REVIEW  ASTHMA AND SEVERE ASTHMA MANAGEMENT IN THE CLINICAL PRACTICE 

Minerva Medica 2021 October;112(5):547-63

DOI: 10.23736/S0026-4806.21.07498-X

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Asthma phenotypes and endotypes

Fabio L.M. RICCIARDOLO ¹ ✉, Francesca BERTOLINI ¹, Vitina CARRIERO ¹, Andrea E. SPRIO ^{1, 2}

¹ Unit of Rare Lung Disease, Department of Clinical and Biological Sciences, Severe Asthma Center, San Luigi Gonzaga University Hospital, University of Turin, Turin, Italy; ² Department of Research, ASOMI College of Sciences, Marsa, Malta

INTRODUCTION: Asthma is a complex disorder characterized by expiratory airflow limitation, wheeze, shortness of breath, chest tightness and cough, which can vary over time and in intensity. Being highly heterogeneous, asthma was characterized and classified in several asthma phenotypes and endotypes from 1947 until today. The present systematic review aims to summarize and describe evidence that was published in the last ten years in the field of asthma phenotyping and endotyping.
EVIDENCE ACQUISITION: The systematic review resumed high-quality evidence (clinical trials and randomized control trials) retrieved on MEDLINE and EMBASE databanks and involving adult asthmatic populations. Analyses of literature were conducted according to PRISMA and CASP guidelines.
EVIDENCE SYNTHESIS: Querying MEDLINE and EMBASE databanks, 5019 and 12261 entries were retrieved, respectively. Applying limitations for year of publication, age of participants, and type of publication, the search results were reduced to 98 and 132 articles, respectively. After data abstraction and resolution of duplications, only 50 articles were further evaluated. The research products were then classified first in macro-areas of interest (phenotypes or endotypes) and then in detailed micro-areas.
CONCLUSIONS: This systematic review overviews the principal findings available from high-quality literature in the last decade concerning asthma phenotypes and endotypes. Asthma has been described from different points of view, characterizing symptoms, microbiota composition, comorbidities, viral infections, and airway and/or systemic inflammatory status. The comprehension of precise mechanisms underlying asthma pathogenesis is thereby the basis for the development of novel therapeutic strategies, likely essential to the development of precision medicine.

KEY WORDS: Asthma; Phenotype; Review