Severe asthma: novel advances in the pathogenesis and therapy

Asthma affects an estimated 300 million people worldwide and is severe in approximately 10% of sufferers. Asthma, especially severe asthma, is a heterogeneous disease that results from complex host-environment interactions. This review article outlines recent advances in both the understanding of pathogenesis and novel therapies. The pathogenesis of severe asthma can be broadly thought of in four domains: T(H)2 inflammation, non-T(H)2 inflammation, airway remodeling, and airway smooth muscle dysfunction. They can develop independently or partly as a consequence of each other. Interactions between these domains, their causation, and consequent impact upon disordered airway physiology and clinical expression are poorly understood. Recent advances in specific T(H)2- and non-T(H)2-targeted therapy, bronchial thermoplasty targeting airway remodeling and advances in therapies for airway smooth muscle dysfunction present new opportunities for treatment and inform our understanding of asthma pathogenesis. As our understanding of the pathogenesis increases, the need for individualized investigation, treatment, and management of asthma becomes more apparent.