severe Asthma?
rent control of the disease (“difficult-to-treat
Despite optimal treatment, some patients
with asthma have uncontrolled severe asthma asthma”). It is estimated that about 24% of
asthma patients have GINA treatment of 4th
or 5th step, 17% of all asthma patients have
“difficult to treat asthma”, while 3.7% of
asthma patients have severe asthma.4. The
systematic review of 195 articles reporting
on severe asthma studies found the preva-
lence of severe uncontrolled asthma to be as
high as 87.4%.5
https://doi.org/10.26 493/978 -961-293 -157-5.115 -123
