Advances in Asthma

Anne E. Dixon, BM BCh

Tara F. Carr, MD

Loretta G. Que, MD

Asthma is one of the most common chronic conditions affecting both children and adults, males and females, and people of different races and ethnicities across the world. Recent estimates suggest that 8% of the U.S. population and more than 400 million people worldwide suffer with asthma. Although a disease recognized since antiquity, asthma still causes major morbidity and sometimes mortality. Over the last few years there have been significant advances in our understanding of the pathophysiology of the disease, the role of environmental factors, comorbidities, and the advent of targeted biologic therapies. Accurate phenotyping is critical to guide treatment, and so the role of new imaging and biomarkers is playing an increasingly important role. Accordingly, the goals of this “Advances in Asthma” issue of Seminars in Respiratory and Critical Care Medicine are to provide an up-to-date review of some of the major changes in our understanding of the asthma, and how these advances have significant implications for clinical practice.

Factors associated with our changing lifestyle can have a significant impact on asthma. One factor that clearly has a major impact on asthma is nutrition, an area that has received little attention in most recent asthma guidelines, and so the review by Drs. Williams, Wood, and colleagues provides a much needed discussion of the recent literature and advances on this topic. Another factor that is having a devastating effect on modern health is obesity; obesity is now recognized as a major risk factor for asthma, and significantly complicates the disease, and so another study focuses on this important topic.

The evaluation of asthma now goes much beyond assessment of lung function and symptoms. Major advances in imaging techniques are changing the way we understand the disease, and this is reviewed in detail in an article by Niedbalski, Castro, and colleagues. Another test frequently used in the evaluation of asthma is exhaled nitric oxide: the study by Drs. Loewenthal and Menzies-Gow provides a valuable update on the latest scientific literature guiding the use of this tool, and explains how exhaled nitric oxide might be most effectively used to gain insights into asthma that are relevant to clinical practice.

Asthma is a heterogeneous disease, and the underlying pathophysiology of this airway disease has a major impact on severity and treatment options. Drs. Mohan and Lugogo provide a comprehensive overview of the literature addressing endotyping and phenotyping of asthma, which has become increasingly important with the advent of therapies targeting pathways causing airway pathology, rather than the downstream manifestations of airway disease.

There have also been major advances in treatment, particularly the changing role of immunotherapy and the use of biologics. Immunotherapy is the one potentially disease-modifying intervention available for asthma; Drs. Eremija and Carr reviewed the evidences regarding the use of immunotherapy, and specifically discuss indications, benefits, and risks associated with the use of both subcutaneous and sublingual immunotherapy in asthma. Biologics for the treatment of asthma have transformed how we treat the disease, particularly severe asthma, and the study by Drs. Imanirad and Tabatabaian reviews what we know about the mechanisms of action of these medications and the evidence that should guide their use. Putting it all together, Dr. Baptist reviewed the 2021 update of the National Asthma Education and Prevention Program guidelines which focused particularly on specific topics related to mild and moderate-to-severe asthma.

While asthma affects people across the world, it causes severe morbidity disproportionately among people of color, and those of lower socioeconomic status, and so Dr. Okelo, in two complementary articles, provides an analysis of the role of racial and ethnic disparities in asthma and asthma care, and provides a much-needed framework to address this critical issue.

While asthma is one of the most common chronic diseases, and has existed since antiquity, the last few years have seen major advances which have transformed our understanding and approach to this disease. We hope that this issue will highlight these scientific advances, while at the same time provide practical insights that can be used in the clinic.

Publication History

Article published online:
08 July 2022