Phenotyping

The notion that severe asthma is a heterogeneous condition that may benefit from phenotyping is becoming more widely accepted.1

Definition of a true phenotype requires2:

  • A unifying and consistent natural history
  • An underlying pathobiology with identifiable biomarkers and genetics
  • Consistent clinical and physiologic characteristics
  • A predictable response to general and specific clinical management options

No present system of subgrouping has achieved all requirements of a true phenotype.

Phenotyping patients with asthma has become a part of the diagnostic workup for patients who do not respond satisfactorily to standard therapy with inhaled corticosteroids (ICS).1,3,4

The future of disease management may be impacted by identification of causal pathways as they apply to the different asthma phenotypes5

The notion of distinct phenotypes in severe asthma is gaining acceptance.
Further identification of asthma phenotypes is being explored for disease management.

Heterogeneity

Emerging data from large cohorts support heterogeneity in severe asthma, with increasing acceptance of the presence of distinct phenotypes4

Individualization

Phenotyping may potentially allow for better understanding of disease heterogeneity and facilitate individualization of patient management by grouping patients with common clinical features6

Management

The future of disease management may be impacted by identification of causal pathways as they apply to the different asthma phenotypes5

However, the stability of phenotypes identified in cluster analyses and their use in predicting long-term outcomes and responses to therapy is still uncertain6

Why Phenotype?

May allow for better understanding of disease heterogeneity and facilitate individualization of patient management by grouping patients with common clinical features2

A goal of phenotyping is to individualize and optimize therapy1

References: 1. Chung KF, Wenzel SE, Brozek JL, et al. International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma. Eur Respir J. 2014;43(2):343-373. 2. Wenzel SE. Asthma phenotypes: the evolution from clinical to molecular approaches. Nat Med. 2012;18(5):716-725. 3. de Groot JC, ten Brinke A, Bel EHD. Management of the patient with eosinophilic asthma: a new era begins. ERJ Open Res. 2015;1(1):00024-2015. 4. Wenzel S. Severe asthma: from characteristics to phenotypes to endotypes. Clin Exp Allergy. 2012;42(5):650-658. 5. Holgate ST, Sly PD. Asthma pathogenesis. In: Adkinson Jr NF, Bochner BS, Burks AW, et al, eds. Middleton's Allergy Principles and Practice. 8th ed. Philadelphia, PA: Elsevier Saunders; 2014:812-842. 6. Bourdin A, Molinari N, Vachier I, et al. Prognostic value of of cluster analysis of severe asthma phenotypes. J Allergy Clin Immunol. 2014;134(5):1043-1050.

825105R0 August 2017