Introduction
Asthma is a chronic heterogeneous disease of the lower airways
characterized by chronic inflammation and airway hyperreactivity leading
to cough, wheeze, difficulty in breathing and chest tightness. The
pathophysiology of asthma is complex. In the past three decades a better
understanding of distinct asthma visible properties (phenotypes) and
mechanisms (endotypes) shaped better diagnostic and therapeutic tools in
support of stratified/personalised interventions based on recognition of
differences in responsiveness to various therapeutic interventions
(theratypes).1,2 In addition, environmental factors,
genetic polymorphisms and epigenetic factors contribute to the
development of asthma, heterogeneity in phenotyping and steroid
responsiveness.3-6 Environmental interventions and
exposure control can improve asthma control and
exacerbations.7
The incidence and prevalence of asthma are increasing, though regular
use of inhaled corticosteroids (ICS) reduces
mortality.8,9 New therapies and therapeutic
targets are required for better control of symptoms and exacerbations in
severe asthma patients and for avoiding adverse reactions caused by the
administration of oral corticosteroids (OCS).
This review highlights the recent studies on immunopathological
pathways, molecular mechanisms, various environmental factors and
microbial dysbiosis in asthma. Clinical trials, multi-centered
international studies and real-world data are reviewed for novel
approaches in asthma diagnosis, candidate biomarkers and management of
asthma in adults and children.