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Phenotypes and Endotypes of Uncontrolled Severe Asthma: New Treatments


P Campo,1 F Rodríguez,2 S Sánchez-García,3 P Barranco,4 S Quirce,4 C Pérez-Francés,5 E Gómez-Torrijos,6 R Cárdenas,6 JM Olaguibel,7 J Delgado8
Severe Asthma Workgroup of the SEAIC Asthma Committee

1 UGC Allergy, Hospital General de Málaga, Málaga, Spain
2 Department of Allergy, Hospital Universitario Marqués de Valdecilla, Santander, Spain
3 Allergy Section, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
4 Department of Allergy, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
5 Department of Allergy, Hospital Universitario Dr. Peset, Valencia, Spain
6 Department of Allergy, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
7 Department of Allergy, Complejo Hospitalario de Navarra, Pamplona, Spain
8 UGC Allergy, Hospital Universitario Virgen Macarena, Sevilla, Spain

J Investig Allergol Clin Immunol 2013; Vol. 23(2): 76-88



Severe asthma is a heterogeneous disease that affects only 5%-10% of asthmatic patients, although it accounts for a significant percentage of the consumption of health care resources. Severe asthma is characterized by the need for treatment with high doses of inhaled corticosteroids and includes several clinical and pathophysiological phenotypes. To a large extent, this heterogeneity restricts characterization of the disease and, in most cases, hinders the selection of appropriate treatment. In recent years, therefore, emphasis has been placed on improving our understanding of the various phenotypes of severe asthma and the identification of biomarkers for each of these phenotypes. Likewise, the concept of the endotype has been gaining acceptance with regard to the various subtypes of the disease, which are classified according to their unique functional or pathophysiological mechanism. This review discusses the most relevant aspects of the clinical and inflammatory phenotypes of severe asthma, including severe childhood asthma and the various endotypes of severe asthma. The main therapeutic options available for patients with uncontrolled severe asthma will also be reviewed.

Key words: Severe asthma. Biomarkers. Endotype. Phenotype. Treatment.