Changing paradigms in asthma management

Asthma is a complex clinical syndrome characterized by airway inflammation that can cause variable, usually reversible airway obstruction and bronchial hyperreactivity. This illness has a spectrum from intermittent to persistent that has mild, medium or severe intensity. As our understanding of the underling inflammatory pathway grows, so too does our catalogue of advanced treatments (such as monoclonal antibodies), opening the path for treatment individually curated for patients. The current approved therapies are directed against IgE, interleukin (IL)-5, IL-5 receptor, IL-4 receptor subunit-alpha and most recently thymic stromal lymphopoietin (TSLP). These therapies all have demonstrated efficacies that make them variably effective in patients with moderate to severe persistent disease. More recently, other inflammatory molecules have been therapeutically targeted and are currently under clinical investigation for future potential use. However, a significant concern remains: the high financial costs for these advanced therapies continues to pose a significant burden both to patients and the healthcare system. Novel uses of long-acting bronchodilator-corticosteroids inhalers may reduce the use of highly priced biologics in many patients with comparatively less severe disease. Furthermore, the variability in patient response demands further research into to identify which patients will best respond to which specific therapy.